Implementing a Birth Kangaroo Care Policy in Labor and Delivery: Bringing Evidence-Based Practice to the Bedside

Purpose for the program:

The birth of a baby is one of the most meaningful experiences in a woman's life. Birth Kangaroo Care (BKC), early skin-to-skin contact between mother and baby from birth until first breastfeeding is accomplished, is recommended by the American Academy of Pediatrics, and many other organizations.  Research shows that BKC provides physiologic and emotional benefits for both mother and infant. Newborn thermoregulation and blood glucose stabilization are enhanced when babies are kept skin-to-skin with their mothers. They cry less and breastfeed easier. Mothers report more confidence, stronger attachment, and distraction from discomfort when they hold their babies immediately after birth. Yet, despite the evidence, most hospitals still practice routine separation of mothers and babies. How can a team of nurses create a policy and change the culture of childbirth in a community hospital?

Proposed change:

Making BKC part of the labor and delivery unit’s normal routine requires more than writing a policy. It requires using change theory and evidence-based research to bridge the gaps between “the way we’ve always done it” and family-centered maternity care. This community hospital wanted to make skin-to-skin contact between mothers and babies part of their normal routine for vaginal and cesarean births.

Implementation, outcomes and evaluation:

Utilizing evidence-based research, a team of nurses wrote a policy that made BKC the standard of care for vaginal and cesarean births. Key issues addressed include management of the third stage of labor while the mother held her baby skin-to-skin; caring for the newborn (vital signs, medications, glucose monitoring, and bathing); time management; and recovering a cesarean section patient during BKC. In addition to logistics, change theories were used to deal with the resistance to change in practice and culture within the institution. Lewin’s Change Theory and Roger’s Diffusion of Innovation Theory were used to bring staff and physicians on board. While the policy was being implemented, management supported staff by ensuring ratios allowed nurses the time they needed as they adjusted to the change. Breastfeeding rates went up initially from 59% to 75%. Maternal satisfaction was enhanced, as letters, surveys, and in-person feedback were all positive.

Implications for nursing practice:

Cultural shift within the unit was facilitated with Lewin’s concepts of unfreezing, moving, and refreezing; and Roger’s concepts of early adopters. Implementing BKC benefited the families served, and the staff were empowered by the process.

Keywords: birth kangaroo care, breastfeeding, family centered maternity care, change theory