Today we celebrate step 4! This month we also celebrate 6 years of placing babies skin to skin (STS) with their mothers (and sometimes fathers) here at Memorial Hospital of South Bend. I’m often asked how we did it. Below is our self-assessment for step 4 followed by part 1 of a series of interviews describing how we made STS care of the newborn after delivery our norm.
STEP 4. Help mothers initiate breastfeeding within an hour of birth.
4.1 Are mothers who have had healthy vaginal deliveries given their babies to hold STS within 5 minutes of delivery, and allowed to remain with them in uninterrupted STS contact until completion of the first feed? Yes
If yes, what percentage of mothers who had normal, vaginal deliveries are given their babies to hold STS within 5 minutes of deliver and remain uninterrupted STS until completion of first breastfeed or for at least 1 hour if not breastfeeding?
100% of babies at Memorial are placed immediately on their mother’s skin unless there is a medical reason to take the baby to the warmer.
4.2 Are the mothers offered help by a staff member to recognize signs that their baby is ready to feed and provided assistance with initiating breastfeeding during this first hour? Yes
4.3 Are mothers who have had cesarean deliveries given their babies to hold, with STS contact, within 5 minutes after they are able to respond to their babies? Yes
If yes, what percentage of mothers who had cesarean deliveries are given their babies to hold STS within 5 minutes after they are able to respond to their babies?
All healthy newborns are placed on their mother’s bare skin before leaving the operating room.
4.4 Do the babies born by cesarean section stay with their mothers, with uninterrupted STS contact, until completion of the first feed? Yes
If yes, what percentage of babies born by cesarean section stay with their mothers, with uninterrupted STS contact, until completion of first breastfeed or for at least 1 hour if not breastfeeding?
100% stay with their mothers for the entire recovery unless they require care in our Level III NICU. If baby goes to the NICU, we help the mother pump her breasts in recovery and deliver any colostrum pumped immediately to the NICU.
My first interview is with Patty DeStefano, R.N., MSN, director of the Memorial Childbirth Unit (CBU). In 2006, when we implemented our policy called, Care of the newborn immediately following delivery, Patty was the CBU manager. Her role has since changed, but her commitment to equipping nurses to put into practice current, evidence-based care remains the same.
How did the idea of placing babies skin to skin after delivery at Memorial begin?
My recollection is it was a project or somehow part of Karen’s midwifery schooling. [Karen was our Perinatal Services manager. She is currently a local midwife and faculty at Frontier Nursing University.] I think it was something she was studying and we all thought, “Why aren’t we doing this at Memorial?”
Why make it a policy? Why not just educate nurses that it is a good idea?
When you are working with 70 nurses and 35+ physicians, you have to make something like this a policy to make sure it gets done, time after time, delivery after delivery.
How did you create buy in?
Karen did a presentation at our annual R.N. skills sessions which included a 20-minute clip from the DVD What Babies Want. (Click here to watch a clip of this film.) Noah Wylie was the narrator. After watching the film clip, there wasn’t a dry eye in the room … the nurses who had been helping to bring new life into the world for many, many years felt badly for what they had not been doing. Why hadn’t we been doing this sooner? Had we done harm to families? They wanted to do the right thing, and they started immediately. I recall it being a wonderful time on the unit.
Was there resistance, and from whom?
I remember anticipating the more experienced nurses were going to have trouble with doing skin to skin. That wasn’t how it was. It ended up being the younger nurses having trouble because they were focused on their “nursing tasks.” It was hard for them to simply let the family be. The more experienced nurses were able to get the room cleaned up, do some wrap-up charting and let the family get to know each other. They were OK with the process. As far as the physicians, the only thing I remember about resistance from them was having a hard time not being able to document the baby’s weight in their charting. That was really the only physician resistance I recall … “Can you just take the baby and get the weight really quickly?”
How did you overcome this resistance?
We had champions that were so great about doing skin to skin. We would have them share different techniques: how they prepared the mom for skin to skin, how they explained it to the mom, how they would put their blankets, towels, etc. I remember telling charge nurses they had to make sure that skin to skin was taking place, and for those who were having trouble, they had to be the leader and quietly show how it was done. The charge nurses were making sure policy was followed.
Does change like this happen best as a top-down process or the other way around?
Both. It is very typical of the CBU nursing staff that when the research is presented, they jump in. They do it without much resistance. I think it gives credit to nursing and the professionalism of our staff. It was the same way with “laboring down.” We presented the research, and they made it happen. Credit must be given to the nurses at the bedside.
Do demographics matter? In other words, are people from certain socio-economic, racial or ethnic backgrounds more likely to reject or embrace this practice?
I don’t think it matters. What is really important is how the nurse explains skin to skin to the patient and her support person. How passionate she is … does she believe what she is saying? Again, it’s up to nursing.