Objective:  
The benefits of breastfeeding are well known. The Surgeon General’s Call to Action to Support Breastfeeding (2011) highlights the impact of maternity care practices on the establishment of exclusive breastfeeding. The Center for Disease Control (CDC) identifies placing the newborn skin-to-skin with the mother after birth as a breastfeeding supportive practice.  Our healthcare system reviewed the maternity care practices at our hospitals, and decided  to implement skin-to-skin contact at delivery.  Would skin-to-skin contact at birth really make a difference in the exclusive breastfeeding rate at discharge? 

Design:
An education program on the importance of skin-to-skin contact after birth was given to the nursing staff. Education included definitions, benefits of skin-to-skin contact, and it's role in successful breastfeeding.  The nursing staff was instructed to offer skin-to-skin at every vaginal delivery.

Setting: It was a sample of convenience of women delivering at an Atlantic Health hospitals in northwestern New Jersey. Morristown Medical Center is a regional perinatal center with approximately 4000 deliveries annually.  Overlook Medical Center is a perinatal intensive hospital with approximately 2400 deliveries annually. 

Patients/Participants: Breastfeeding women who had a vaginal delivery of a term  singleton infant. We excluded cesarean delivery, preterm delivery, multiple gestations, and teen mothers.   A sample size of 148 was required at each hospital for both the skin-to-skin group and the control group for a 95% confidence interval.

Methods: Retrospective closed chart review comparing the exclusive breastfeeding rates at discharge of women who did not have skin-to-skin contact prior to implementation of skin-to-skin and women who did have skin to skin contact with their infants. Exclusive Breastfeeding was defined as no other liquid or solid fed to the infant except for medication.

Results: Data was compared using paired t- tests. A  p value of less than 0.05 was considered significant.  At Morristown Medical Center the exclusive breastfeeding rate prior to the implementation of skin-to-skin was 54%.  The exclusive breastfeeding rate for women with skin-to-skin at birth was 74%.  This resulted in a p value of 0.0003 which was statistically significant.  At Overlook Medical Center the exclusive breastfeeding rate prior to the implementation of skin-to-skin was 51%.  The exclusive breastfeeding rate for women with skin-to-skin contact at birth was 63%. The resultant p value was 0.0196 which was also statistically significant.  

Conclusion/Implications for nursing practice: Skin-to-skin contact at birth does increase the exclusive breastfeeding rate at dishcarge. There may be increased nurse and patient satisfaction. Further research is needed.

Keywords:  Breastfeeding. Skin-to-skin, Exclusive Breastfeeding