Innovations In Practice: Supporting The Breastfeeding Dyad In Labor & Delivery

Objective: Improve support of the breastfeeding mother-infant dyad by increasing skin-to-skin (STS) care and initiating breastfeeding within the first hour of birth.

Design: Pre-post intervention design. Exclusive breastfeeding for six month of life is endorsed by many healthcare organizations.  Both of these interventions have demonstrated improved breastfeeding outcomes.

Sample: Inclusion criteria - stable mother-infant dyad, not separated after birth. Random sample selected (minimum of 30 charts/month) of dyads admitted to the Mother-Baby unit after birth.

Methods: Retrospective chart review.

Implementation Strategies: Several nurses in the Labor & Delivery (L&D) unit passionate about breastfeeding initiated this project as one way to increase success of breastfeeding. The L&D shared governance council committed to improving skin-to-skin care and early initiation of breastfeeding and the commission of this quality improvement initiative. Quality improvement methodology (PDCA) was paired with change management theory (Roger’s Theory of Innovation) to enhance outcomes. Baseline data was obtained. A literature review was conducted. Unit champions or innovators, identified. Implementation of skin-to-skin care and early initiation of breastfeeding was instituted by these nurses. Staff education was completed for all staff. Champions assisted other nurses in accomplishing STS care, even at times in the operating room. Monthly audit data was shared with staff. Challenges were encountered along the way. One challenge was the introduction of a new electronic medical record. Physician resistance was at times met. Resistance was overcome by education, persistence and culture change. Slowly change occurred. Anesthesiologists became champions along the way. Skin-to-skin care and early breastfeeding are now part of Labor & Delivery’s routine practice.

Results: Monthly data audits were completed for each indicator.  Increase in STS care from a baseline of 25% (July, 2010, all delivery types) to close to 90% by July 2013. In this same timeframe, breastfeeding within the first hour went from 66% to 90%.

Conclusion/Implications for nursing practice: Skin-to-skin care and early breastfeeding after birth has proven benefits for both the mother and infant.  Perinatal nurses must find ways to provide this care by overcoming barriers to implementation.  Unit champions are invaluable to making change.

Continual reinforcement is needed to sustain change. Outside factors (such as change in documentation system) impacts care. Need to plan for change. This project demonstrates change strategies for project execution.

Keywords: skin-to-skin care, breastfeeding, quality improvement, change management, Labor & Delivery