Early Skin-to-Skin to Improve Breastfeeding after Cesarean Birth

Purpose for the program:

Studies show that breastfeeding rates are lower among women who give birth by cesarean compared to women who give birth vaginally. Keys to successful breastfeeding include initiation within an hour of birth, feeding frequently and on demand, limiting maternal-infant separation, and maternal-infant skin-to-skin contact soon after birth. However after a cesarean birth, mother and baby may be monitored postoperatively for several hours, often in separate rooms and without the opportunity to breastfeed and bond. The purpose of this program is to increase rates of successful breastfeeding initiation after cesarean section by increasing rates of early skin-to-skin.

Proposed change:

Prior to the intervention, standard care routines hindered opportunities for skin-to-skin and breastfeeding soon after cesarean birth. Therefore the intervention involved nurses putting healthy infants skin-to-skin with their mothers briefly in the operating room after cesarean birth and providing more prolonged skin-to-skin soon after. A small sampling prior to the program suggested that infants born by cesarean had lower rates of exclusive breastfeeding and lower rates of early skin-to-skin compared to infants born vaginally. Our goal was to increase early skin-to-skin after cesarean, with the ultimate goal being that all healthy mothers and infants will have the opportunity for early skin-to-skin contact.

Implementation, outcomes and evaluation:

The implementation process was modeled after the PDSA Rapid Cycle Process Model. After the initial planning phase, we developed a flowchart to outline the team-based intervention process and provided in-service presentations to the staff. After three months, the rate of early skin-to-skin among healthy babies born by cesarean increased from 20% to 68%, and the rate of infants who did not get skin-to-skin contact within four hours of birth decreased from 40% to 9%. In addition, lower LATCH scores and lower breastfeeding exclusivity was observed among the healthy infants who did not experience skin-to-skin within the first four hours of birth. Data collection is ongoing to continue to evaluate the program.

Implications for nursing practice:

Baby-Friendly USA suggests that skin-to-skin contact should be provided for every healthy mother and infant immediately after birth, or as soon as possible during the first 30 minutes. Our experience shows that it is feasible to improve the quality of care after cesarean birth in a relatively short period of time. Nurses can be leaders in changing practice to incorporate early skin-to-skin contact into regular cesarean care for mothers and infants.

Keywords: Cesarean birth, Skin-to-skin, Breastfeeding