Early Skin-to-Skin After Cesarean to Improve Breastfeeding

Abstract

This article describes a quality improvement project in which early skin-to-skin (STS) contact, in the operating room (OR) and during recovery, was used as an intervention to increase the success of breastfeeding initiation among healthy infants after cesarean, at a large, urban, acute care teaching hospital. The nursing role is key for the intervention, but the program involves the entire perinatal team, including the obstetricians, pediatricians, and anesthesiologists. During the first 3 months of our intervention, the rate of early STS among healthy babies born by cesarean increased from 20% to 68%. The rate of infants who did not get STS contact within 4 hours of birth decreased from 40% to 9%. Nine months after the initiation of the intervention, 60% of healthy cesarean births utilized STS in the OR, and 70% involved STS within 90 minutes of birth. Healthy infants born by cesarean who experienced STS in the OR had lower rates of formula supplementation in the hospital (33%), compared to infants who experienced STS within 90 minutes but not in the OR (42%), and those who did not experience STS in the first 90 minutes of life (74%). We concluded that STS contact was feasible after cesarean and could be provided for healthy mothers and infants immediately after cesarean birth. Perinatal and neonatal nurses should be leaders in changing practice to incorporate early STS contact into routine care after cesarean birth.

ABM Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term, Revision 2013

“…10,36 Infants are to be put close to the breast, as soon after birth as is feasible for both mother and infant, to allow for a latch and feeding, ideally within an hour of birth. 28,[31][32][33][34][35] This practice is to be initiated in the delivery, operating, or recovery room, and every mother should be instructed in proper breastfeeding technique. 5,10,31,[37][38][39][40][41] (I, II-2, II-3, III) 2.…”

“…28,[31][32][33][34][35] This practice is to be initiated in the delivery, operating, or recovery room, and every mother should be instructed in proper breastfeeding technique. 5,10,31,[37][38][39][40][41] (I, II-2, II-3, III) 2. Mother-baby rooming-in on a 24-hour basis enhances opportunities for bonding and for optimal breastfeeding initiation.…”

“…10,[25][26][27][28][29] Extensive early skin-to-skin contact likely increases the duration of any and exclusive breastfeeding. [27][28][29][30][31][32][33][34][35] Delaying procedures such as weighing, measuring, administering eye prophylaxis as well as vitamin K, up to 6 hours after birth, and the initial bath enhances early parent-infant interaction. 10,36 Infants are to be put close to the breast, as soon after birth as is feasible for both mother and infant, to allow for a latch and feeding, ideally within an hour of birth.…”

Vaginal delivery to reduce the risk of hypothermia to newborn

“…The cause of the delay in the implementation of maternal EBI is mostly found in a cesarean delivery due to the surgery procedure and fatigue of mother. The delay in the implementation of EBI could decrease the breast milk secretion [11,12].…”

“…The improvement of the quality of antenatal care and the attempt to reduce the Caesarian Section without any indication is an effective step in the successful implementation of EBI [10]. The cause of the postpone in the implementation of maternal EBI mostly occurs in cesarean delivery due to the surgery procedure and fatigue experienced by mother, and delay in the implementation of EB could reduce the breast milk secretion [11,12].…”