Skin-to-skin after cesarean

Jane Grassley PhD, RN, IBCLC

Judy Jones, MSN, RN, NEA-BC

Idaho Perinatal Project Presentation -2014

FAMILY CENTERED CESAREAN BIRTH

IntroductionThe mission of SLRMC L&D is: “… to

provide exceptional, compassionate, and individualized patient care to the

pregnant women and families of our region.” St. Luke’s Health System,

2012

OverviewOur project was to pilot skin to skin care for moms and babies experiencing scheduled cesarean births in expectation that this will eventually improve exclusive breastfeeding rates

Leading Change Framework

J. Skeleton-Green, B. Simpson and J. Scott (2007)

Approach•J and J approached unit leadership for

L&D and NICU, physician from one group for pilot, and chief of OB anesthesia

•Key staff were identified from L&D, NICU and a CRNA from Anesthesia

•JJ presented at OB Supervisory and MD-RN collaborative

•JG’s senior nursing students were invaluable to the process

Approach•Adopted JHNEBP model, consistent with

hospital•Requires planning, evidence, and

translation•P phase – using PICO approach, identified

practice issues: identify barriers and facilitators(O) to offering skin to skin care in the OR for at least 15 minutes (I) to mothers and newborns after uncomplicated cesarean birth(P)

Approach (cont’d)•Used the power of simulation•Worked through process•Simulation in the OR itself•Video of simulation once process

identified•Pilot to continue up to 3 months and

involve about 40-50 moms from single clinic experiencing scheduled, uncomplicated cesarean

Approach•Education of all staff who might

participate in scheduled cesarean from L&D and NICU; one page summary for CRNAs since unable to attend

•Video simulation provided as adjunct to staff education

•Pilot ran from January to mid-March, 2013

Education module for employees

• Describes roles of healthcare providers

• Addresses questions &

concerns

Parent Flyer

Skin-to-skin contact means holding your baby on your bare chest tummy down. This allows time for hugging and bonding in the operating room. Skin-to-skin can occur as soon as both the mother and baby are stable.

If you want to do skin-to-skin, let your nurse know when you check in. Feel free to ask questions.

About 5 minutes after birth, a nurse will bring your baby to you. The nurse will help you hold your baby across your chest for around 15 minutes.

What is so good about hugging your baby skin-to-skin?

Calms baby and reduces crying

Helps keep baby warm

Helps baby’s blood sugar stay normal

Steadies baby’s breathing and heart rate

Bonds mothers and their babies

Lowers the risk of postpartum blues

Promotes better breastfeeding

Helps mothers recover after surgery

Hug me, I’m cute! Deciding if Skin-to-Skin Contact after a Cesarean Birth is

Right for You and Your Baby

P: 208.381.2222 190 East Bannock Street

Boise, Idaho 83712 www.stlukesonline.org

•Addresses what skin-to-skin is

•What to expect

•Benefits for mother and infant

Results•SSC offered to moms of pilot clinic per criteria

by L&D RN on admission•If yes, surgical team informed at surgical pause•Pilot completed at 2 ½ months with 44 families•Results were compiled by either L&D or NICU

RN completion of the outcomes form.•11%(5) declined•43%(19) held their infants at least 15 minutes•37%(16) held newborns less than 15 minutes

Results (cont’d)•9% were unable due to a newborn or

maternal condition – newborn size, stability, nausea

•Short length of surgery contributed to minimal time for SSC

•87% of nurses responded that they felt knowledgeable of process

•Positive patient feedback reinforced the experience for staff involved

Results (cont’d)• Parent comments included:

“I wasn’t able to do this with my other 2 Csections” “It was really nice; my last baby I did not see for half an hour” Patient was thrilled; position was comfortable; baby nestled in neck; Mom stated “baby didn’t mind at all”Dads were also enthusiastic although it was mom that we asked to consent.

Follow up•Pilot discontinued in mid-March•Results reported at OB Dept, MD-RN

collaborative, and to CNO•Letter to physicians offering this well

received approach to patients scheduled for uncomplicated repeat cesarean

•Hardwiring aided by providing documentation opportunity in EHR

Implementation Recommendations

1. Evaluate staff knowledge of skin-to-skin.

2. Educate L&D and NICU/Nursery staff who attend cesarean births. Include physicians’ office to involve their staff with further information about the skin-to-skin process.

3. Encourage physicians/office nurses to educate patients about skin-to-skin as an option following cesarean births.

4. Evaluate patient satisfaction with skin-to-skin.

Recommendations (cont.)

Recommendations (cont.)5.Consider the creation of a policy change

to include skin-to-skin as standard protocol.

6.Encourage documentation of the occurrence of skin-to-skin following cesarean births.

Recommendations (cont.)7. Identify RN liaisons, one in L&D and

another in NICU, to address staff and patient/family questions and concerns about skin-to-skin.

8. Disseminate approach and project results with delivering hospitals.

Special Thanks to:•Senior nursing students who drafted our

education, scripted and taped our simulation, and made this project easy to do! BOISE STATE UNIVERSITY

SCHOOL OF NURSINGCLASS OF 2012

Samantha Byrnes, Lorinda Coombs, Rachel Finnell, Patricia Jones,

Angelica Kovach, Jenna Lindsay, Monika Ryan, Shelley Sinclair, Caitlin Sitz, Caroline Strong, Caitlyn Uhnak

Special Thank You•SLRMC L&D •SLRMC NICU•Jane Kornfield•Donna Swirczynski

Thank you!