Background: Step 4 of the Baby-Friendly Hospital Initiative states “Help mothers initiate breastfeeding within a half-hour of birth” (WHO, 2006a, p. 3). This step has been interpreted internationally as: “Place babies in skin-to-skin contact with their mothers’ immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed” (WHO, 2006b, p. 10). National and professional organizations have revised their policies and guidelines regarding care for the newborn immediately after delivery to reflect the above interpretation.  But to implement step 4 in an U. S. hospital means dramatic changes to current care practices and perhaps a change in the philosophical paradigm related to what is important immediately after birth.
Current practice: At Fairview Hospital newborn infants are handed off to a “baby” nurse as soon as the cord has been cut and taken to a warmer where initial assessments are completed, medications given and identification applied.  Once the repair is completed and mother is “cleaned up,” she is given her infant swaddled in several blankets.  If mom desires she is encouraged to attempt breastfeeding, but the infant may not latch-on successfully. Approximately one hour after the birth baby is taken to the newborn nursery for two hours of monitoring and first bath.  Mom is taken to her room on the postpartum floor.
Proposed changes: Implementation of birth kangaroo (skin-to-skin) care (BKC) as routine immediate post-birth care for all newborns. Infants will be placed skin-to-skin on their mother’s abdomen/chest and remain there until after the first breastfeeding is completed.
Implementation strategies: A committee of maternity nurses gathered to explore the implementation BKC. Working with nurse faculty researchers from a local university, the committee examined the evidence for BKC, documented current practices, delineated the barriers and developed bench marks to monitor outcomes of the practice change, especially on breastfeeding. Hospital policies were revised to assure they supported KC and breastfeeding. Bench marking data was gathered for 6 months before the nursing staff attended a 4-hour educational session and the implementation of BKC began.
Evaluation strategies: Pre-and post-bench mark data will be compared.  Breastfeeding mothers will be followed for up to 6 months assessing how long they provide exclusive or any breastfeeding.  Patient satisfaction will be assessed.
Results: Will be available at time of presentation.
Implications for practice: Nurses have the ability and power to make practice changes to improve care especially when based on evidence.  Major changes to practice take detailed planning by all stakeholders involved in or affected by the change.  Champions for the change need to take leadership roles, leading by example and by supporting colleagues.  Providing evidence-based care which enhances maternal-infant interaction increases maternal confidence and satisfaction.