Implementing Skin to Skin Contact Routine Practice following Birth

Implementing Skin to Skin Contact

Routine Practice following Birth

By Margaret O’Leary C.M.S. Lactation

& Margaret Hynes C.M.S. Lactation

Baby Friendly Hospital Initiative (BFHI)

• Launched in 1991 by WHO/UNICEF

• Aim – to counteract worldwide decline in breastfeeding

• BFHI is

• Mother / Baby Friendly

• Global Initiative

• Health Promoting

Baby Friendly Hospital Initiative (B.F.H.I)

Cert of commitment

- 1999

- 2001

Full Award

- 2004

Baby dried & wrapped in blanket Held by parents

or Put in incubator within mother’s

view Generally feeding established in

postnatal ward

Common PracticePrior to B.F.H.I.

Implementing Change

Change in practice and routine

Policies to ensure sustainability

Why Skin to Skin ?

• Reduces by 74% the production of stress hormones in baby which aids digestion & reduces incidence of hypoglycaemia.

• Calms baby.• Regulates baby’s heart beat & breathing.• Maintains core body tempeture in baby.• Helps establish & sustain breastfeeding.• Promotes close mother/baby relationship.

Practice/Routine Staff education

– Training

– Video

– Written information

– Photographs

Parent education– Antenatal classes

– Skills workshop

– Private & public antenatal clinic

– Written information

Hospital PoliciesHospital Clinical Guideline on management

of breastfeeding & lactation“Within half an hour of birth all mothers regardless of feeding

choice will be given their baby to hold with skin to skin contact

for at least 30 minutes”

Hospital policy for mothers

Hypoglycaemia policy

Regional Breastfeeding Policy

Obstacles

Large number of staff

Turnover of patients in labour ward –

“too busy”

Old habits die hard

Consistency in recording in maternity

notes – incidence, duration and reason

for discontinuing

Overcoming Obstacles

Parentcraft team

Role of the Clinical Midwifery Specialist (CMS)

Additional education time at antenatal clinic

Informing mothers antenatally

Key people from each area in Hospital Baby

Friendly Hospital Initiative Committee

Providing research based articles on

importance of skin to skin

Initial B.F.H.I assessment for full award

was June 2004

78% of mothers met the criteria

(Minimum requirement is 80%)

What can we do to improve?

“Never give up”

Recommence on postnatal wards

Following infant’s first bath

Co-operation of postnatal & neonatal ward

staff

Checking charts for documentation

Feeding back at ward report time

Care attendants

What’s beneficial to achieve & maintain

practice Rooming in

No “well baby” nurseries

Supportive staff in all areas

Safety rails on beds in postnatal wards

Infant bathing at bedside

Feedback to staff of positive comments from

mothers

Baby Friendly Award

Audit of Practice

February 2005

Questionnaires

• To 120 women (+ 36 weeks gestation)

• To 100 mothers (Day 2 Postnatal)

ResultsAntenatal Questionnaire 84% returned

What is skin to skin contact? 93% knew

Others Thoughts linked with breastfeeding

and childbirth – more vague

Mother’s perceptionWhen will skin to skin contact be initiated? 94% immediately or shortly after birth

Others Perceived it would happen with breastfeeding

Why? Bonding - 79% Antibody/Immune system - 23% Comfort/Safety - 9% Breastfeeding - 6% Temperature control - 4% Heart rate - 4%

Postnatal Questionnaires Results

70 out of 100 replied

68 of these received skin to skin contact

100% - positive feedback from this group

When?

81% - immediately after birth

22% - on admission to ward

16% - following bath

What did mothers say?- good for mother

84%- Bonding/sense of comforting/liked baby

next to them

16%- Sense of relief!

Many individual positive comments

What did mothers say?- good for baby

56% - Relaxing, soothing, reassuring, security, happy, calm, comfort

53% - Bonding, including smell, heart rate, sight of mother

24% - Warmth ( temperature)

2% - Sleep 2% - Make baby alert

Individual Comments

“It reassured me baby was ok”

“Made me feel like a mother”

“Just amazing, no words can

describe it”

“I found the

experience very

rejuvenating”

“ A complete

high”

“The feeling of bonding was very natural”

Individual Comments

“Made the arrival of the baby

more real”

“Breastfeeding started quicker”

“Reassurance that I was able to calm baby”

“Lovely to let him and I bond and be quiet

together”

“ Calmed baby after

birth”

“Very relaxing and

great for bonding”