The Benefits of Skin to Skin Contact for Momabd Baby
Kangaroo care is defined as the way of “holding a preterm or full term infant so that there is skin-to-skin contact between the infant and the person holding it. The baby, wearing only a diaper, is held against the parent’s bare chest. Kangaroo Care (also Kangaroo Maternal [Mother] Care or Skin-to-Skin Contact and Breastfeeding) is a method used to restore the unique mother-infant.
Mothers are more likely to be able to practice skin to skin contact or kangaroo care following a vaginal delivery versus a cesarean which is seen as a medical procedure and not a delivery. Infants born to mothers via cesarean are usually whisked away to a nursery and are separated from their mother for as long as two hours. Infants most alert period is the first one to two hours after delivery and most babies born via cesarean spend this time in the nursery away from their mothers and once they are reunited with their mothers they are now in a deeper sleep state and tend to not breastfeed as well as babies that are born vaginally and allowed skin to skin contact immediately. This paper focuses on the need to change the way we take care of mothers and infants that give birth via cesarean and allow them the same bonding experience as mothers that give birth to their infants vaginally.
Step 1: Assess the Need for Change in Practice
The best way to promote change in a healthcare facility is to show how it will benefit the patients and improve the way they view the hospital. Currently during a caesarian section the newborn, immediately after delivery, is handed to the nurses and evaluated and assessed. The mother continues to get treatment as a surgical patient and the time frame of newborn to mother contact can be as long as 40 minutes.
Nurses should look into the benefits to both mother and baby in regards to their health when they receive time to do skin to skin contact in the operating room (OR). Evaluate what potential obstacles could hinder the surgical procedure by doing skin to skin contact and come up with potential solutions so that skin to skin contact in the OR does not interfere with the surgical procedure. The PICOT question: P- newborn babies, I- Delayed time in parent/ person skin to skin time after birth, C- Encourage skin to skin time sooner after birth with parent/person, O- Encourage bonding, stabilize newborns heartbeat, temperature, and breathing. T- Within 6 months.
Step 2: Link the Problem, Interventions, and Outcomes
The problem with the delay in skin to skin contact is that for many years physicians have performed Cesarean sections in a certain way and therefore it becomes difficult when changing the way they practice this procedure. Hospital procedures are written and followed for many years and physicians can be very reluctant to change the way they practice. The first step is to show both the OB and Pediatric doctors the benefits to mother and baby skin to skin time.
Some of these benefits include: stabilize the infant’s heartbeat (especially if they are preterm), temperature, and breathing. Researchers also have found that mothers who use kangaroo care often have more success with breastfeeding and also improve their milk supply. Further, researchers have found that infants who experience kangaroo care have longer periods of sleep, gain more weight, decrease their crying, have longer periods of alertness, and earlier hospital discharge (Kangaroo Care, 2010). The benefits to mom are “enhanced maternal-infant attachment & bonding increased maternal self-confidence, increased maternal affectionate behavior, enhanced relaxation and experience less anxiety, less breast engorgement, and more rapid involution (uterus returning to pre-pregnant size)” (Kangaroo Care, 2010).
These benefits could be shown to the physicians and nurses during their monthly meetings and also how improving a mother’s birth experience could raise hospital scores which can improve reimbursement rates in the future. Also showing the nurses and physicians that they can continue to do their jobs without the skin to skin contact causing major disruptions there is a better possibility for change. A protocol could be devised and discussed in staff meetings, then possibly have a “mock cesarean surgery” to show how it would work if the protocol was to be implemented. This allows the nurses and doctors a way to see it in action, see how it would impact their job duties, while also coming up with other interventions if needed.
Step 3: Synthesize the Best Evidence
Research has been done to assist in proving the importance of skin to skin contact of mother/ person and newborn. 1) One study talked about the effectiveness of skin-to-skin contact (SSC) after vaginal delivery, but had concerns after a cesarean section (Gouchon, 2010). It explained that after cesarean births, SSC is not done for practical and medical safety reasons because it is believed that infants may suffer mild hypothermia. The aim of this study was to compare mothers’ and newborns’ temperatures after cesarean delivery when SSC was practiced (naked baby except for a small diaper, covered with a blanket, prone on the mother’s chest) with those when routine care was practiced (dressed, in the bassinet or in the mother’s bed) in the 2 hours beginning when the mother returned from the operating room.
Temporal temperatures were taken on the newborns with a thermometer at half-hour intervals. Results of the study showed that newborns who received routine care versus SSC cesarean-delivered, were not at risk for hypothermia due to both groups having almost identical temperatures. The average time from delivery to the mothers’ return to their room was 51 min. The SSC newborns attached to the breast earlier and the SSC mothers expressed high levels of satisfaction with the intervention” (Gouchon, 2010). This study showed that the skin to skin contact for the infants born via cesarean does not have a potential risk for hyperthermia, which was one of the theories that most doctors use as to why they feel skin to skin contact should not be allowed while mother was still in the OR. 2).
This next study found that little to no SSC during the first two hours after birth is associated with less infant self-regulation, and decreased maternal sensitivity and attachment that is not made up for by rooming-in. Although research suggests that early SSC is key to successful initiation of breastfeeding, it is rarely use immediately after a healthy cesarean birth. “Nurses can be leaders in changing practice to incorporate early SSC into regular cesarean care for mothers and infants by ensuring that the routine care after cesarean births is family-centered and research-based” (Berg, 2011).
This research shows how nurses need to advocate for their patients and show how skin to skin contact early on even while still in the OR, can have long term positive effects for both mothers and babies This can make such a positive difference on a mother’s birth experience which can impact the way a hospital is viewed in the community 3). Another study pointed out that if a mother is unable to do skin to skin contact with the infant after cesarean, then the father can do the kangaroo care and still have positive effects on the infant. The goal of this study was to show the benefits of skin-to-skin contact with a newborn during the first 2 hours after birth, even if it was form the father. Twenty-nine father-infant pairs partook in a randomized controlled trial, in which infants were randomly selected to be either in the skin-to-skin contact group with their father or the standard care group.
The data was collected from both groups by naturalistic observations that looked at the infants’ behavioral response that was recorded every 15 minutes and was given a score in the Neonatal Behavioral Assessment Scale (NBAS). This research information is helpful because it shows that even skin to skin contact from the father can positively impact the newborn. SSC helps to calm the infant and facilitate a drowsy state for the infant sooner than the infants that received the standard care (Erlandsson, 2007). This information can be used to show that if a mother is unable to do SSC, the father can take over the role. This can be written into the protocol so that even cesarean under general anesthesia are still allowed to provide the best care to their newborn which is skin to skin care.
Step 4: Design Practice Change
Hospital policies need to be re-evaluated anytime there is evidence based research that supports change in the way healthcare is practiced. Taking babies away from the mother after cesarean birth is a long held practice and now research shows that this is not beneficial to mother or baby. Showing that even a father providing SSC can benefit the child it a huge step. Nurses need to be the ones to advocate for their patients and show the research to the physicians as well as hospital administration in order to get the ball rolling and change the way we care for cesarean mothers and infants.
Step 5: Implement and Evaluate the Change in Practice Policy reviewed by a committee and re-written so that skin to skin contact between mother and infant or father and infant is allowed immediately after cesarean in the OR unless there is a life threatening issue to mom or baby which would override the skin to skin contact.
Providing in-services to inform staff and physicians to the policy change and the benefits that skin to skin contact has for mothers and infants. Keep a log of cesarean deliveries, whether skin to skin contact was implemented, at what point in the delivery was the skin to skin contact initiated and for how long, any issues, and any comments from the parents on how this affected their birth experience. This information should be over a six month study period.
Step 6: Integrate and Maintain the Change in Practice The information obtained should help show the benefits of skin to skin contact to all mothers and babies whether they deliver vaginally or cesarean. Hospital policy should be re-written so that all mothers or fathers are able to do skin to skin contact no matter how they deliver and only if there is a life threatening issue to mom or baby would this override the kangaroo care after delivery. Once the policy is rewritten then all staff including physicians will adhere to the policy in order to provide the best possible care to all mothers and their newborn infants. Summary
Skin to skin contact or kangaroo care has only been used for vaginal mothers and infants. However, now research has shown that an infant can do skin to skin contact with its mother or father in the OR without any potential issue to the mother or baby. In fact the research shows that it is very beneficial to the mother and infant if they do skin to skin contact immediately after delivery. The setback of cesarean section is having the baby whisked away from the OR to the nursery. If they are shown the evidence based research on how skin to skin immediately after cesarean can benefit both mother and infant and how it can improve the overall birth experience, then they will be more likely to initiate the change in policy and practice.