Purpose for the Program
Skin-to-skin cesarean delivery is an innovative way to facilitate the involvement of the family during a cesarean delivery. Just by changing the routine to incorporate immediate skin-to-skin contact there is a potential enhancement of the bonding process for the family and the facilitation of breastfeeding.
To establish a team involved in care during cesarean deliveries for the purpose of the development of a protocol, which includes family input, to institute skin-to-skin care immediately after cesarean deliveries.
Implementation, Outcomes, and Evaluation
The inclusion criteria for skin-to-skin contact candidates were foundational to the protocol development. The families included experienced nonemergent, elective, repeat cesarean deliveries, or cesarean deliveries performed because of a failure to progress/dilate or breech presentation. The infants were greater than 38 weeks of gestation and in no acute distress. Role responsibilities were developed for the neonatal registered nurse, certified registered nurse anesthetist/anesthesiologist, circulating registered nurse, delivering physician, scrub technician, the mother, and the mother's support person. The protocol included a surgical unit that was setup to allow the mother to select music, provided the use of dim lighting, provided extra sterile plastic cord clamp on field, and positioned warmed blankets and an infant cap near the head of the mother's bed. The protocol of family education was to discuss with the mother and her support person one of the following three options: (a) observe the delivery from the moment of uterine incision up to the birth (not for breech deliveries); (b) immediate skin-to-skin contact if the infant is vigorous and stable; and (c) delayed skin-to-skin contact for infants with any situation that would lead to a delay transition. Key elements of skin-to-skin contact after cesarean delivery were open communication with the operating room team and the family throughout the procedure; placing of the infant on the mother's chest if infant is deemed stable; monitoring infant's axillary temperature every 10 minutes; and perform measurements, medications, and footprints when the mother requests them to be done.
Implications for Nursing Practice
Assuring the provision of family-centered care during a cesarean delivery that includes skin-to-skin contact may improve breastfeeding, bonding, and family satisfaction with the birth experience. Continued evaluation is ongoing on these outcome indicators.