Education on the Use of Skin to Skin Contact During Cesarean Sections

By: Katelyn Swanger PSU SN

Problem Statement• Skin to skin contact : placing a diapered infant on the bare

chest of their mother and covering with warm blankets. • Skin to skin use is beneficial for newborns and mothers.• The World Health Organization recommends newborns

spend at least the first hour of life in skin to skin contact. • Skin to skin is common practice after vaginal deliveries;

however, common practice post c-section includes separation of newborn and mother

• Approximately 33% all newborns in the US are delivered via Cesarean Section.

• Research identifies the largest barrier to implementation of skin to skin contact intra-operatively is lack of education among staff and patients.

• The Purpose of this research study is to educate nursing staff at the Holy Spirit Birthplace on the use of ski n to skin contact intra-operatively.

PICO QuestionIn maternal-newborn dyads, is immediate skin to skin contact post cesarean section as effective as usual care in promoting infant stability, breastfeeding and maternal satisfaction?

Review of LiteratureNewborn Outcome Benefits: thermoregulation, decreased respiratory rate, blood glucose control, greater infant comfort, less infant cryingBreastfeeding Benefits: earlier initiation of feeding, increased pro-feeding behaviors, greater LATCH scores, more effective suck, decreased formula supplementationMaternal Outcomes: increased satisfaction with birthing process, improved mother-infant bonding, increased mother-infant communication, decreased perception of pain, less feelings of anxiety, skin to skin reported to be effective distraction from operating room environment,Techniques for Implementation: keep maternal chest and arms free, lower drape for delivery observation, baby-nurse complete care at HOB and remain with newborn

Methods DiscussionOverall, implementation of education on the use of skin to skin contact intra-operatively was successful at increasing knowledge of participants and generating common themes related to barriers of implementation and necessary changes in the operating room. Limitations to Implementation: • Due to time constraints the pre and post survey were

administered together with the education board. • Small sample size decreases reliability and

generalizability. • Suggestions of change in practice was met with

resistance from some participants could have hindered data collection.

Future Implications and Research• The results of this study were presented to staff on the

Holy Spirit Birthplace and can be used to assist in development of future protocols and policies related to the use of skin to skin contact intra-operatively.

• Once protocols are drafted Holy Spirit Birthplace can continue to educate staff and progress to regular implementation of skin to skin intra-operatively.

• After regular implementation is established more research can be conducted in order to measure the effects of this practice.

Future Research: With more implementation time, education could have been expanded to all members of the surgical team including anesthesiology, surgery and pediatrics in order to gather more data and assist with collaboration process.

ReferencesGouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., & Di Giulio, P. (2010). Skin-to-skin contact after cesarean delivery: An experimental study. Nursing Research, 59(2), 78-84. Hung, K. J., & Berg, O. (2011). Early skin-to-skin after cesarean to improve breastfeeding. The American Journal of Maternal/Child Nursing, 36(5), 318-324. Moore, E. R., Anderson, G. C., Bergman, N., Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants (review). Cochrane Database of Systematic Reviews, 5. Nolan, A., & Lawrence, C. (2009). A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(4), 430-442. Smith, J., Plaat, F., & Fisk, N.M. (2008). The natural caesarean: A woman-centred technique. BJOG: An International Journal of Obstetrics & Gynaecology, 115(8), 1037-1042. Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin‐to‐skin contact after a caesarean section: A review of the literature. Maternal & Child Nutrition, 10(4), 456-473. Sundin, C. S., & Mazac, L. B. (2015). Implementing skin-to-skin care in the operating room after cesarean birth. The American Journal of Maternal/Child Nursing, 40(2), 249-255. Zwedberg, S., Blomquist, J., & Sigerstad, E. (2015). Midwives’ experiences with mother-infant skin-to-skin contact after a caesarean section: ‘Fighting an uphill battle.’ Midwifery, 31(1), 215-220.

• Education board was created presenting facts, definitions, benefits of use, barriers to and techniques for implementation of skin to skin contact intra-operatively

• Pre and post surveys utilizing Likert scoring and open-ended questions administered

• Participants instructed to complete pre-survey prior to reviewing education board and completing post-survey

• Purpose of surveys was to gather demographic data and measure participants knowledge, perceptions, opinions and past experience with using skin to skin contact intra-operatively

• Analysis of data included averaging Likert scorings, comparing pre and post education scores and reviewing open-ended questions for common themes.

ResultsParticipants: 15 members of the Holy Spirit Birthplace nursing staff. Education levels ranged from BSN to master level degrees. Labor and delivery nursing experience ranged from 2.5-36 years.Skin to Skin Experience: Only 7/15 participants had past experience utilizing skin to skin contact intra-operatively.Finding: Knowledge was increased with education. Common Themes: Anesthesia was identified as most resistant to implementation, Participants indicated need for protocol development and continued education of entire surgical team on use of skin to skin intra-operatively.Other Suggestions: Using extra nurse intra-operatively to stay with newborn. Rearranging operating room equipment to create more space at the HOB.