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

2. Tobey Hospital

3. 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

4. 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!

5. 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

6. 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

7. SKIN TO SKIN
ZONE
HIGH SKIN
AREA

8. 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

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

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

11. 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

12. 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