“Keep Me With My Mom”: An Evidenced-Based Initiative to Keep Mother and Newborn Together Following Cesarean Birth
Title: “Keep Me With My Mom”: An Evidenced-Based Initiative to Keep Mother and Newborn Together Following Cesarean Birth
- Describe the benefits of keeping stable newborn STS with mother during following birth
- Identify challenges when standardizing post-birth practice and implementing STS care following cesarean birth
- Plan to integrate into practice early STS care following cesarean birth
Design: Evidence-based guidelines support post-birth recovery of term stable newborns, skin-to-skin (STS), with mother to promote mother-newborn synchrony. The Plan-Do-Study-Act (PDSA) Cycle was utilized to implement our practice change.
Sample: Pre-implementation:Three month (November 2012-January 2013) retrospective chart review of recovery care, 42 term stable newborns born by cesarean birth; 14 newborns per month.
Pilot:One month project (March 2013) included keeping mother and newborn together for 4 selected cesarean births.
Implementation:From April 2013 until present keeping mother and newborn together for all cesarean births. Ongoing monthly retrospective chart review of recovery care following cesarean birth(14 charts per month).
Methods: Retrospective chart review includes: date and time of birth, feeding choice, time of breastfeeding initiation, time of newborn admission to the nursery. Patient satisfaction questions/comments relevant to the project were obtained from the hospital’s patient satisfaction survey. Implementation phase retrospective chart review collected data about documentation of initiation of STS.
Implementation Strategies: A list of “Top Ten Reasons for Keeping Mother and Baby Together Post-Birth” was posted prior to implementation to engage staff and prompt dialogue. Labor & delivery staff, designated as project champions, and the education specialist reorganized the cesarean birth recovery room to safely accommodate mother and newborn. Multidisciplinary in-service education was provided. A pilot project was conducted to identify any barriers. A workflow algorithm was created to highlight changes to staff responsibilities. Staff dialogue continues to share progress, address challenges and concerns, offer support and learning about keeping mothers and newborns together.
Results: The length of time mother and newborn stayed together following cesarean birth increased from 35 minutes to 90-120 minutes. The length of time to initiation of breastfeeding decreased from 5 hours to 2 3/4 hours. Initiation of STS increased 7% to 57%. Patient satisfaction scores remain consistent over 90%.
Conclusion/Implications for nursing practice: Utilization of the PDSA cycle can accomplish successful implementation of practice change. Standardized care following cesarean birth should include STS and early initiation of breastfeeding. Unexpected practice improvement may be realized.
Keywords: Skin-to-Skin Care, Post-Birth Recovery Care, Cesarean Birth, Plan-Do-Study-Act-Cycle