Implementing Skin to Skin Contact Routine Practice following Birth By Margaret O’Leary C.M.S. Lactation & Margaret Hynes C.M.S. Lactation

Baby Friendly Hospital Initiative (BFHI) Launched in 1991 by WHO/UNICEF Aim – to counteract worldwide decline in breastfeeding BFHI is Mother / Baby Friendly Global Initiative Health Promoting

Baby Friendly Hospital Initiative (B.F.H.I)  Cert of commitment  Full Award -2004

 Baby dried & wrapped in blanket  Held by parents or  Put in incubator within mother’s view  Generally feeding established in postnatal ward Common Practice Prior to B.F.H.I.

Implementing Change  Change in practice and routine  Policies to ensure sustainability

Why Skin to Skin ? Reduces by 74% the production of stress hormones in baby which aids digestion & reduces incidence of hypoglycaemia. Calms baby. Regulates baby’s heart beat & breathing. Maintains core body tempeture in baby. Helps establish & sustain breastfeeding. Promotes close mother/baby relationship.

Practice/Routine  Staff education –Training –Video –Written information –Photographs  Parent education –Antenatal classes –Skills workshop –Private & public antenatal clinic –Written information

Hospital Policies  Hospital Clinical Guideline on management of breastfeeding & lactation “Within half an hour of birth all mothers regardless of feeding choice will be given their baby to hold with skin to skin contact for at least 30 minutes”  Hospital policy for mothers  Hypoglycaemia policy  Regional Breastfeeding Policy

Obstacles  Large number of staff  Turnover of patients in labour ward – “too busy”  Old habits die hard  Consistency in recording in maternity notes – incidence, duration and reason for discontinuing

Overcoming Obstacles  Parentcraft team  Role of the Clinical Midwifery Specialist (CMS)  Additional education time at antenatal clinic  Informing mothers antenatally  Key people from each area in Hospital Baby Friendly Hospital Initiative Committee  Providing research based articles on importance of skin to skin

Initial B.F.H.I assessment for full award was June 2004  78% of mothers met the criteria (Minimum requirement is 80%)

What can we do to improve?  “Never give up”  Recommence on postnatal wards  Following infant’s first bath  Co-operation of postnatal & neonatal ward staff  Checking charts for documentation  Feeding back at ward report time  Care attendants

What’s beneficial to achieve & maintain practice  Rooming in  No “well baby” nurseries  Supportive staff in all areas  Safety rails on beds in postnatal wards  Infant bathing at bedside  Feedback to staff of positive comments from mothers

Baby Friendly Award Audit of Practice February 2005 Questionnaires To 120 women (+ 36 weeks gestation) To 100 mothers (Day 2 Postnatal)

Results Antenatal Questionnaire  84% returned What is skin to skin contact?  93% knew Others  Thoughts linked with breastfeeding and childbirth – more vague

Mother’s perception When will skin to skin contact be initiated?  94% immediately or shortly after birth Others  Perceived it would happen with breastfeeding Why?  Bonding-79%  Antibody/Immune system-23%  Comfort/Safety-9%  Breastfeeding-6%  Temperature control-4%  Heart rate-4%

Postnatal Questionnaires Results  70 out of 100 replied  68 of these received skin to skin contact  100% -positive feedback from this group When?  81%-immediately after birth  22%-on admission to ward  16%-following bath

What did mothers say? - good for mother  84%-Bonding/sense of comforting/liked baby next to them  16%-Sense of relief!  Many individual positive comments

What did mothers say? - good for baby  56%-Relaxing, soothing, reassuring, security, happy, calm, comfort  53%-Bonding, including smell, heart rate, sight of mother  24%-Warmth (  temperature)  2%-Sleep  2%-Make baby alert

Individual Comments “It reassured me baby was ok” “Made me feel like a mother” “Just amazing, no words can describe it” “I found the experience very rejuvenating” “ A complete high” “The feeling of bonding was very natural”

Individual Comments “Made the arrival of the baby more real” “Breastfeeding started quicker” “Reassurance that I was able to calm baby” “Lovely to let him and I bond and be quiet together” “ Calmed baby after birth” “Very relaxing and great for bonding”