Cerino, Brittany, BSN, RN

Cichonski, Keli, BSN, RN

Daignault, Lee, BSN, RN

Gogle, Julia, RN

Wagner, Roxann E, MSN, RN, RNC-NIC

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingSkin -To-Skin Contact After Cesarean Delivery.Brittany Cerino BSN, RNLehigh Valley Health Network, Brittany_R.Cerino@lvhn.orgKeli Cichonski BSN, RNLee Daignault BSN, RNJulia Gogle RNLehigh Valley Health Network, Julia.Gogle@lvhn.orgRoxann E. Wagner MSN, RN, RNC-NICLehigh Valley Health Network, Roxann_E.Wagner@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtCerino, B. Cichonski, K. Daignault, L. Gogle, J. Wagner, R. (2017, October 25). Skin -To-Skin Contact After Cesarean Delivery.Presentation Presented at: Research Day 2017, Lehigh Valley Health Network, Allentown, PA.SKIN-TO-SKIN CONTACT AFTER CESAREAN DELIVERYBRITTANY CERINO, RNKELI CICHONSKI, RNLEE DAIGNAULT, RNUpdated presentation presented by: Brittany Cerino, Julia Gogle, Roxanne Wagner PurposeDevelop a pilot study intended to decrease the time to skin-to-skin contact after cesarean deliveries on the Labor and Delivery Unit at Lehigh Valley Hospital-Cedar Crest.Today: Review and compare data regarding the implementation of immediate skin to skin in OR.Background & Significance Current cesarean section rate in the United States is approximately 33% (Brady, Bulpitt & Chiarelli, 2014) LVHN current cesarean section rate is 34%  (2014) Average time between cesarean section delivery and first skin-to-skin contact at LVHN in September, 2014 through January, 2015 is approximately 82 minutes (according to a review of 10 charts) Implementation of Baby Friendly Health Initiative at LVHN which includes immediate skin-to-skin contactTRIGGER According to the IOWA Model▪ Problem and Knowledge focused triggersIdentification of clinical problem(problem trigger)National agencies or organizational standards & guidelines(knowledge trigger)Philosophies of care(knowledge trigger)Delay in 1st skin-to-skin contact between infant and mom/support person after cesarean deliveryAWOHNN recommends that stable babies remain in the surgical suite with the motherBaby Friendly Initiative encourages skin-to-skinImproved newborn outcomesIncreased rates of breastfeedingSignificance of trigger and problem▪ After delivery, newborn is briefly introduced to the mother. Newborn and support person go to newborn nursery while mother remains in OR for remainder of surgery. ▪ Mother is transferred to PACU at conclusion of surgery.  Newborn and support person, accompanied by MBU nurse, return to PACU▪ Currently, time between delivery and first skin-to-skin contact averages more than 60 minutes.(2014)EVIDENCE▪ Babies are most responsive to skin-to-skin contact in the first few hours after birth (VanDevanter, Gennaro, Budin, Calalang-Javiera, & Nguyen, 2014).▪ Despite the numerous benefits to immediate skin-to-skin contact, women giving birth via cesarean section have less opportunity to have this contact in the immediate postpartum timeframe (Moran-Peters, Zauderer, Goldman, Baierlein, & Smith, 2014).▪ Immediate skin-to-skin contact helps with newborn adaptation to the extrauterine environment (Moran-Peters et al., 2014).▪ Part of the Baby Friendly Health Initiative includes skin-to-skin contact immediately following birth (Brady, Bulpitt, & Chiarelli, 2014). EVIDENCE▪ Spatial, visual and auditory separation of mother and infant often occurs after cesarean delivery, which is inconsistent with family centered care (Nolan & Lawrence, 2009).▪ Infants separated from mothers immediately following delivery cry more (therefore increasing respiratory and heart rates) than infants not separated (Nolan & Lawrence, 2009).▪ Early skin-to-skin contact decreases risk of jaundice, reduces the stress of birth, and encourages bonding between mother and infant (Stevens, Schmied, Burns & Dahlen, 2014).BARRIERS & STRATEGIESBarriers StrategiesRN staffing Dedicated baby nurse (asrecommended by AAP, ACOG, & AWHONN) for all cesarean deliveries who remains with newborn and support person in the OR and Recovery RoomRN education on early skin-to-skin contact RN education hoursParent education about early skin-to-skin contactAntepartum education as part of doctor visits and/or hospital tourInfant safety in Operating Room (pain and sedation medications used for mothers) and Recovery RoomReduction of sedation of mothers immediately following surgery, dedicated baby nurse, educationAccommodating newborn needs in the Recovery RoomAdding radiant warmer beds to the Recovery Room, creation of dedicated couplet care spacePROJECT PLANS▪ Evaluate current practice at LVHN on the Labor and Delivery unit for maternal/infant separation following cesarean delivery▪ Assess current patient satisfaction with time to skin-to-skin contact after cesarean delivery▪ Determine current time interval between delivery time and skin-to-skin contact in cesarean deliveries.▪ Develop strategies with nursing staff (MBU, NICU and L&D), physicians, & anesthesia personnel to minimize time interval to skin-to-skin after cesarean deliveries.▪ Develop and implement pilot study for decreasing time to skin-to-skin in cesarean deliveriesIMPLEMENTATION1. Process Indicators Documentation of skin-to-skin after cesarean delivery Presence of baby nurse Infant remains in OR with mother/support person2. Outcomes  Time to skin-to-skin interval decreased Patient satisfaction – survey on MBU* Newborn assessment data, including blood glucose levels, temperature, crying*3. Baseline Data  Average time skin-to-skin after cesarean delivery is approximately 82 minutes (2014)*was not implementedIMPLEMENTATION4. Design (EBP) Guideline(s)/Process Phase I Document time to skin-to-skin after cesarean delivery Survey current patients for baseline data including type of delivery, time to skin-to-skin, pt satisfaction* Gather data on infant assessment post cesarean section* Phase II Educate all staff of the benefits of immediate skin-to-skin after cesarean section Preparation and education of parents during the antepartum period  about benefits of skin-to-skin and what to expect during a cesarean section  Address staffing needs to accommodate Baby RN Redesign OR to accommodate infant and support person remaining in OR* Redesign PACU to accommodate infant and support person* Phase III Stable infant remains in OR with assigned baby RN and support person.  Baby RN aids in implementation of skin-to-skin contact with mother or support person Mother and infant transferred to PACU/recovery room together Documentation of time of initial skin-to-skin Follow up survey of patient satisfaction, newborn assessment data, breastfeeding rates for cesarean deliveries*IMPLEMENTATION5. Implemented EBP on Pilot Units Implementation of pilot on L&D unit for all scheduled, non-complicated, full-term cesarean deliveries6. Evaluation (Post data) of Process & Outcomes Evaluate documented skin-to-skin time for a reduction in overall time Survey postpartum cesarean delivery patients* 7. Modifications to the Practice Guideline Stable infants remain in OR with support person and mother during a cesarean section 8. Network Implementation Only pertains to L&D, MBU and NICUExpected Outcomes Decreased time intervals for skin-to-skin contact with cesarean deliveries Increase length of skin-to-skin contact Earlier initiation of breastfeedingRegulation of infant temperature*Regulation of infant blood glucose*Decrease maternal stress and pain* Higher breastfeeding rates* Increased patient satisfaction Anecdotal evidence *Data not evaluatedImplications for LVHN▪ Increased patient satisfaction with cesarean deliveries▪ Increased optimal outcomes for infants after delivery▪ Increased staffing needs on the L&D/MBU unitsPractice Change▪ Addition of an RN for infant in OR during cesarean sections. (staffing previously increased due to AWHONN  recommendations—position given more structure/purpose)▪ Infant to remain with mother and support person in the OR after delivery▪ Infant and mother transferred together to the PACU/RR at the end of the surgery■ TLC learning■ Antepartum education for parents■ Initiation of prenatal care pathway (9-14-16)■ Education in baby bundle book■ Baby Nurse Role: Vitals, STS, assist with nursing, measurements, bracelets, footprintsStrategic Dissemination of ResultsBackground and Significance Comparision▪ Cesarean section rate in United States• 2014 ~ 33% (Brady, Bulpitt & Chiarelli, 2014)• 2016~ 31.9% (Hamilton BE, Martin JA, OstermanMJK, et al)▪ LVHN Cesarean section rate• 2014~34%• 2017- 30%▪ Average time to first skin to skin contact• 2014 ~82 minutes• 2017~ 27 minutesSignificance of trigger and problem▪ LVHN previous practice (2014/2015)  • Infant brought to MBU• Remained there until the mother is in the PACU/Recovery Room. • Time between delivery and first skin-to-skin contact and first feed averages more than 60 minutes.▪ LVHN current practice (2016/2017) • Infant placed skin to skin if both mom and baby are stable• Mother and newborn are not separated unless medically necessary • Newborn can breastfeed immediatelyFY17 Stats▪ Time from Cesarean birth to Skin to Skin• Quarter 1= 26 min• Quarter 2= 30 min• Quarter 3= 28 min• Quarter 4= 25 min▪ Overall time from C-section birth to S2S• 27 minFamily Time▪ Mother and Father response to S2S▪ Baby responseReferences▪ Brady, K., Bulpitt, D., & Chiarelli, C. (2014). An interprofessional quality improvement project to implement maternal/infant skin-to-skin contact during cesarean delivery. Journal of Obstetric, Gynecological and Neonatal Nursing, 43(4), 488-496, doi:10.1111/1552-6909.12469▪ Ferrarello, D., and Hatfield, L. (2014). Barriers to skin-to-skin care during the postpartum stay.  The American Journal of Maternal-Child Nursing, 39(1), 56-61, doi: 10.1097/01.NMC.0000437464.31628.3d▪ Hamilton BE, Martin JA, Osterman MJK, et al. Births: Provisional data for 2016. Vital statistics rapid release;no 2. Hyattsville, MD: National Center for Health Statistics. June 2017. Available from: https://www.cdc.gov/nchs/data/vsrr/ report002.pdf.▪ Moran-Peters, J., Zauderer, C., Goldman, S., Baierlein, J., Smith, A. (2014). A quality improvement project focused on women’s perceptions of skin-to-skin contact after cesarean birth.  Nursing for Women’s Health, 18(4), 295-303, doi: 10.1111/1751-486X.12135▪ Nolan, A., & Lawrence, C. (2009). A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. Journal of Obstetric, Gynecological and Neonatal Nursing, 38(4), 430-442), doi:10.1111/j.1552-6909.2009.01039.xReferences▪ Smith, J., Plaat, F., and Fisk, NM. (2008). The natural cesarean: a woman-centered technique. British Journal of Obstetrics and Gynecology, 115, 1037-1042.▪ Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin-to-skin contact after a cesarean section: A review of the literature. Maternal & Child Nutrition. Doi: 10.1111/mcn.12128.▪ Valendia, M., Matthisen, A., Uvnas-Moberg, K., & Nissen, E.,  (2010). Onset of vocal interaction between parents and newborns in skin-to-skin contact immediately after elective cesarean section. Birth 37(3), 192-201.▪ VanDevanter, N., Gennaro, S., Budin, W., Calalang-Javiera, H., and Nguyen, M. Evaluating implementation of a baby friendly hospital intiative. The American Journal of Maternal-Child Nursing, 39, 231-237. doi: 10.1097/NMC.0000000000000046Questions/Comments?▪ Thank you!

Skin -To-Skin Contact After Cesarean Delivery.

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Skin -To-Skin Contact After Cesarean Delivery.

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