Listening to Newborns: What Babies Have to Say about Transitions to Life

Purpose for the program:

In April 2008, members of the clinical practice team at the Birthplace at Baystate Franklin Medical Center attended a conference entitled: The Evidence for Newborn Care.  Barbara Graves CNM, MN, MPH, FACNM presented research which challenged the evidence behind traditional birth interventions and promoted the benefits of natural newborn transitions to life.  Intrigued by the evidence, and opportunities to improve practice, the team was inspired to implement a program for change.

  Using AWHONN’s Standards for Professional Nursing Practice as a framework, the team set out with a purpose to implement a program that would provide high quality care based on evidence and not tradition alone.  After meeting collaboratively with obstetricians, midwives, pediatricians and family practice physicians, reviewing the research and discussing implications for practice, the “Listening to Newborns” program was initiated.

Proposed change:

Four interventions were identified for quality monitoring: clamping and cutting of the umbilical cord, routine bulb suctioning, skin to skin contact and self attachment.  At each birth, RN’s utilize assessment skills during labor and delivery to evaluate newborn status.  Equipment is readily available, and with indication of distress, interventions taken as appropriate.  All well babies are placed immediately skin to skin with no routine bulb suctioning.  Cord clamping and cutting are delayed until pulsation stops and breastfeeding babies are encouraged to self attach.  

Implementation, outcomes and evaluation:

Data was collected and analyzed.  Results were shared at interprofessional team meetings.  Staff were educated, barriers discussed and addressed.  Current statistics reveal a delayed cord clamping rate of 94%, bulb suctioning rate of 14%, skin to skin contact, 89% and self attachment to the breast, 76%.   Newborns with little to no medical intervention display equivalent apgar scores, temperature, respiratory and cardiac adaptation.  

Implications for nursing practice:

The Listening to Newborns program has made a significant impact on nursing practice at The Birthplace.  At each birth, nurses experience first hand the benefits of applying evidence to practice by using their assessment skills to provide quality care.  The program has proven to be an excellent opportunity for collaborative practice, has allowed nurses to use their leadership roles, and has inspired several other programs.  Perhaps the greatest benefit has been a change in culture, a stronger curiosity about how we practice, a need to know what the evidence supports, and a deeper commitment to deliver high quality, evidence based care to promote the health of women and newborns.

Keywords: newborn transitions; skin to skin; self attachment; umbilical cord clamping; bulb suctioning