The Baby Friendly Hospital Initiative (BFHI) is the commitment to advancing nursing knowledge related to breastfeeding education among perinatal healthcare providers. As the BFHI gains support and momentum, several challenges have been identified. Supporting new mothers when initiating and continuing breastfeeding during the immediate recovery and postpartum hospital stay presents challenges to nursing staff in perinatal nursing units, especially after Cesarean birth. Cesarean-section delivery rates are increasing in the United States, with preliminary data indicating a rate of 32% of all deliveries (National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention [CDC], 2017). Cesarean birth is known to reduce the incidence of immediate or early (within 1 hour) skin-to-skin contact and in turn delay the initiation of the first breastfeeding attempt. This delay in breastfeeding initiation reduces the incidence of exclusive breastfeeding during the postpartum hospital stay and may increase rates of supplementation (Dalbye, Calais, & Berg, 2011; Hung & Berg, 2011; Stevens et al., 2014).
Methods: Despite evidence of its benefits, skin-to-skin contact after operative birth remains a challenge for many labor and delivery units and direct-care nurses. To promote evidence-based practice, a quality improvement project was designed to promote the clinical application of early skin-to-skin contact after Cesarean birth in a small, suburban, Magnet-designated hospital. Data were collected three months prior to the implementation of the practice change to recover newborns and mothers together in the post-anesthesia care unit (PACU). In addition, three months of post-practice change data were examined to evaluate the practice of proximity between mother and newborn and its effects on skin-to-skin contact practices and breastfeeding initiation. A retrospective analysis of secondary data was utilized to examine the frequency of skin-to-skin care practices and initiation of breastfeeding before and after the practice change was implemented. The outcome measure was skin-to-skin contact.
Results: The incorporation of early skin-to-skin contact immediately after birth was improved when a practice change was implemented to reduce separation after birth. The chi-square comparison was significant, χ2 (1, N = 127) = 6.53, p = .01. The post-intervention group had significantly more successful breastfeeding initiation than did the pre-intervention group, χ2 (1, N = 130) = 5.63, p = .02.
Conclusion: The results showed that most of the women observed for this study who were recovered in the PACU with close proximity to their newborns practiced early skin-to-skin care during the first hour of life following birth. Significant others were often present in the PACU, and if mothers were unable to provide skin-to-skin practice, the significant family member was sometimes available to provide that care. Of those maternal-newborn dyads in this study who practiced skin-to-skin care, most experienced successful breastfeeding initiation during the first hour of life. Maternal-newborn dyads who are recovered in close proximity immediately after birth have improved breastfeeding outcomes, and should be encouraged without discrimination for mode of delivery.
Limitations of the study included a small sample size, a change in the platform for electronic health records was adopted during post-implementation data collection, and possible nursing bias to improve breastfeeding status to improve accreditation for Baby Friendly Hospital status.
Recommendations for future research includes utilizing previously capture secondary data to examine breastfeeding initiation rates between primary Cesarean section patients and repeat Cesarean section patients. Furthermore, it is recommended that staff workload and perceived stress be examined after the revised practice change.