Family-Centered Care During Cesarean Delivery: A New Approach

Purpose for the program: A significant number of women deliver their babies by Cesarean Section in the Operating Room.  in most hospitals this number is more than one out of every four deliveries.  The primary emphasis in Cesarean delivery is safety for both our mom and baby during the surgical procedure.  To adhere to the traditional standards of the operating room, we have limited the number of people in attendance, as well as limited the time mothers spend with their newborns.  Our current challenge is how to adhere to opearting room standards, keep our patients safe, and still promote bonding, family-centered care and successful breastfeeding. 

Proposed change: Patient feedback as well as current literature inspired us to review our current Cesarean delivery practices. Our facility created an inter-disciplinary team to explore alternative options and devleop a realistic plan that met the needs of the patients as well as the staff.   Our goal was to increase patient satisfation and promote comfort, bonding, the family unit, and early breastfeeding initiation.  

Implementation, outcomes and evaluation:  After successful initiation with vaginal deliveries of a skin-to-skin and early breastfeeding campaign entitled 'The Golden Hour," we covened an interdiscplinary team to evaluate how we could implement a family-centered care approach for the entire Cesarean delivery experience. The plan included the following elements  1)Comfort (I-Pods in the OR with playlists, dimmed lighting, comfortable positioning) 2) Bonding (adjusting the baby warmer to have better line of sight for mom, keeping the stable baby in the OR, and offering skin-to-skin) 3) Family unit (allowing dad to be in the OR for spinal placement during scheduled deliveries and when appropriate allowing 2 family members in the OR). After an initial small pilot, verbal feedback from patients and providers suggested that patients were most satisifed when their family remained together and they had the opportunity for skin-to-skin interaction, if even for a short time.  Both anesthesia and nursing requested increased nursing staff in the OR to make this experience successful.  They also requested the development of specific guidelines to define which patients are candidates for these options.  

Implications for nursing practice: Patients who deliver by Cesarean Section often have delayed breasfeeding initation and bonding due to separation from their baby.  As nurses we are in a position to find creative ways to overcome these barriers and help families remain together.

Keywords: Family-Centered Care, Cesarean Delivery, bonding, skin-to-skin, early breastfeeding initiation