Skin to Skin Care in the Hospital

By, Lindsay Sims, BSN, RN-C 

At one hour old, life outside the womb is a special time when a baby meets his or her parents for the first time, and a family is formed. The manner in which a new baby is welcomed into the world during the first hours after birth may have both short-term and long-term consequences. There is good evidence that newborns who are placed skin-to-skin (s2s) with their mothers immediately after birth make the transition from fetal to newborn life at greater strides than not being placed on their mother’s bare chest.  One of the main benefits seen fairly quickly after s2s is initiated is the process of breastfeeding. Babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when s2s with their mothers. When the newborn is placed s2s with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Evidenced based practice shows that a baby placed s2s immediately after birth will succeed with breastfeeding at a higher rate and for a longer period of time compared to those who go to the radiant warmer after birth. In 2012, researchers pooled the results from 34 randomized, controlled trials in a meta-analysis (Moore, Anderson et al. 2012). The researchers found that babies who were randomly assigned to receive early s2s (initial or before 2 hours of age) were 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who received routine hospital care. This is a "sacred" time that should be honored, cherished and protected whenever possible.

S2s is a trend that more and more U.S. hospitals are embracing. Hospital protocols can be modified to support uninterrupted s2s contact immediately after birth for both vaginal and cesarean births. In the sections below we will cover how the baby and mother benefit from s2s, what the patient should request, and the barriers seen by the nursing/medical staff in regards to s2s.  

Skin-to skin is recommended by the American Academy of Pediatrics (AAP), the U.S. Department of Health and Human Services (HHS), the World Health Organization (WHO) and many other health organizations. One of the AAP's recommendations is that “nurses will encourage moms and dads alike to continue skin-to-skin contact throughout their hospital stay.” The Baby Friendly Hospital Initiative states that all mothers must have the opportunity for s2s contact for at least one hour or until after the first breastfeed, whichever is sooner.

As nurses/medical staff we are faced with many hurdles during this intimate/important time of s2s and breastfeeding. Some of the s2s challenges faced in hospital include the need for immediate documentation (weight/length for MD, delivery record; assessing mom & baby); family disturbances; staffing/time constraints; unstable baby; C/S baby; patient's level of pain, being tired or cold; and patient/family being uneducated on s2s and breastfeeding. An important fact to keep in mind is that the rate of Cesarean births has increased significantly in the U.S., and currently averages around 32% - or 1.4 million American babies born by Cesarean per year. The low rates of skin-to-skin care provided to this population means that there are a significant number of mothers and babies who are not receiving skin-to-skin care.

Nurses, physicians, childbirth educators, and lactation consultants have unique opportunities to develop relationships with mothers prior to birth providing education on wellness and health promotion including s2s and breastfeeding. We must take advantage of this role! With this role in hand we can customize our plan of care and interventions to allow this one hour of uninterrupted s2s, with a little adjustments of charting and caring for the patient(s).

Patients should be educated on the importance and benefits of practicing skin to skin care with their newborn baby.  They should tell the nurses/medical staff they want immediate s2s and Golden Hour when they arrive to the hospital and throughout their stay. They are in control of their stay and the staff should do everything in their power to make sure they grant their wishes towards s2s and breastfeeding.

Benefits of s2s care in the newborn:

1. Accelerates BRAIN DEVELOPMENT

2. Reduces Crying/Stress (negative effects of separation)

3. Regulates BODY TEMPERATURE

4. Improves QUALITY OF SLEEP

5. Enhances IMMUNE SYSTEM

6. Stimulates DIGESTION & WEIGHT GAIN

7. Synchronizes HEART RATE & BREATHING

8. Encourages BREASTFEEDING BEHAVIOR (aids in attachment)

 

Benefits to the mother:
1. Reduces risk of POSTPARTUM DEPRESSION

2. Increases MILK PRODUCTION

3. Speeds RECOVERY TIME

4. Promotes PSYCHOLOGICAL WELL BEING

Skin to skin contact and breastfeeding are hot topics at this time in the hospital with The Joint Commission Perinatal Care Core Measures and Baby Friendly Hospital Initiative goals all aligning to promote the practice. As a nurse in Labor and Delivery, I want to stress that we must be educated and adjust our plan of care and interventions to allow for this. This process change from what we are used to will only show positive outcomes, as we all know! For the mother (parents), please come educated on your rights as a patient and be ready to let the hospital know your specific wishes. Do not allow your medical team to adjust the plan unless deemed necessary! You deserve to have this special time with your newborn, as you will never get that one hour of skin to skin directly after birth ever again! Enjoy every second!

Edited by Sara Steelman, MPH (2/25/2015)