BEST PRACTICE

GUIDELINES FOR
MELINA MILLER SKIN-TO-SKIN
CONTACT
FOLLOWING BIRTH
CHAPTER ONE
Background and Purpose
BACKGROUND

Skin-to-skin care immediately after vaginal birth is the optimal

form of care for full-term, healthy infants (Erlandsson, Dsilna, Fagerberg, & Christensson,
2007)

Baby Friendly Guidelines: opportunity to practice Kangaroo

Mother Care as soon as the infant is ready (Baby-Friendly USA, 2016).

Clinicians have begun to have more interest in implementing

SSC following cesarean births (Fredrick, Busen, Engebretson, Hurst, Schneider, 2014)
PURPOSE

To develop best practice guidelines for SSC immediately

following both vaginal and cesarean births
To explore what the most common benefits of SSC are for
mothers, preterm and term babies
If having SSC directly after cesarean sections is as beneficial as
it is when it is implemented after vaginal births
CHAPTER TWO
Synthesis of Evidence
 SKIN-TO-SKIN CONTACT AND MATERNAL
OUTCOMES

Decrease in post-partum hemorrhage (Saxton, Fahy, Rolfe, Skinner, & Hastie, 2015)
Higher odds of breastfeeding (Redshaw, Hennegan, & Kruske, 2014)
Decline in maternal and baby cortisol levels (Neu, Hazel, Robinson, Schmiege, & Laudenslager, 2014)
Decrease in depression and anxiety (Bigelow, Power, MaclellanPeters,Alex, & McDonald, 2012)
Peaceful experience in the OR (Fredrick et al., 2014)
Better birthing experience (Moran-Peters, Zauderer, Goldman, Goldman, Baierlein, & Smith, 2014)
 BENEFITS OF SKIN-TO-SKIN CONTACT FOR
INFANTS

Better breastfeeding performance

Normal abdominal temperatures, lower heart rates, lower
respiratory rates, and higher blood glucose levels (Moore, Anderson, & Bergmen, 2009)

No significant difference in temperature

Higher rooting reflex and sucking reflex (Beiranvand,Valizadeh, Hosseinabadi, & Pournia, 2014)
 BENEFITS OF SKIN-TO-SKIN CONTACT FOR
PRE-TERM INFANTS
More weight gain per day
Greater increase in length and head circumference
Reduction in infection, sepsis, and hypothermia (Conde-Agudelo & Daz-Rossello, 2016)

MRSA decolonization (Filho, Sousa, Sousa Freitas, Lamy, Ferreira Simoes, Moura da Silva, & Barbieri, 2015)
Supported Diagonal Flexion increased communication and vocalization
(Buil, Carchon, Apter, Laborne, Granier, & Devouche, 2016)
THE FATHERS ROLE IN SKIN-TO-SKIN CONTACT

More vocal communication

Reduction in infants crying (Velandia, Uvns-Moberg, & Nissen, 2012)

Infants became calm and drowsy faster (Erlandsson et al., 2007)

HEALTH CARE WORKERS EXPERIENCES WITH
SKIN-TO-SKIN CONTACT
Immediate SSC following Midwives have difficulty
deliveries seldom happens implementing SSC
Difficulty warming the baby Poor collaboration
Interfering with IV lines and cardiac Space limitations
leads Mothers pain
Mothers want baby cleaned first (Zwedberg, Blomquist, & Sigestad, 2013)

Lack of education
(Koopman, Callaghan-Koru, Alaofin, Argani, & Farzin, 2016)
CHAPTER THREE
Best Practice Guideline Recommendations and
Educational Pamphlet
CLASSIFICATIONS FOR PROVIDING SSC FOR BOTH
INFANTS AND MOTHERS

Infants with major healthcare concerns should not engage in

SSC immediately following birth
Infants who have an APGAR score of 7 or above, after 5
minutes of birth, should be considered for early SSC

Article supporting: Saxton et al., 2015

 TIMING OF SSC: HOW SOON AND FOR HOW
LONG

If possible, SSC should be initiated immediately

In the operating room, SSC should be initiated within 15 minutes
SSC should take place for at least 60 minutes
SSC should be continued for the first month of life

Articles supporting: Moore et al., 2007; Fredrick et al., 2014; Redshaw et al., 2014; Bigelow et al., 2012
BENEFITS OF SSC FOR PRETERM INFANTS
(BIRTH AT LESS THAN 37 WEEKS)
Important for weight gain and reduction in infection, sepsis, and
hypothermia
Increase in breastfeeding success
Decrease in cortisol levels following birth
Decolonization of MRSA

Articles supporting: Conde-Agudelo et al., 2016; Neu et al., 2014; Filho et al., 2015
BENEFITS OF SSC FOR TERM INFANTS AND
MOTHERS
Higher success rate of breastfeeding, breastfeeding sooner
Higher scores for their rooting and sucking reflex
Article supporting: Beiranvand et al., 2014;

Decrease in occurrence of postpartum hemorrhage

Reduction in depression and anxiety experienced as mothers
Articles supporting: Saxton et al., 2014; Redshaw et al., 2014
REASONS TO HAVE SSC FOLLOWING CESAREAN
SECTIONS AND INVOLVING THE FATHER
Better birthing experience overall
No risk for developing hypothermia
Article supporting: Moran-Peters et al., 2014; Beiranvand et al., 2014

Help infant reach calm and drowsy state faster

Less likely to cry
Article supporting: Erlandsson et al., 2007; Velandia et al., 2012
HOW TO ACHIEVE SKIN TO SKIN CONTACT

Supported Diagonal Flexion can lead to better communication

between the mother and infant
Supported Diagonal Flexion is sometimes preferred due to comfort
Kangaroo Care is more common
Article supporting: Moran-Peters et al., 2014; Beiranvand et al., 2014
INFORMATION FOR HEALTHCARE PROFESSIONALS
INVOLVED IN SSC PROCESS
Need for educational sessions to help professionals implement SSC
during cesarean and vaginal births
Communication between midwives and professionals should be
established prior to birthing process
Article supporting: Koopman et al., 2016; Zwedberg et al., 2013
CHAPTER FOUR
Implementation and Evaluation
EDUCATIONAL PAMPHLET
Two different populations
Parents coming into the hospital in labor
Nurses form labor and delivery, mom baby, and NICU

Format of pamphlet
Simple language, short sentences
Text coherence, colors, different size texts and fonts
Working memory with pictures and texts
DIFFUSION OF INNOVATIONS
Theorist Everett Rogers
Focuses on how a new
product is implemented
into an existing social
system
5 stages
KNOWLEDGE
Parents
When the parents receive the pamphlet for the first time
Discussing the meaning during childbirth classes
Childbirth educator will be involved
Nurses
Nurse managers will present pamphlet and fact sheet
During morning huddle
PERSUASION
Individual is forming an attitude toward the innovation
Parents and Nurses
Comparing to other practices
Compatible with existing values
Conflicting values
Complexity of pamphlet
Information presented at the right time
Demonstration
DECISIONS
Accepting or rejecting
Parents
Discussions and demonstrations
Childbirth educator will facilitate the
discussion

Nurses
Will this work on the unit
Nurse manager will facilitate the
discussion
IMPLEMENTATION
Putting the information to use
Parents
Take information from educational pamphlet
Engage in SSC with their newborn
Hopefully continued for a few months

Nurses
Assisting parents in SSC
Implementation for extended period
Regular practice
CONFIRMATION
Looking for reinforcement to prevent a state of dissonance
Parents
Consistent information regarding SSC
Combination of pamphlet and childbirth class
Including risks

Nurses
Same information parents received
 KNOWLEDGE CONFIRMATION
PARENTS NURSES
Childbirth class survey Monthly meeting survey
Whether parents learned any new Plan on using the information to
information
educate?
Did it help them decide?
Was the information helpful?
Include pamphlet evaluation
Will they implement SSC?
Hospitalization survey
Comments concerning additional
Only parents that took the childbirth
information or less information
class
Did SSC happen? Will it continue?
STRENGTHS AND LIMITATIONS
Strengths
Thorough review of literature
Information on mothers, fathers, preterm, and term infants
Looking at caesarian section deliveries
Incorporation of risks

Limitations
Lack of research on how to improve SSC in the OR
Lack of high level evidence for OR studies
Primary prevention level
RECOMMENDATIONS FOR THE FUTURE
Research for implementing SSC in the OR
Benefits of SSC on preterm infants
Long-term benefits of SSC
 REFERENCES

Baby-Friendly USA. (2016). Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation. Albany, NY: Baby-Friendly USA.

Beiranvand, S., Valizadeh, F., Hosseinabadi, R., & Pournia, Y. (2014). The effects of skin-to-skin contact on temperature and breastfeeding successfulness in full-term newborns after cesarean delivery.
International Journal of Pediatrics, 1-7. http://dx.doi.org/10.1155/2014/846486

Bigelow, A., Power, M., MacLellanPeters, J., Alex, M., & McDonald, C. (2012). Effect of mother/infant skintoskin contact on postpartum depressive symptoms and maternal physiological stress. Journal of
Obstetric, Gynecologic & Neonatal Nursing, 41(3), 369-382. doi:10.1111/j.1552-6909.2012.01350.x

Buil, A., Carchon, I., Apter, G., Laborne, F. X., Granier, M., & Devouche, E. (2016). Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between
mothers and very preterm infants. Archives de Pediatrie 23(9), 913-920. doi: 10.1016/j.arcped.2016.04.023

Conde-Agudelo, A., & Daz-Rossello, J. L. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 8(2016), 1-153. doi:
10.1002/14651858.CD002771.pub4

Erlandsson, K., Dsilna, A., Fagerberg, I., & Christensson, K. (2007). Skin-to-skin care with the father after caesarian birth and its effect on newborn crying and prefeeding behavior. Birth 34(2), 105-114. doi:
10.1111/j.1523-536X.2007.00162.x

Filho, F. L., Cavalcante de Sousa, S. H., Sousa Freitas, I. J., Lamy, Z. C., Ferreira Simoes, V. M., Moura da Silva, A. A., & Barbieri, M. A. (2015). Effects of maternal skin-to-skin contact on decolonization of
Methicillin-Oxacillin-Resistant Staphylococcus in neonatal intensive care units: A randomized controlled trial. BMC Pregnancy and Childbirth, 15(63). doi:10.1186/s12884-015-0496-1

Fredrick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M., Schneider, K, M. (2014). Exploring the skin-to-skin contact experience during cesarean section. Journal of the American Association of Nurse
Practitioners, 28(2016), 31-38. doi:10.1002/2327- 6924.12229
 REFERENCES CONTINUED

Koopman, I., Callaghan-Koru, J. A., Alaofin, O., Argani, C. H., & Farzin, A. (2016). Early skin to-skin contact for healthy full-term infants after vaginal and caesarean delivery: A qualitative study on
clinician perspectives. Journal of Clinical Nursing, 25(9-10), 1367-1376. doi:10.1111/jocn.13227

Moore, E. R., Anderson, G. C., & Bergmen, N. (2007). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3.
doi:10.1002/14651858.CD003519.pub2

Moran-Peters, J. A., Zauderer, C. R., Goldman, S., Baierlein, J., & Smith, A. E. (2014). A quality improvement project focused on women's perceptions of skin-to-skin contact after cesarean birth.
Nursing for Women's Health, 18(4), 294-303. doi:10.1111/1751-486x.12135

Neu, M., Hazel, N. A., Robinson, J., Schmiege, S. J., & Laudenslager, M. (2014). Effect of holding on co-regulation in preterm infants: A randomized controlled trial. Early Human Development, 90(3),
141-147. doi:10.1016/j.earlhumdev.2014.01.008

Redshaw, M., Hennegan, J., & Kruske, S. (2014). Holding the baby: Early motherinfant contact after childbirth and outcomes. Midwifery, 30(5). doi:10.1016/j.midw.2014.02.003

Saxton, A., Fahy, K., Rolfe, M., Skinner, V., & Hastie, C. (2015). Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study.
Midwifery, 31(11), 1110-1117. doi:10.1016/j.midw.2015.07.008

Velandia, M., Uvns-Moberg, K., & Nissen, E. (2012). Sex differences in newborn interaction with mother or father during skin-to-skin contact after Caesarean section. Acta Paediatrica, 101(4), 360-
367. 10.1111/j.1651-2227.2011.02523.x

Zwedberg, S., Blomquist, J., & Sigestad, E. (2013). Midwives' experiences with motherinfant skin-to-skin contact after a caesarean section: Fighting an uphill battle. Midwifery, 31(1), 215-220.
doi:10.1016/j.midw.2014.08.014