Introduction
According to the World Health Organization and the United Nations International Children’s Emergency Fund, skin-to-skin contact (SSC) between mothers and newborns should be established as soon as possible after the child is born (Stevens, Schmied, Burns, & Dahlen, 2014). SSC can be defined as “placing a naked infant onto the bare chest of the mother” (Stevens et al., 2014, p. 456). Employing this technique within one hour after birth is considered to have some benefits for a baby.
The most significant include maintaining the infant’s thermoregulation, reducing jaundice risk, reducing the stress of birth, and stimulating lengthier and more successful breastfeeding (Stevens et al., 2014). Thus, the current change project addresses practical issues related to the effect of SSC within the first 10 minutes to one hour of birth instead of placing the newborn in a radiant warmer after delivery. The scope of practice significant to the project is that newborns are separated from their mothers instead of being immediately placed naked on their mother’s chest (SSC) for thermoregulation and to encourage breastfeeding. Thus, education is needed concerning the benefits of SSC in promoting breastfeeding.
Change Model Overview
One of the appropriate models for change in evidence-based practice is the ACE Star Model, also known as the model of knowledge transformation, developed by Kathleen Stevens (White & Dudley-Brown, 2012). The model includes five stages: knowledge discovery, evidence summary, translation into practice, integration into practice, and evaluation (White & Dudley-Brown, 2012). It is a perfect model for evidence-based practice change because it includes the translation of knowledge from discovery into practice in the following evaluation.
Defining the Scope of the EBP
The practice issue identified for this change project is as follows. Babies are frequently placed in a radiant warmer after delivery and then assessed, weighed, foot-printed and medicated, then wrapped in a blanket and given to the mother without skin-to-skin contact to promote breastfeeding. This happens due to a lack of knowledge concerning the benefits of skin-to-skin contact. In my facility, more than half of all deliveries follow a practice that demands placing healthy newborns in radiant warmers after delivery instead of immediately placing them on their mother’s chest, promoting skin-to-skin contact for thermoregulation and stimulation of breastfeeding.
Early separation of newborns from their mothers is a problem, and a lack of SSC can negatively influence thermoregulation and the future duration of breastfeeding. The significant question for evidence-based practice to answer during the change project implementation is: What is the effect of skin-to-skin contact within the first 10 minutes to one hour of birth? On a broader range in the field of health care, the issue of early SSC can be meaningful in problems involving nutrition and the related problem of obesity.
Stakeholders
The stakeholders involved in the project will form a team of seven members. I will fulfill the duties of team leader. Other members of the project team are a gynecologist, an obstetrician-gynecologist, a pediatrician, a charge nurse, a nurse, and a visiting nurse.
Determining Responsibilities of Team Members
Every team member has a definite scope of responsibilities. For example, as the leader of the team, I will guide the project. A gynecologist will control the condition of the pregnant women before and after delivery. An obstetrician-gynecologist will be in charge of the delivery process, vaginal or caesarean section. A pediatrician will provide assessment of the newborn babies and give recommendations on care.
A charge nurse will control and organize care for women and their newborns, and a nurse will provide care for women and infants with a focus on successful breastfeeding. A visiting nurse will help to assess the organization of breastfeeding and the babies’ condition after they are discharged. All those activities are significant in allowing the project to provide a valid assessment of the impact of early SSC on successful breastfeeding.
Evidence
Summarizing the Evidence
Moore, Bergman, Anderson, and Medley (2016) conducted a systematic review of impacts that early SSC has on mothers and their healthy newborn infants. The practice problem in the review concentrates on the separation of mothers and newborns immediately after birth in hospitals. The authors claim that routine care for babies post birth is to separate them from mothers by placing the babies in radiant warmers and swaddling them in blankets before the newborns are given to mothers.
The review investigated 46 randomized studies involving 3,850 mother–newborn couples, and 38 studies with 3,472 infants and mothers were selected for further analysis (Moore et. al., 2016). Moore et al. (2016) aimed to reveal the effects of skin-to-skin contact and how it stimulates the autonomic nervous system through thermoregulation in supporting bonding, as well as promoting breastfeeding. The review compares babies placed prone on their mother’s chest to blanket-swaddled babies or those placed in a radiant warmer. Early SSC is significant not only for babies born by means of vaginal delivery.
Stevens et al. (2014) reviewed the literature on the implementation of immediate or early SSC after caesarean section. The authors came to the conclusion that their review provided some evidence of a possibility for SSC implementation during caesarean surgery. Moreover, there is evidence that immediate or early SSC following a caesarean section can be favorable to initiating breastfeeding (Stevens et al., 2014). In addition, early or immediate SSC can “decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress” (Stevens et al., 2014, p. 456).
Beiranvand, Valizadeh, Hosseinabadi, and Pournia (2014) also provided evidence of the effects of SSC after caesarean delivery on temperature and success of breastfeeding. Thus, the authors concluded that “skin-to-skin contact between mother and infant after delivering via cesarean section did not cause a drop in infants’ temperatures and that it was effective in their breastfeeding successfulness” (Beiranvand et al., 2014, p. 4).
Research by Aghdas, Talat, and Sepideh (2014) also contributed to evidence supporting the influence of immediate and continuous mother–infant SSC on the self-efficiency of breastfeeding by primiparous women. For example, their findings showed that for those mothers who had immediate SSC, the successful breastfeeding initiation rate was 56.6% compared to those mothers who did not have early SSC (Aghdas et al., 2014). Further supporting evidence undergirding the significance of early SSC following normal delivery for incidence of hypothermia in neonates is suggested by Nimbalkar et al. (2014).
Their findings revealed that newborns who experienced early SSC could achieve thermal control faster than those who were separated from their mothers. Moreover, early SSC reduces the incidence of hypothermia within the first two days of life (Nimbalkar et al., 2014). Thus, the major strength of the research studies is that they provide evidence of the importance of early or immediate SSC between a mother and an infant for thermoregulation and successful breastfeeding.
Developing Recommendations for Change Based on Evidence
The recommendations based on the research include the following interventions.
- Providing skin-to-skin contact is strongly recommended for mothers and infants immediately after birth in the case of vaginal or caesarean delivery of healthy babies at term.
- It is important to support skin-to-skin initiation immediately after birth to regulate the baby’s temperature.
- Necessary assessments and routine procedures can be provided without interrupting SSC.
- It is significant to facilitate continuous skin-to-skin contact through the first breastfeeding.
- In case the mother’s condition does not allow SSC, it should be encouraged with other caregivers.
- It is necessary to educate all prospective mothers about the health benefits of breastfeeding as well as the risks associated with formula.
- It is advisable to encourage the mother to room in with her infant while in the hospital and to encourage feeding on cue demand.
- Exclusive breastfeeding for the first six months is recommended.
Translation to Practice
Action Plan
The implementation plan for the change project will include the following steps. First, it is necessary to present the project objectives to the stakeholders. Another important action will include nursing education and improvement of practical skills appropriate for the organization of early SSC and further successful breastfeeding. One more significant step for the project is patient education, including informing women of the importance of immediate SSC for breastfeeding and an infant’s wellbeing and teaching them foundations of baby care and breastfeeding.
The timeline for plan implementation is two months, which includes two to three weeks of nursing training followed by the implementation itself. Finally, after the implementation of the change project, it will be important to evaluate the outcomes and report the results. The evaluation plan will include a survey-based research of breastfeeding organizational success and quantitative research on infants’ outcomes based on medical records. The evaluation of breastfeeding success can be executed at least after six months after birth.
Process, Outcomes Evaluation, and Reporting
The desired outcomes of the change implementation include an increase in successful breastfeeding rates and improvement in the general condition of infants related to thermoregulation due to early or immediate SSC. Results will be measured through a survey-based study of breastfeeding organization success and quantitative research into infants’ outcomes based on the medical records of hospitals. The findings will be reported to the stakeholders in the form of a report and accompanying presentation. Moreover, the results can be published on the web page of the project.
Identifying Next Steps
On a larger scale, the findings of the project can be included as a component in nursing and patient education. Despite their validity, the results of the project are not applicable to other units and the facility as a whole because of its specific connection to the maternity department. To ensure the permanent character of the project’s implementation, both nursing and patient education interventions should be provided on a regular basis to make them aware of the significance of early SSC.
Disseminating Findings
The findings obtained during the implementation of the change project can be disseminated both internally, among colleagues, and externally, outside the organization. For internal distribution of findings, the presentation of the project findings can be used. Distributing the findings externally can involve publishing in specialized journals and presenting at conferences or workshops dedicated to the issue of breastfeeding and related problems.
Conclusion
On the whole, the suggested change model contributes to a solution to the identified problem. One key aspect of the problem is the negative impact of an early separation of a mother and her infant compared to immediate SSC. The change model provides the discovery of knowledge, summary of evidence proving the importance of early or immediate SSC and its positive influence, ideas for translation into practice, a plan for integration into practice, and ideas for evaluation of the project.
References
Aghdas, K., Talat, K., & Sepideh, B. (2014). Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial. Women and Birth, 27(1), 37-40. Web.
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, 2014. Web.
Moore, E., Bergman, N., Anderson, G., & Medley, N. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. Web.
Nimbalkar, S., Patel, V., Patel, D., Nimbalkar, A., Sethi, A., & Phatak, A. (2014). Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology, 34(5), 364-368. Web.
Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. Maternal & Child Nutrition, 10(4), 456-473. Web.
White, K.M., & Dudley-Brown, S. (2012). Translation of evidence into nursing and health care practice. New York, NY: Springer Publishing Company.