1. Skin-to-skin after cesarean Jane Grassley PhD, RN, IBCLC Judy Jones, MSN, RN, NEA-BC Idaho Perinatal Project Presentation -2014 FAMILY CENTERED CESAREAN BIRTH

2. Introduction The mission of SLRMC L&D is: “… to provide exceptional, compassionate, and individualized patient care to the pregnant women and families of our region.” St. Luke’s Health System, 2012

3. Overview Our project was to pilot skin to skin care for moms and babies experiencing scheduled cesarean births in expectation that this will eventually improve exclusive breastfeeding rates

5. Leading Change Framework J. Skeleton-Green, B. Simpson and J. Scott (2007)

6. Approach J and J approached unit leadership for L&D and NICU, physician from one group for pilot, and chief of OB anesthesia Key staff were identified from L&D, NICU and a CRNA from Anesthesia JJ presented at OB Supervisory and MD-RN collaborative JG’s senior nursing students were invaluable to the process

7. Approach Adopted JHNEBP model, consistent with hospital Requires planning, evidence, and translation P phase – using PICO approach, identified practice issues: identify barriers and facilitators(O) to offering skin to skin care in the OR for at least 15 minutes (I) to mothers and newborns after uncomplicated cesarean birth(P)

8. Approach (cont’d) Used the power of simulation Worked through process Simulation in the OR itself Video of simulation once process identified Pilot to continue up to 3 months and involve about 40-50 moms from single clinic experiencing scheduled, uncomplicated cesarean

9. Approach Education of all staff who might participate in scheduled cesarean from L&D and NICU; one page summary for CRNAs since unable to attend Video simulation provided as adjunct to staff education Pilot ran from January to mid-March, 2013

10. Education module for employees Describes roles of healthcare providers Addresses questions & concerns

11. Parent Flyer Addresses what skin-to-skin is What to expect Benefits for mother and infant

12. Results SSC offered to moms of pilot clinic per criteria by L&D RN on admission If yes, surgical team informed at surgical pause Pilot completed at 2 ½ months with 44 families Results were compiled by either L&D or NICU RN completion of the outcomes form. 11%(5) declined 43%(19) held their infants at least 15 minutes 37%(16) held newborns less than 15 minutes

13. Results (cont’d) 9% were unable due to a newborn or maternal condition – newborn size, stability, nausea Short length of surgery contributed to minimal time for SSC 87% of nurses responded that they felt knowledgeable of process Positive patient feedback reinforced the experience for staff involved

14. Results (cont’d) Parent comments included: “I wasn’t able to do this with my other 2 Csections” “It was really nice; my last baby I did not see for half an hour” Patient was thrilled; position was comfortable; baby nestled in neck; Mom stated “baby didn’t mind at all” Dads were also enthusiastic although it was mom that we asked to consent.

15. Follow up Pilot discontinued in mid-March Results reported at OB Dept, MD-RN collaborative, and to CNO Letter to physicians offering this well received approach to patients scheduled for uncomplicated repeat cesarean Hardwiring aided by providing documentation opportunity in EHR

16. Implementation Recommendations 1. Evaluate staff knowledge of skin-to-skin. 2. Educate L&D and NICU/Nursery staff who attend cesarean births. Include physicians’ office to involve their staff with further information about the skin-to-skin process.

17. 3. Encourage physicians/office nurses to educate patients about skin-to-skin as an option following cesarean births. 4. Evaluate patient satisfaction with skin-to- skin. Recommendations (cont.)

18. 5.Consider the creation of a policy change to include skin-to-skin as standard protocol. 6.Encourage documentation of the occurrence of skin-to-skin following cesarean births.

19. Recommendations (cont.) 7. Identify RN liaisons, one in L&D and another in NICU, to address staff and patient/family questions and concerns about skin-to-skin. 8. Disseminate approach and project results with delivering hospitals.

20. Special Thanks to: Senior nursing students who drafted our education, scripted and taped our simulation, and made this project easy to do! BOISE STATE UNIVERSITY SCHOOL OF NURSING CLASS OF 2012 Samantha Byrnes, Lorinda Coombs, Rachel Finnell, Patricia Jones, Angelica Kovach, Jenna Lindsay, Monika Ryan, Shelley Sinclair, Caitlin Sitz, Caroline Strong, Caitlyn Uhnak

21. Special Thank You SLRMC L&D SLRMC NICU Jane Kornfield Donna Swirczynski

22. Thank you!