Increasing Early Skin-to-Skin for Newborns of Uncomplicated Cesarean Birth

Abstract

Background: Following a cesarean birth (CB), newborns can be separated from the mother for up to 3 hours, delaying skin-to-skin contact (SSC). Immediate or early SSC is recommended as a standard of care to prevent hypothermia, hypoglycemia, tachypnea in newborns and to increase bonding, yet few newborns of CB engage in this practice. When mothers are unable to engage in SSC, fathers/support persons are viable options to facilitate early SSC in newborns. Local Problem: The proposed clinical site houses a small labor and delivery unit where it was not standard practice for newborns of cesarean births to engage in SSC within 1 hour following delivery. The purpose of this quality improvement (QI) project is to implement early SSC between fathers/support persons and stable, full-term newborns of uncomplicated cesarean births when the mother is unable to provide SSC. For this QI project, early SSC was considered to be SSC within 1 hour of birth Interventions: A process change was introduced to allow fathers/support persons perform SSC soon after CB. Nurses learned how to identify eligible participants and a checklist was used to serve as a reminder for when and how to execute the new process. Once identified, families were educated on SSC, then the mother appointed an alternative SSC provider. Unit practice was changed to allow fathers/support persons to follow the newborn and the nurse to the nursery after an uncomplicated CB for an opportunity to perform early SSC. If newborns were determined to be stable, SSC was initiated. During the course of the project, goals, information and results were disseminated on the unit via presentations, discussions, posters and handouts. Results: There was a total of 21 CBs during the implementation timeline; nine ineligible cases and twelve eligible cases. Out of the 12 eligible cases, 5 newborns received SSC in less than 1 hour, 5 newborns received SSC more than 1 hour but less than 2 hours and 2 newborns did not receive SSC in the required time frame. The nurses also engaged mothers in early SSC with their newborns. As a result, outcomes included 6 mothers who performed SSC with their newborns within 2 hours of birth. Conclusions: Creating an environment that incorporates early SSC as a standard of care, regardless of method of delivery, is important to improving newborn and family outcomes. In situations where mothers are not available to perform SSC, it is feasible for fathers/support persons to act as alternative SSC provider. This process change allows the newborns of uncomplicated CB to safely enjoy the same benefits as newborns of vaginal deliveries, who routinely perform immediate or early SSC. During this QI project, the checklist made it easier for the nurses to facilitate early SSC. Although adoption to utilize the checklist was slow, when used, it served to streamline the process change. By the end of implementation there was an increased awareness of fathers/support persons as alternative SSC providers and increased action to initiate SSC earlier for newborns of uncomplicated CB on the unit.