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Skin-To-Skin is Coming to an OR Near You!!

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That’s right! Initiating skin-to-skin and breastfeeding in the OR after a cesarean section is becoming the standard of care in many places.

Step 4 of the Baby-Friendly Hospital Initiative has helped moved this idea forward. Mothers are loving it! And providers are finding that is easy enough to do.

Step 4:  Help mothers initiate breastfeeding within a half-hour of birth
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

We have known for a long time that holding an infant skin-to-skin immediately after birth improves the physiologic stability for both mother and baby and increases maternal bonding behaviors. It is also the optimal start for breastfeeding. 

The nine instinctive stages of newborn behavior, first described by Anne Marie Widstrom, unfold during the first hour after birth while the infant is in skin-to-skin.

  1. Birth cry - This distinctive cry occurs as the infant’s lungs expand.
  2. Relaxation – Mouthing movements begin and the hands are relaxed.
  3. Awakening – The infant moves his head, opens his eyes, and shows some mouth and shoulder activity. This begins at about 3 minutes after birth.
  4. Activity – Mouthing and sucking movements increase as the rooting reflex becomes more obvious.  Eight minutes after birth.
  5. Resting – Periods of resting are interspersed with activity.
  6. Crawling – The infant approaches the breast with crawling and thrusting movements. Begins about 35 minutes after birth.
  7. Familiarization – The infant begins licking and nuzzling the nipple. Begins at 45 minutes after birth and may last for 20 + minutes.
  8. Suckling – The baby self-attaches to the breast and suckles.
  9.  Sleep – Both mother and baby fall asleep. Usually about 1 ½ to 2 hours after birth.

Interruption of skin-to-skin holding can interfere with the normal progression of the infant through these nine stages. He then has to “start-over” delaying his first attempt at breastfeeding.

I highly recommend the article by Philips for a full discussion of the benefits of skin-to-skin and very practical steps to initiate these procedures in the OR**.

 

References:

Burke-Aaronson AC.  Skin-to-skin care and breastfeeding in the perioperative suite.  MCN Am J Matern Child Nurs. 2015 MarchApr;40(2);105-9.

Grassley JS, Jones J.  Implementing skin-to-skin contact in the operating room following cesarean birth.  Worldviews Evid Based Nurs. 2014 Dec;11(6):414-6.

Hung KJ, Berg O.  Early skin-to-skin after cesarean to improve breastfeeding.  MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24.

** Phillips R.  The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth.  Newborn & Infant Nursing Reviews.  June 2013Volume 13, Issue 2, Pages 67–72

http://www.researchgate.net/publication/257612445_The_Sacred_Hour_Uninterrupted_Skin-to-Skin_Contact_Immediately_After_Birth

Sundin CS, Mazac LB.    Implementing Skin-to-Skin Care in the Operating Room After Cesarean Birth.   MCN Am J Matern Child Nurs. 2015 Jul-Aug;40(4):249-55. 

Widstrom AM,  Aaltomaa-Michalias P, Dahllof A, Lintula M, Nissen E.  Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.  Acta Paediatr 2011.  Jan:100(1): 79-85.

Vergie Hughes has a long history of experience in Maternal Child Health including labor and delivery, post-partum and pediatrics, and for the past 25 years she has been involved in lactation management. Ms. Hughes has a BSN from Pacific Lutheran University and a MS from Georgetown University. She has been a board certified lactation consultant since 1985. At Georgetown University Hospital, she was the director of the Human Milk Bank. She created and developed the National Capitol Lactation Center and the one week Lactation Consultant Training Program. This course has trained more than 4,000 Lactation Consultants since its inception in 1990.


She has been a private practice lactation consultant and business owner, and operated her own lactation center, Washington’s Families First. Lactation Education Resources On-Line is her website, offering training to professionals and information to parents as well. Ms. Hughes has served on the International Board of Lactation Consultant Examiners and has served on the IBLCE exam writing committee. Her first love is teaching and that is exemplified by the creativity of the courses she has developed. A series of courses “The In-patient Breastfeeding Specialist,” "The Out-patient Breastfeeding Specialist” and “The NICU Breastfeeding Specialist” are all designed to advance the lactation management skills of nurses at the bedside. She regularly teaches skills to labor and delivery nurses and just recently developed the course “Towards Exclusive Breastfeeding.”


Ms. Hughes is the program director and content manager for all of the on-line Lactation Education Resources courses. Ms. Hughes was recently honored with a “lifetime achievement award” as Fellow of the International Lactation Consultant Association (FILCA).

Comments

  • UthupLissy Karuvalath
    UthupLissy Karuvalath Wednesday, 26 August 2015

    great topic

  • Guest
    Rebecca Friday, 04 September 2015

    Hoping to see this in our BFHI hospital!!!

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Guest Monday, 20 November 2017