Family-Centered Cesarean Birth Offers Appropriate Thermoregulation in Term Neonates

•    Purpose for the program:

 Evidence-based practice is a cornerstone of safe effective care. Evidence indicates skin-to-skin contact is beneficial in terms of parent/child bonding, physiologic regulation, and stimulation of milk production and neonate rooting. Exclusive breastfeeding is a best practice; its success increases when skin-to-skin contact is initiated within the first hour of life. Although this practice has been adopted in many delivery rooms, it is less frequently used in the operating room. This project sought to implement early skin-to-skin contact for mothers after cesarean birth.

•    Proposed change:

Practices following a cesarean birth included taking neonates to the nursery for assessment, medications, and bathing. Thus, neonates were separated from mother for an hour or more immediately post-birth. Often, neonates were not reunited with their mom until the recovery room or post-partum. To facilitate family-centered cesarean, neonates stay in the operating room with mother as surgery is completed. The neonate is placed skin-to-skin with mother or support person shortly after birth. If actively rooting, breastfeeding is initiated. Bathing is delayed, to allow adequate time for neonates to transition to extra-uterine life.  

•    Implementation, outcomes and evaluation:

To implement family-center cesarean a nurse was hired to initiate skin-to-skin contact in the operating room. Obstacles were encountered during implementation. Pre-term neonates, those with life threatening anomalies, and neonates born to mothers with infectious STDs are not candidates for family-centered cesarean. Surgeons had to become comfortable with the window drape, where mother could see into the surgical field as neonates were delivered. Anesthesia had to become comfortable with sharing space at the head of the table so the nurse has access to the infant. Stakeholders were offered explanation of benefits of family-centered cesarean birth, including improved patient satisfaction. After 1 month of discussion they were agreeable and eager to implement the changes.

Safety was measured through temperature. Rectal temperature was obtained shortly after birth, prior to skin-to-skin and immediately after skin-to-skin. Data from 47 neonates revealed none had starting temperatures below normal and 5 had starting temperatures above normal limits. Following skin-to-skin, temperatures were within normal limits. Following skin-to-skin, 2 remained stable, 3 increased and 42 decreased. The average change in temperature from before to after skin-to-skin was -1%. This data indicates that skin-to-skin contact is safe for neonates.

•    Implications for nursing practice:

Family-centered cesarean birth offers safe care that may enhance bonding and breastfeeding.

•    Keywords:

Cesarean section, Skin-to-skin, Thermoregulation