Speaker Info Mary Ellen Boisvert, RN, MSN, CLC, CCE Nurse Manager Family Centered Unit Southcoast Hospitals Group – Tobey Hospital

Tobey Hospital

Tobey Hospital Wareham, Massachusetts Community Hospital Tobey is part of Southcoast Hospitals Group Approximately 500 births/year 3 Labor Rooms, 6 Postpartum Rooms, Normal Newborn Nursery Interesting Fact: 7 CLC and 2 IBCLC RNs work in the FCU Share info regarding percentage of nurses who are CLC/IBCLC as compared to overall number of staff: 35% have certification in lactation and one more scheduled to take the course/exam this spring

Topic/Background Skin-to-Skin During C-sections Placing the unclothed newborn on the bare chest of the mother and covering them with a blanket Newborns are calmer and cry less, have more stable temperatures and glucose levels, more successful with breastfeeding Mom’s have a decreased perception of pain, promotes bonding Skin-to-Skin has been normal practice with vaginal deliveries and in the recovery room after a c-section for many years Summer 2010: Time to move to the next level – skin-to-skin during c-sections!

Challenges C-sections are staffed by circulators and scrub techs from the main OR (not OB staff) Personnel in the OR during c-sections: Patient and support person, OB & assist, anesthesiologist, circulator, scrub tech, 2 OB nurses for newborn care and emotional support of patient & her support person How would the anesthesiologists respond? How would we put this into practice? Maintaining skin-to-skin during transfer from c-section room to recovery Talk about role of OB nurses during c-sections

How We Did It Skin-to-skin is a nursing intervention OB nurses are in the c-section room to provide newborn care OB nurse stays in the OR with the mother and newborn RN champions Support from obstetrician, CNM & pediatrician One anesthesiologist was a champion for skin-to-skin “Let’s make a skin-to-skin zone!” Nurses can do whatever they need to do as long as one of the OB nurses is caring for the newborn while in the c- section room Share info about the champions and their role in our success

SKIN TO SKIN ZONE HIGH SKIN AREA

How We Did It Putting it into practice required teamwork Newborn goes to the warmer for the 1 minute apgar If newborn and mom are both stable, newborn then goes skin-to-skin with mom Mom’s gown is unbuttoned and newborn is unwrapped Placed skin-to-skin across mom’s upper chest/neck Hat and warm blanket over newborn Support person helps support newborn OB nurse stands nearby to observe and assess Share info regarding compromise of the team – waiting for the one minute apgar vs immediately to mom

RN placing newborn skin-to-skin after a c-section

Dad wants to do skin-to-skin too – in the recovery room

What’s Next Our next goal is to maintain “uninterrupted” skin-to- skin during transfer and into the recovery room Talk about wanting to support the Baby’s 9 Instinctive Stages in the first hour – uninterrupted time is important We will have to focus on safe transfer techniques

Lessons Learned Focus on what is best for the patient(s) Evidence based care, best practice Positive feedback from patients and support person Talk about the change Identify champions Make small changes Be willing to negotiate as you work towards your goal Share the success Talk about your outcomes Share some of the most recent patient experiences: Patient with nausea that resolved once skin-to-skin began Mom with previous c-section who “just stared at the ceiling” – this time got to focus on her baby – time went by so quickly Stable babies