1. Delay the Baths Anne Marie Henri, RN, BSN Nurse Manager Mother Baby Units Boston Medical Center

2. Boston Medical Center • Urban setting (Boston) • Academic teaching hospital • Strong affiliations with neighborhood health centers • Births per year: About 2,500 • Maternity unit on two floors • 17 (4th floor) and 15 (3rd floor) private rooms • NICU: Level 3, 12 beds • Step Down Unit: Level 2, 6 beds

3. Delay the Bath Initiative • Background: After birth, a baby’s blood glucose level reaches it’s lowest point at about 2 hours of life • Our practice for years has been to bathe babies at 2 hours of life or when a stable temperature (>97.6 ax) achieved • We would sponge bathe the babies body, wash the hair under the facet, and then place the baby on the warmer • With new private rooms came the opportunity to bathe babies in their rooms without taking them to the nursery • Also the opportunity to review the best time to bathe

4. Challenges • MDs on board with delaying the bath • Staff nurses were not enthused for the following reasons: • “Gooky” • “Smelly” • “Parents will hate it” • “Infections” • “It’s not the way we do things”

5. How we did it • Lots of discussion and coaxing • Finally, we picked a GO date • On May 10, 2010, the Delay the Bath Initiative would begin • Baths would be delayed until infant 12 hours of life • Except if history of maternal HIV+, hepatitis B or C positive • Then after the the bath, infant placed skin-to-skin on mother’s chest

6. Signs were posted in unit areas

7. Informationposted in maternity rooms in three languages

8. We added a bassinette card

9. Our first baby! This mom had C-Sec and insisted on getting out of bed to give the first bath.

10. Skin-to-skin after the bath

11. Skin-to-skin can be with Dad too!

12. Lessons Learned • Change is hard. Discuss, review evidence-based practice, discuss again and then at some point you just gotta GO • Parents love it. No complaints. Great opportunity to teach about baths. Great opportunity to reinforce importance of and teach about skin-to-skin, bonding and breastfeeding • Hypoglycemia has almost vanished (?TTN?) • Study underway • At UCSD they don’t bathe babies at all