Skin-to-Skin Contact An Evidence-Based Nursing Intervention
Background • Mother-infant separation post birth is common in Western culture. Early skin-to-skin contact (STS) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother’s bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evoked neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiological ‘sensitive period’ for programming future behavior.
World Health Organization (WHO) • Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.
AAP Policy Statement (2005 ) • Healthy infants should be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished.
The alert, healthy newborn infant is capable of latching on to a breast without specific assistance within the first hour after birth. • Dry the infant, assign Apgar scores, and perform the initial physical assessment while the infant is with the mother. • The mother is an optimal heat source for the infant. • Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. • Infants affected by maternal medications may require assistance for effective latch-on. • Except under unusual circumstances, the newborn infant should remain with the mother throughout the recovery period. American Academy of Pediatrics 2005
Benefits of Skin-to-Skin Contact • Interaction between mother and infant • Opportunity for breastfeeding • Thermoregulation • Glucose Regulation • Easier Transition to Extra-Uterine Life • Pain Management
In several controlled studies, skin-to-skin contact (SSC) was shown to improve maternal bonding behaviors such as: • Face-to-face contact • Kissing • Smiling • Holding • Caretaking Behaviors
Breastfeeding Recommendations • Breastfeeding is the preferred method of infant feeding, which should be initiated within the first 30-60 minutes following birth. (AAP, 2005; WHO, 1998)
Opportunity for Breastfeeding Many studies have shown improvements in breastfeeding with early STS contact. • More likely to be breastfeed 1-4 months post birth • More successful breastfeeding immediately post birth • Shorter time to first effective breastfeeding • Better infant recognition of own mother’s milk by 4 days of age • Less engorgement
Thermoregulation Infant temperatures were compared in groups that had the opportunity for STS vs. infants that were wrapped in pre-warmed blankets, or placed on radiant warmers. STS groups showed: • Higher rates of neutral thermal range temps • Higher mean skin temperatures • Less temperature variability
Infant Radiant Warmers • Placing the newborn under a radiant warmer is unnecessary in the majority of healthy newborns. • Apgar scores, initial physical assessment and placement of newborn ID bands can be performed while newborn is in STS contact with its mother • Administration of Vitamin K may be deferred until after the first feeding at the breast is accomplished. (AAP)
Glucose Regulation • Glucose levels measured after 80 min of STS vs. 80 min wrapped in a bassinet • Glucose levels measured in STS infants vs. infants wrapped and in mother’s arms or wrapped in bassinet x 75 min • Significantly higher glucose levels in 75-90 minutes for babies in STS groups
Easier Transition to Extrauterine Life • Lower mean heart rates • Lower mean respiratory rates • Higher SCRIP scores (measuring RR, HR, and O2 sats) • Less infant crying • Increased sleep states • Higher optimal flexion scores
Pain Management • STS reduces the pain responses of crying, grimacing and dramatic heart rate increases in newborns during painful procedures • Evidence supports the use of STS in preventing pain during heel sticks and other interventions
What interferes with STS? • Cesarean Birth • Staffing guidelines • Resistance to accepting STS for improved outcomes • Inability to complete nursing tasks
MWH Maternal-Newborn Quality Improvement Goals: • Most mothers will experience mother-infant skin-to-skin contact for at least 30 minutes within one hour of uncomplicated vaginal birth and within 2 hours of uncomplicated cesarean birth. • 80% of mothers who have had normal vaginal births, and 60% of mothers who had cesarean births, and who are planning to breastfeed, will confirm that within a ½ hour of birth they were given their babies to hold with STS contact and offered help by a staff member to initiate breastfeeding within one hour of birth.
What can YOU do? • Discuss skin-to-skin with parents prior to birth • Review the benefits of skin-to-skin • Help mothers initiate skin-to-skin after birth • Delay procedures until after initial STS or perform them during STS • Collaborate with other members of the healthcare team to promote STS
Skin-to-Skin Contact; more than just a nice thing to do… it’s an evidence- based, best-practice, for improved infant outcomes.