Purpose for the Program
The Professional Practice Committee hypothesized that we could improve postpartum wellborn baby care by switching from sponge bathing to immersion bathing. A research review revealed evidence supporting the theory that immersion bathing improved temperature stability, bonding, breastfeeding, and parental education. The current practice in the Providence Alaska Medical Center Maternity Center is to perform sponge bathing under a radiant warmer on newborns within 2 hours of birth in the absence of birth stress or trauma. Parental involvement is minimal because of decreased mobility from anesthesia, exhaustion, and environmental or social distractions during the immediate postpartum period. Nurses also reported that breastfeeding and skin-to-skin bonding time often was interrupted to complete baths in the allotted 2-hour recovery time.
The Professional Practice Committee proposed a policy and procedural change to immersion bathing founded on evidence-based research, which incorporated these key principles:
- Delay infant baths 2 to 4 hours to establish thermoregulation and decrease negative side effects of hypothermia, including increased oxygen consumption, respiratory distress, and hypoglycemia.
- Stable temperature defined as 97.7°F to 99.5°F for 2 to 4 hours.
- Tub bathing appears to be more effective than sponge bathing at maintaining body temperature and preventing temperature loss. Also, studies showed there is no difference in umbilical cord infection and healing rates and infants appeared more relaxed and less agitated during tub baths.
- Infants at risk of transmission of hepatitis B and human immunodeficiency virus from maternal sources will be bathed within 2 hours of birth.
Implementation, Outcomes, and Evaluation
The Professional Practice Council presented their research and findings to the Nursery Committee and received permission to proceed with a practice change. Currently, the Professional Practice Council is developing a training video, policy, and care competency. These tools will be presented to the staff at regularly scheduled staff meetings. Hands-on training of nurses and techs will be conducted to assure comfort and competency in practice. The goals for this project are consistent immersion bathing per guidelines, increased infant relaxation, increased parental involvement and education covering proper positioning, temperature regulation, and signs and symptoms of infant distress.
Implications for Nursing Practice
Increased parental involvement in newborn care results in greater uninterrupted bonding time, improved breastfeeding, extended skin-to-skin contact in the postpartum period, as well as improved neonatal outcomes from decreased cold stress and calmer stabilization.