Transcript Skin-to-skin after cesarean

FAMILY CENTERED CESAREAN BIRTH
Jane Grassley PhD, RN, IBCLC
Judy Jones, MSN, RN, NEA-BC
Skin-to-skin after cesarean
Idaho Perinatal Project Presentation -2014
Introduction
The mission of SLRMC L&D is: “… to provide
exceptional, compassionate, and individualized
patient care to the pregnant women and
families of our region.”
St. Luke’s Health System, 2012
Overview
Our project was to
pilot skin to skin care
for moms and babies
experiencing
scheduled cesarean
births in expectation
that this will
eventually improve
exclusive
breastfeeding rates
Leading Change Framework
J. Skeleton-Green, B. Simpson and J. Scott (2007)
Approach
• J and J approached unit leadership for L&D and
NICU, physician from one group for pilot, and
chief of OB anesthesia
• Key staff were identified from L&D, NICU and a
CRNA from Anesthesia
• JJ presented at OB Supervisory and MD-RN
collaborative
• JG’s senior nursing students were invaluable to
the process
Approach
• Adopted JHNEBP model, consistent with
hospital
• Requires planning, evidence, and translation
• P phase – using PICO approach, identified
practice issues: identify barriers and
facilitators(O) to offering skin to skin care in the
OR for at least 15 minutes (I) to mothers and
newborns after uncomplicated cesarean birth(P)
Approach (cont’d)
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Used the power of simulation
Worked through process
Simulation in the OR itself
Video of simulation once process identified
Pilot to continue up to 3 months and involve
about 40-50 moms from single clinic
experiencing scheduled, uncomplicated cesarean
Approach
• Education of all staff who might participate in
scheduled cesarean from L&D and NICU; one
page summary for CRNAs since unable to attend
• Video simulation provided as adjunct to staff
education
• Pilot ran from January to mid-March, 2013
Education module for employees
•Describes roles of
healthcare providers
•Addresses questions &
concerns
Hug me, I’m cute!
Parent Flyer
Deciding if Skin-to-Skin Contact after a Cesarean Birth is
Right for You and Your Baby
 Skin-to-skin contact means holding your baby on your bare
chest tummy down. This allows time for hugging and bonding
in the operating room. Skin-to-skin can occur as soon as both
the mother and baby are stable.
•Addresses what
skin-to-skin is
 If you want to do skin-to-skin, let your nurse know when you
check in. Feel free to ask questions.
 About 5 minutes after birth, a nurse will bring your baby to
you. The nurse will help you hold your baby across your chest
for around 15 minutes.
What is so good about
hugging your baby skin-to-skin?
•What to expect
•Benefits for
mother and infant
 Calms baby and reduces crying
 Helps keep baby warm
 Helps baby’s blood sugar stay normal
 Steadies baby’s breathing and heart rate
 Bonds mothers and their babies
 Lowers the risk of postpartum blues
 Promotes better breastfeeding
 Helps mothers recover after surgery
P: 208.381.2222
190 East Bannock Street
Boise, Idaho 83712
www.stlukesonline.org
Results
• SSC offered to moms of pilot clinic per criteria
by L&D RN on admission
• If yes, surgical team informed at surgical pause
• Pilot completed at 2 ½ months with 44 families
• Results were compiled by either L&D or NICU
RN completion of the outcomes form.
• 11%(5) declined
• 43%(19) held their infants at least 15 minutes
• 37%(16) held newborns less than 15 minutes
Results (cont’d)
• 9% were unable due to a newborn or maternal
condition – newborn size, stability, nausea
• Short length of surgery contributed to minimal
time for SSC
• 87% of nurses responded that they felt
knowledgeable of process
• Positive patient feedback reinforced the
experience for staff involved
Results (cont’d)
• Parent comments included:
“I wasn’t able to do this with my other 2
Csections”
“It was really nice; my last baby I did not see for
half an hour”
Patient was thrilled; position was comfortable;
baby nestled in neck; Mom stated “baby didn’t mind
at all”
Dads were also enthusiastic although it was
mom that we asked to consent.
Follow up
• Pilot discontinued in mid-March
• Results reported at OB Dept, MD-RN
collaborative, and to CNO
• Letter to physicians offering this well received
approach to patients scheduled for
uncomplicated repeat cesarean
• Hardwiring aided by providing documentation
opportunity in EHR
Implementation Recommendations
1. Evaluate staff knowledge of skin-to-skin.
2. Educate L&D and NICU/Nursery staff who
attend cesarean births. Include physicians’
office to involve their staff with further
information about the skin-to-skin process.
Recommendations (cont.)
3. Encourage physicians/office nurses to educate
patients about skin-to-skin as an option
following cesarean births.
4. Evaluate patient satisfaction with skin-toskin.
Recommendations (cont.)
5. Consider the creation of a policy change to
include skin-to-skin as standard protocol.
6. Encourage documentation of the occurrence of
skin-to-skin following cesarean births.
Recommendations (cont.)
7. Identify RN liaisons, one in L&D and another
in NICU, to address staff and patient/family
questions and concerns about skin-to-skin.
8. Disseminate approach and project results with
delivering hospitals.
Special Thanks to:
• Senior nursing students who drafted our
education, scripted and taped our simulation,
and made this project easy to do!
BOISE STATE UNIVERSITY
SCHOOL OF NURSING
CLASS OF 2012
Samantha Byrnes, Lorinda Coombs, Rachel
Finnell, Patricia Jones, Angelica Kovach,
Jenna Lindsay, Monika Ryan, Shelley
Sinclair, Caitlin Sitz, Caroline Strong,
Caitlyn Uhnak
Special Thank You
•SLRMC L&D
•SLRMC NICU
•Jane Kornfield
•Donna Swirczynski
Thank you!