Purpose for the Program
A significant number of women deliver their infants by cesarean in the operating room (OR). In most hospitals, this number is more than one of every four deliveries. The primary emphasis in cesarean delivery is safety for mother and infant during the surgical procedure. To adhere to the traditional standards of the OR, we have had to limit the number of people in attendance and limit the time mothers spend with their newborns. Our current challenge is to identify ways to adhere to OR standards, keep our patients safe, and still promote bonding, family-centered care, and successful breastfeeding.
Patient feedback as well as current literature inspired us to review our current cesarean delivery practices. Our facility created an interdisciplinary team to explore alternative options and develop a realistic plan that met the needs of patients and staff. Our goal was to increase patient satisfaction and promote comfort, bonding, the family unit, and early breastfeeding initiation.
Implementation, Outcomes, and Evaluation
After successful initiation with vaginal deliveries of a skin-to-skin and early breastfeeding campaign entitled The Golden Hour, we convened an interdisciplinary team to evaluate how we could implement a family-centered care approach for the cesarean delivery experience. The plan included the following three elements: Comfort (iPods in the OR with playlists, dimmed lighting, comfortable positioning); Bonding (adjusting the infant warmer to have a better line of sight for the mother, keeping the stable infant in the OR, and offering skin-to-skin contact); and Family unit (allowing the father to be in the OR for spinal placement during scheduled deliveries and when appropriate allowing two family members in the OR). After an initial small pilot, verbal feedback from patients and healthcare providers suggested that patients were most satisfied when their families remained together and they had the opportunity for skin-to-skin interaction, even for a short time. Anesthesiologists and nurses requested increased nursing staff in the OR to make this experience successful. They also requested the development of specific guidelines to define which patients were candidates for these options.
Implications for Nursing Practice
Patients who deliver by cesarean often have delayed breastfeeding initiation and bonding because they are separated from their infants. As nurses we are in a position to find creative ways to overcome these barriers and help families remain together.