Skin to Skin Cesarean Section

Purpose for the program:

Skin to Skin Cesarean Section is an innovative way to facilitate the involvement of the family during a cesarean section. Just by changing the "routine" to incorporate immediate skin - to - skin, there is a potential enhancement of the bonding process for the family and the facilitation of breastfeeding.

Proposed change:

The proposed change is the development of a team involved in care during cesarean sections for the purpose of the development of a protocol, that includes family input, to institute skin-to-skin care immediately following cesarean section deliveries.

Implementation, outcomes and evaluation:

The inclusion criteria for candidates for skin-to-skin was the foundational to the protocol development. Families included are experiencing non-emergent, elective, repeat cesareans or cesareans performed due to failure to progress/dilate or breech presentation. The infants are greater than 38 week gestation in no acute distress. Role responsibilities were developed for the neonatal registered nurse, CRNA/Anesthesiologist, circulating registered nurse, delivering physician, scrub technician, the mother and the mother’s support person. Protocol include surgical unit set up allowing mother to select music, the use of dim lighting, extra sterile plastic cord clamp on field, and positioning of warmed blankets, infant cap near the head of the mother’s bed. Family education protocol to discuss with the mother and her support person one of three options: 1.) Observing the birth from the uterine incision through the birth (not for breech deliveries). 2.) Immediate skin-to-skin if infant is vigorous and stable. 3.) Delayed skin-to skin for infants with any situation that lead to a delay transition. Key elements of the skin-to-skin cesarean section were open communication with the OR team and the family throughout the procedure, placing of the infant on the mother’s chest if infant is deemed stable, monitoring infant’s axillary temperature every 10 minutes and perform measurements, medications, footprints when mother requests them to be done.

Implications for nursing practice:

Assuring the provision of family centered care during a cesarean section that includes skin-to-skin contact may improve breastfeeding, bonding and family satisfaction with the birth experience. Continued outcome evaluation is ongoing on these outcome indicators.

Keywords:

cesarean section; kangaroo care; skin - to - skin, bonding.