Implementing Skin to Skin Contact Routine Practice following Birth

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Implementing Skin to Skin ContactRoutine
Practice following Birth

• By
• Margaret OLeary C.M.S. Lactation
• Margaret Hynes C.M.S. Lactation

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Baby Friendly Hospital Initiative (BFHI)

• Launched in 1991 by WHO/UNICEF
• Aim to counteract worldwide decline in
  breastfeeding
• BFHI is
• Mother / Baby Friendly
• Global Initiative
• Health Promoting

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Baby Friendly Hospital Initiative (B.F.H.I)

• Cert of commitment
• - 1999
• 2001
• Full Award
• - 2004

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Common PracticePrior to B.F.H.I.

• Baby dried wrapped in blanket
• Held by parents
• or
• Put in incubator within mothers view
• Generally feeding established in postnatal ward

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Implementing Change

• Change in practice and routine
• Policies to ensure sustainability

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Why Skin to Skin ?

• Reduces by 74 the production of stress hormones
  in baby which aids digestion reduces incidence
  of hypoglycaemia.
• Calms baby.
• Regulates babys heart beat breathing.
• Maintains core body tempeture in baby.
• Helps establish sustain breastfeeding.
• Promotes close mother/baby relationship.

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Practice/Routine

• Staff education
• Training
• Video
• Written information
• Photographs
• Parent education
• Antenatal classes
• Skills workshop
• Private public antenatal clinic
• Written information

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Hospital Policies

• Hospital Clinical Guideline on management
• of breastfeeding lactation
• Within half an hour of birth all mothers
  regardless of feeding choice will be given their
  baby to hold with skin to skin contact for at
  least 30 minutes
• Hospital policy for mothers
• Hypoglycaemia policy
• Regional Breastfeeding Policy

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Obstacles

• Large number of staff
• Turnover of patients in labour ward too busy
• Old habits die hard
• Consistency in recording in maternity notes
  incidence, duration and reason for discontinuing

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Overcoming Obstacles

• Parentcraft team
• Role of the Clinical Midwifery Specialist (CMS)
• Additional education time at antenatal clinic
• Informing mothers antenatally
• Key people from each area in Hospital Baby
  Friendly Hospital Initiative Committee
• Providing research based articles on importance
  of skin to skin

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• Initial B.F.H.I assessment for full award was
  June 2004
• 78 of mothers met the criteria (Minimum
  requirement is 80)

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What can we do to improve?

• Never give up
• Recommence on postnatal wards
• Following infants first bath
• Co-operation of postnatal neonatal ward staff
• Checking charts for documentation
• Feeding back at ward report time
• Care attendants

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Whats beneficial to achieve maintain practice

• Rooming in
• No well baby nurseries
• Supportive staff in all areas
• Safety rails on beds in postnatal wards
• Infant bathing at bedside
• Feedback to staff of positive comments from
  mothers

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Baby Friendly Award

• Audit of Practice

• February 2005
• Questionnaires
• To 120 women ( 36 weeks gestation)
• To 100 mothers (Day 2 Postnatal)

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Results

• Antenatal Questionnaire
• 84 returned
• What is skin to skin contact?
• 93 knew
• Others
• Thoughts linked with breastfeeding and childbirth
  more vague

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Mothers perception

• When will skin to skin contact be initiated?
• 94 immediately or shortly after birth
• Others
• Perceived it would happen with breastfeeding
• Why?
• Bonding - 79
• Antibody/Immune system - 23
• Comfort/Safety - 9
• Breastfeeding - 6
• Temperature control - 4
• Heart rate - 4

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Postnatal Questionnaires Results

• 70 out of 100 replied
• 68 of these received skin to skin contact
• 100 - positive feedback from this group
• When?
• 81 - immediately after birth
• 22 - on admission to ward
• 16 - following bath

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What did mothers say?- good for mother

• 84 - Bonding/sense of comforting/liked baby
  next to them
• 16 - Sense of relief!
• Many individual positive comments

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What did mothers say?- good for baby

• 56 - Relaxing, soothing, reassuring,
  security, happy, calm, comfort
• 53 - Bonding, including smell, heart rate,
  sight of mother
• 24 - Warmth (? temperature)
• 2 - Sleep
• 2 - Make baby alert

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Individual Comments
It reassured me baby was ok
Made me feel like a mother
A complete high
I found the experience very rejuvenating
Just amazing, no words can describe it
The feeling of bonding was very natural
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Individual Comments
Made the arrival of the baby more real
Breastfeeding started quicker
Calmed baby after birth
Lovely to let him and I bond and be quiet
together
Reassurance that I was able to calm baby
Very relaxing and great for bonding