Skin to Skin and Breastfeeding

Evidence Based Practice Task 2

WGU

Meredith Clifford RN

April 20, 2018

A1. Healthcare Problem

No one can deny that breastmilk is what’s best for every infant, some calling it the best gift a mother can give to her newborn (Srivatava, Gupta, Bhatnagar, & Dutta, 2014). Breastmilk is full of vital nutrients and the first few days, when all the mother has is colostrum are often the most crucial. Breastmilk is imprinted with everything that infant will need based on age, viruses onboard and different antibodies. This breastmilk helps to develop an infant’s immune system and also helps to battle infection. There has been a decrease in the number of mothers who exclusively breastfeed their infants and we suspect many different reasons for this decline.

A2. Significance of Problem

        Some of the reasons for the decline include an increase rate of cesarean deliveries, lack of education, lack of family support, increase in drug usage, increase of ill mothers, low birth weights and young mothers. As healthcare professionals we have a duty to educate our patients on the best things for them and for their infant and to help them achieve those things. We need to take a look at what are barriers to them and also what we can implement to assist them as much as possible. There is discussion that immediately placing an infant skin-to-skin (SSC) with their mother or their father can increase the breastfeeding rates. Margaret Boyd states that when the birth process stimulates certain hormones that assist the newborn in adapting to extrauterine life. After the acute effects of this surge end, there are stress-related negative consequences that may follow. Skin to skin can help to counteract these negative consequences. There are also hormones known to influence attachment behaviors that may be enhanced by skin to skin contact. Early SSC has also been connected to early initiation of breastfeeding and breastfeeding duration (Boyd, 2017).

A3. Current Practice

Current practice at the facility I work at is to try to get the infant of a vaginal delivery skin to skin with the mother within the first minute of life. Although this is not the practice everywhere. Since transitioning to this practice I have noticed an increase in successful breastfeeding. Although this works sometimes there are barriers to this practice that continue to need improvements. For instance, lack of education. Some mothers and family members don’t understand the significance of immediate skin to skin contact so we as the providers need to ensure that education is provided prior to delivery. Another barrier is when the infant is delivered via cesarean section. As we will see in some of these studies there are places that are implementing policies to work around this barrier.

A4. Impact on Background

        When the infant is whisked away quickly after birth for assessment, measurements etc instead of being allowed the skin-to-skin contact that’s so crucial a lot of people are impacted. The mother/patient for instance could become very frustrated with the situation and even more frustrated if the infant struggles to breastfeed after not getting enough skin-to-skin time. The infant would be impacted as that initial skin-to-skin contact time, followed by early breastfeeding, assist the infant in temperature regulation, decreased crying and cardiorespiratory stability (Guala, et al., 2017). The nurse could be impacted because she needs to comfort the mother and the infant and provide extra resources to allow for breastfeeding assistance since the infant did get the benefits of that initial bonding time with mom.

B. PICO Table

B1. PICO Question

Among new mothers and infants, does immediate skin-to-skin contact increase the rates of successful breastfeeding as compared to no or late skin-to-skin contact?

C1. Keywords

The keywords used in this search were skin to skin contact and breastfeeding duration.

C2. Number and Types of Articles

Of the first 20 articles in my search there were 6 articles, 5 randomized control trials, 3 qualitative studies, 2 cohort studies, 2 cross-sectional studies, 1 literature review and 1 randomized clinical pilot study.

C2A. Research and Non-Research Evidence

In the research article Efficacy of early skin-to-skin contact on the rate of exclusive breastfeeding in term neonates: a randomized control trial the authors set out to research the effects of early skin-to-skin contact on exclusive breastfeeding at 6 weeks of age. Through their study they determined that of the mothers that practiced early skin-to-skin contact the rate of exclusive breastfeeding at 6 weeks was significantly higher than those mothers who did not practice early skin-to-skin contact (Sharma, 2016).

        The research article Skin-to-skin contact in cesarean birth and duration of breastfeeding: a cohort study discussed the relationship between onset and duration of breastfeeding and skin-to-skin contact in the OR with the mother or the father. The researchers studied 252 women who had cesarean sections and determined a direct positive relationship between skin-to-skin contact and exclusive breastfeeding rates (Guala, et al., 2017)

        The first non-research article reviewed was Implementing skin-to-skin contact for cesarean birth where the author talks about how the transition went when this was implemented at their facility. Skin-to-skin contact is important and easier to due during a vaginal delivery than a cesarean section, however no less important during a cesarean section. The goal for implementation was for 15-30 min of skin-to-skin contact and a month after implementation the average skin-to-skin time was 42.5 minutes (Boyd, 2017).