Speaker Info

Mary Ellen Boisvert, RN, MSN, CLC, CCE

Nurse ManagerFamily Centered Unit

Southcoast Hospitals Group – Tobey Hospital

Tobey Hospital

Tobey HospitalWareham, Massachusetts

Community HospitalTobey 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

Topic/BackgroundSkin-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!

ChallengesC-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

How We Did ItSkin-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 newbornRN 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

SKIN TO SKIN ZONE

HIGH SKIN AREA

How We Did ItPutting 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/neckHat and warm blanket over newbornSupport person helps support newbornOB nurse stands nearby to observe and assess

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

Lessons LearnedFocus on what is best for the patient(s)

Evidence based care, best practicePositive feedback from patients and support person

Talk about the change Identify champions

Make small changesBe willing to negotiate as you work towards your goal

Share the successTalk about your outcomes