Proposed change: Implementing Skin-to-Skin Care in a Baby Friendly Community Hospital

Implementation, outcomes and evaluation: Health First, Inc. Cape Canaveral Hospital, a Baby Friendly facility since June 2000, launched a Skin-to-Skin Initiative in 2009. An evidence-based practice protocol for placing newborns skin-to-skin at birth and in the immediate postpartum was incorporated into our LDRP unit, and encouraged during the entirety of the Postpartum stay.  Staff Nurses were educated in appropriate skin-to-skin techniques and patient instruction, first in a small group interactive setting and later followed with a video and discussion format.  Patient education pamphlets were distributed to laboring women and Kangaroo Care shirts made available for loan to new mothers during their hospital stay.  Families were encouraged to attempt to keep their newborn skin-to-skin up to 6 hours a day for the first week of life, and a minimum of two hours a day for the second through fourth weeks. Mothers were assured that anyone, e.g. fathers and grandmothers, can put the infant skin-to-skin.

Studies have reported benefits of skin-to-skin care of the newborn to include reduced crying, improved mother-infant interaction, warmer babies and greater breastfeeding success.  (apps.who.int/rhl/newborn/gpcom/en/index.html, August 16, 2011) Additional positive effects on neonatal self-regulation during the transition from intra- to extra-uterine life include increased sleep, decreased apnea and bradycardia, improved respiration and oxygen saturation, accelerated weight gain; and, for the mother, increased milk production. (www.pediatrics.aappublications.org/content/113/4/858.full-August 16,2011)  The staff at CCH has observed anecdotal evidence of these benefits.

The nursing and lactation staff at Cape Canaveral Hospital strives to achieve skin-to-skin care with every new mother-baby couplet, making allowance for individual circumstances and infant condition.  A chart audit was conducted from 2010 to 2011 for evidence of skin-to-skin care attempted/encouraged immediately after birth and within the first hour of life, and of documentation of mother education on benefits of skin-to-skin care.  Results show a 90% success rate, indicative of a positive trend in the number of mother-baby couplets opting for this practice, and verbalizing their intent to continue skin-to-skin at home.  Mothers seen one-on-one in the Lactation Clinic after discharge are further encouraged to continue skin-to-skin care in the first weeks. 

Implications for nursing practice: The practice of skin-to-skin care as a component of our Baby Friendly philosophy contributes positively to neonatal transition, enhances attachment, and promises long-term benefit to new families.  We at Cape Canaveral Hospital are committed to continuing promotion of skin-to-skin care as part of best practice.

Keywords: breastfeeding; skin-to-skin care; kangaroo care; newborn