Skin to skin contact (SSC) or kangaroo care occurs when a naked infant or an infant only dressed in a diaper and hat is positioned on the mother’s chest, ideally this will occur immediately following the birth of the newborn. SSC is recommended by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) for babies born at 37 and 0/7 weeks with stable mothers regardless if born by vaginal or cesarean section and the most recent Cochrane review recommends immediate SSC at 35 and 0/7 weeks. The SSC practice has been studied for almost half of a century and is endorsed by the American Academy of Pediatrics, American Heart Association (AHA), American College of Obstetricians and Gynecologists, AWHONN and the Center for Disease Control (CDC) beginning in 2011. SSC does not typically interfere with the routine care needed to be provided for the mother and infant and it is suggested that SSC is continued without disruption for at least 1 full hour or until the baby has its first breastfeed, if applicable. Even with all the recommendations for SSC about one third of births did not finish with immediate skin-to-skin contacts between the newborn and the mother and practice has not changed very much over the last three decades.
SSC is able to be performed following both vaginal and cesarean section births although it is more frequently achieved following the recommended guidelines following a vaginal birth due to different barriers. While SSC following a vaginal birth is fairly commonplace, in 2013 over half of newborns born through uncomplicated cesarean section in US hospitals had SSC within two hours of birth. There are many studies dating back decades studying SSC following vaginal birth and fewer studying SSC following cesarean section births. This thesis aims to bring information of SSC following both vaginal and cesarean section births into one paper as well investigate the reasons some hospitals are not following the recommended guidelines and what healthcare practices can be changed to further the future of SSC in hospitals.
Immediate SSC following birth is not implemented for a variety of reasons. One of the first reasons that come to mind is that SSC is not typically initiated in emergency situations. When the mother is extremely sick, or the baby is having trouble adjusting to extrauterine life, it is not reasonable to have immediate SSC contact. While immediate SSC benefits are important, they are not beneficial when the infant or mother is struggling to continue living. SSC would then be recommended when both the mother and infant are stable. The benefits of SSC are dose related meaning that the mother and baby are still able to have some of the effects of SSC even if the SSC is not immediately following birth. Furthermore, infants who are stable after birth when the mother is not are able to benefit from SSC with the father or other support person of the family.
Attitudes of healthcare workers have a huge impact on the care of the dyad following birth. Without the healthcare workers, namely the nurses, educating on the importance of immediate SSC the families may not realize all the benefits. Healthcare worker attitudes have the ability to not only shape the patient’s care but greatly impact the patient’s education. Koopman et. al (2016) looked at a health professionals’ opinions of immediate SSC in a hospital in the United States. The healthcare professionals include OB nurses, NICU nurses and doctors from both NICU and Labor/Delivery units, all of which were female between the ages 21 and 54. The data was collected on 2014 and was collected from two different interviews with the healthcare professionals about SSC, one about vaginal birth and one about cesarean births. The healthcare professionals were knowledgeable about the benefits of immediate SSC but generally suggested that actual practice was not consistent. Some mothers would receive immediate SSC and some would not, other mothers would also have SSC for longer durations. It was found that it rare to have SSC with a cesarean section birth. These interviews revealed safety concerns for the mother and infants as reasons why SSC would not occur. Furthermore, patient education was another factor that these healthcare providers saw as a barrier to immediate SSC. Some parents think that the infant seems unclean and do not want to hold the naked infant or the mother does not want to breastfeed therefore she feels that SSC is not very beneficial for her.
Another reason that SSC may not occur immediately after birth is that the patient may refuse SSC with her newborn. This can happen because of cultural differences, misinformation or even a lack of education. Birth is an extremely exhausting experience and some mothers may feel that they would not be safe holding their infant so soon after birth, especially if they feel weak. Vittner et al. (2017) looked at the impact of nurses’ influence on SSC perception of the new mother. This study looked at 79 nurses’ responses to a survey regarding education and opinions on SSC. 62% of nurses responded that SSC was managed on their units well but those nurses with higher levels of education (BSN or higher) responded that their units did not manage SSC very well. The nurses were well educated on the benefits of SSC and knew that SSC can decrease the stress response for both the mother and infant but they do not necessarily implement SSC or give education depending the patient’s situation and stabi. Furthermore, Bidlow et. al (2017) developed a study that determined that SSC did not occur immediately after birth because of cesarean section birth and the mother’s choice. This study was hospital in Pennsylvania that had an immediate SSC rate of 53% following all deliveries. This study aimed to increase the education of mothers on SSC to decrease the refusal rate. With education for the mother at arrival onto the labor and delivery unit, the SSC rate increased to 83% and with education of staff the reason of cesarean section birth for not initiating SSC was eliminated. The new reasons for those not having SSC included the mother’s preference, unstable situation and healthcare worker interventions.
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