/
Skin to Skin in the OR: Implementing a Deeper Path to  Family Centered Care Skin to Skin in the OR: Implementing a Deeper Path to  Family Centered Care

Skin to Skin in the OR: Implementing a Deeper Path to Family Centered Care - PowerPoint Presentation

celsa-spraggs
celsa-spraggs . @celsa-spraggs
Follow
346 views
Uploaded On 2019-10-31

Skin to Skin in the OR: Implementing a Deeper Path to Family Centered Care - PPT Presentation

Skin to Skin in the OR Implementing a Deeper Path to Family Centered Care Anne Faust RN MSN IBCLC RNCOB CEFM I have no conflicts of interest or relevant financial relationships At the conclusion of this presentation the participants will be able to ID: 761547

sts skin birth infant skin sts infant birth mother breastfeeding amp contact cesarean nursery 2011 newborn baby review care

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Skin to Skin in the OR: Implementing a D..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Skin to Skin in the OR: Implementing a Deeper Path to Family Centered Care Anne Faust RN, MSN, IBCLC, RNC-OB, C-EFM

I have no conflicts of interest or relevant financial relationships

At the conclusion of this presentation, the participants will be able to: Define skin-to-skin and its impact for the mother-baby dyad Understand the term thermal synchronyLearn how to be an advocate for skin-to-skin Verbalize the process to develop, promote and implement skin-to-skin after a cesarean birth Objectives

Skin to skin contact, first called “Kangaroo Care” describes the placement of a naked infant , occasionally with a diaper or hat on, directly on the mothers bare skin over the greater part of his/her body, with the exposed side/back of the infant covered by blankets and towels. (UNICEF, 2011) What is Skin to Skin (STS)

Skin to Skin contact promotes maternal attachment behaviors Oxytocin – “Love hormone” STS is not a new concept!Multiples studies in the 1970-1980Mothers kissed and looked at their babies more – amazing! KEY : Any STS time is beneficial!! Skin-to-skin: Why?

Maintains newborn thermoregulation Stabilizes blood glucose levels Decreases the risk of jaundiceReduces the stress of birthEncourages bonding between the mother and newbornEncourages longer duration of breastfeeding Benefits of STS: Newborn (Stevens et al ., 2014)

Temperature of mother’s chest will:Increase by 2 degrees Celsius if baby is too coolDecrease by 1 degree Celsius if baby is too warm(Matthiesen et al , 2001) Thermal Synchrony What if Mom is not available? – Try Dad!

Reduced risk of postpartum depression Increased milk production Faster recovery after birthPromotes physiological well-being Benefits of STS: Mother (Smith et al., 2008)

Infant Cries less; a shorter birth cry period Better temperature stabilizationHigher blood glucoseInitiates an innate reflex to breastfeedInduces calmness and relaxation Clinical and Psychosocial Benefits of Immediate STS after birth Mother Can have a calming effect following a traumatic delivery; can distract from remaining surgery Increases maternal/infant bonding Increased maternal satisfaction/confidence in birth experience Reduced anxiety regarding infant safety Improved trust/satisfaction with nurses (Hung & Berg, 2011; Zauderer & Goldman, 2012)

Early STS contact has a positive effect on the success of the first breastfeeding as well as breastfeeding status on PPD 3, at 1 to 4 months and total breastfeeding duration STS: Requires minimal financial resourcesNot associated with adverse effects among healthy infantsShows an overall positive effect on breastfeeding Appears to improve newborn stabilization during transition Vital Facts about STS (Moore et al., 2007; Hung & Berg, 2011) “How quickly the post-birth time went by (when I was being cleaned out and stitched up, presumably) because my baby was on my chest, I didn't have any concept of anything other than him. It just took me to another place.” ~KM

Dr. Nils Bergman, co-creator of “kangaroo mother care” defines and details the value of SSC – (http://www.skintoskincontact.com/ssc-place.aspx, retrieved September 2015)Skin-to-Contact is a “ Place” “Skin-to-skin contact is a “place” – a place where care is provided. Our care does not change – it is a place where any care we give works with our biology”

Birth Cry – cry immediately after birth Relaxation – resting, no activityAwakening – begins to make small movements of head and shouldersActivity – starts rooting and pushing of limbsCrawling – starts moving on the mothers chestResting – resting, may move mouth and suck hands Familiarization – licking, nipple and areola Suckling – suckling at the breast Sleeping – resting, with eyes closed Nine Instinctive Newborn Behaviors (Adapted from Crenshaw et al ., (2012) and Widstrom et al ., (2011)

As a Baby Friendly hospital and in alignment with our core values, vision and system wide strategic goals, we seek to promote healthiest communities through compassionate care as evidenced by providing STS in the OR (for non-emergent cesarean deliveries) to enable: Improved neonatal transition to the extra uterine environment Improved breastfeeding successIncreased maternal satisfaction with birth experienceBaby Friendly USA suggests that STS contact should be provided to every healthy mother and infant immediately after birth or as soon as possible during the first hour of birth I needed a project to promote to a clinical nurse III – as an L & D nurse and an IBCLC, it was a perfect fit! We already provided STS for our vaginal deliveries so consistently, why NOT the OR too? Why Skin to Skin (STS) in the OR?

Literature suggests that women who undergo cesarean section have : Less satisfactory childbirth experiences than those who deliver vaginallyMore prone to postnatal depressionBonding difficultiesUnsuccessful breastfeedingCesarean Birth (Smith et al., 2008)

“While couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having a cesarean.”Professor & OB/GYN, Nicholas FiskLondon, England (Smith et al., 2008)

The first video is intended to stretch our brains and help us think about the possibilities. The second is more representative of what we can begin to implement right away. http://www.youtube.com/watch?feature=player_embedded&v=m5RIcaK98Yghttp://www.youtube.com/watch?v=OR7uE4wu9dw

Out of the 1,208 births that occurred at a south Orange County Hospital in 2011, 27.1% were born via cesarean section. That means that at least 326 Mothers were not able to hold their newborn until approximately 60 minutes or more after their birth.Who does this current practice impact?

Where We Were… Standard Care Routines include: Infant delivered by OB, cord clamped/cut Infant handed to NICU MD – to radiant warmer Infant dried VS taken and initial assessment done ID bands applied, footprints taken (FOB encouraged to visit warmer, take pictures) (approx 7-10 minutes later) Infant swaddled, given to mother for bonding (< 5 min) Infant back to Nursery RN Nursery RN with FOB take infant to PACU via isolette for weighing, measuring - Infant bath delayed until MOB able to provide STS (per LD RN approval – ensuring MOB stable for STS) (approx) 30-60 minutes after birth

Educate Mother and Support Person of STS benefits and desire to participate in STS in ORPre-operatively (1-2 days prior to surgery)Day of Delivery by Circulating RNIf MOB requests STS in OR, LD RN informs Nursery RN, Anesthesia, OB, NICU MDLD circulator ensures IV, B/P, pulse ox are on the same arm – to allow for one free arm to hold, touch infant while STSLD circulator ensures OR and PACU temp ≥ 72 ˚ In OR prior to delivery: Nursery RN ensures spatial set-up behind curtain is adequate to provide STS procedure (blue drape is hung below the mother’s breasts – allowing space for infant to lie transverse – across the mothers’ upper chest) Ensures the mothers’ gown is unbuttoned (but not exposed) awaiting STS - Plan: Family Centered Cesarean Birth

Plan, cont’d…. Infant delivered by OB, cord clamped/cut – infant transferred to warmer for assessment by NICU MD. ID bands/diaper applied by Nursery RN Perform “ infant time out .” Confirm with surgeon, anesthesia and NICU MD that infant status is stable and mother still desires STS before placing infant in mom’s arms. Nursery RN transfers infant from warmer to mother (right side) Infant placed transverse across mother’s bare chest with baby’s face towards mother’s right side NURSERY RN to monitor infant at all times! Nursery RN covers infant back with 3 warm blankets If possible, move infant to midline position (between mother’s breasts) Infant remains STS (midline position) with mother until surgery is complete

Maybe even this could happen….

When surgery is complete, infant remains STS while MOB is transferred from OR to PACU via LIFTER with nursery RN and circulator RN at patient side. In PACU, Nursery RN ensures PACU temp is ≥ 72 ˚ and provides thorough newborn assessment after the first breastfeeding. Administration of newborn medications (per parents consent) with weighing, measuring and infant footprints can be provided while STS. Plan cont’d… Plan adapted from Hung & Berg, 2011

The Nursery RN is responsible for infant at all times The Circulating RN is responsible for the mother at all times This process is designed for the healthy mother and newborn and for a routine, non-emergent cesarean which can change at anytime!No guarantees that STS will occur, but with OR team, OB, LD RN approval (“infant time out”) performed – STS can be successful!Always rely on your clinical judgment regarding the safety of implementing STS Things to Consider…

How Did We Do it? Develop an evidence-based quality improvement program (STS in the OR) Present project to MDT (Multi-Disciplinary Team) meeting Design staff pre-survey with project outline – send out via Survey Monkey Gain insight on thoughts, concerns and barriers to successful implementation – determine from input RN and MD champions ( who are they?) Present survey results to MDT team Develop STS in OR Simulation – for staff feedback of process Develop STS in Labor and Delivery Operating Room Procedure Update Breastfeeding policy to include STS in OR component Develop a pilot study - 10 cases Post- survey from each case, from each participant (Patient, RN’s, MD’s – anesthesia, obstetrician, scrub tech)

Develop staff SLM – STS in the OR. To include: Watch DVD “Skin-to-Skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth” – 15 minutes Review of STS in OR Procedure/Breastfeeding Policy revisionReview STS in the Operating Room Algorithm Review STS Documentation – on admission and delivery record (for compliance and data collection) Review STS in the OR “Key Points” handout gleened from Dr. Raylene Phillips STS presentation Complete STS in OR post test Review Patient Education Materials Begin Pilot study – 10 cases – tabulate results Begin Implementation of STS in OR process Track STS in the OR cases – monthly Tabulate changes/increase of exclusive breastfeeding rates for a 6 month period Present results to MDT team – present at a local conference! How did we do it cont’d…

Skin to Skin in the OR Staff Education Module

Staff Education Checklist Skin to Skin in Labor and Delivery Operating Room Staff Education Competency Checklist   ⃝ Watch DVD “Skin to Skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth” – 15 minutes ⃝ Review Skin-to-Skin in Labor and Delivery Operating Room Procedure ⃝ Review Skin to Skin in the Operating Room Algorithm (For Term Well-Newborn Infants) ⃝ Watch DVD of Dr. Phillips Presentation (initially presented in person on 4/22/14) for content specific to the purpose and practice behind Skin to Skin for the mother-infant dyad. If you attended the original presentation on 4/22/14, please initial the attached attendance sheet confirming your understanding of the content presented. The slides provided during the presentation are provided here for your review if needed. ⃝ Review Skin-to-Skin Documentation : On admission and on Delivery Record ⃝ Review Skin to Skin in the OR:“Key Points” handout gleened from Dr. Phillips presentation evaluations ⃝ Complete Skin-to-Skin in the OR: Post Test and return in envelope at Charge Nurse Desk ⃝ Review Patient Education Materials My signature below states that I have completed the requirements of the Skin-to-Skin in the Labor and Delivery Operating Room: Staff Education Competency Checklist and confirm that I will support and provide to patients, when applicable the procedure of skin-to-skin in the operating room. Print Name: _________________________ Signature : ___________________________________ Date: ______________

Suggestions /Lessons Learned Implement a STS task force/committee that includes all members of the medical team including: OB/GYN Nursery RN LD RN Anesthesia NICU MD APN/Educator Nurse Manager (LD & OB) Staff survey (both LD and Nursery RN) should be conducted to assess ideas/concerns/barriers and potential solutions to implementation - During this survey, various nurse champions can be determined to sit on task force Initiate a pilot study with all task force members present to determine best process for implementation, including a simulation in the OR Patient STS surveys can be distributed to all patients who practiced STS to elicit information regarding thier experience and measure outcomes (i.e. breastfeeding rates and patient satisfaction)

Questions asked: Do you practice STS in the OR? If so, how long?Who is responsible for baby when STS?What does anesthesia think of this process? (supportive, were they part of the STS task force/committee at the hospital?)Do you have a written policy/procedure/standard of care for STS in the OR?Do you advertise to the community that you promote STS in the OR? Who is providing STS in OC? Hospitals in OC who currently practice STS : Hoag YES - Anaheim Memorial NO - St. Joseph NO Saddleback NO - Fountain Valley NO - St. Jude NO OCMMC NO - Los Alamitos NO - UCI NO Mission Hospital

The benefits of keeping moms and babies together are so impressive that many professional organizations have made recommendations promoting immediate skin-to-skin contact and rooming in and opposing routine separation of mothers and babies after birth. The Academy of Breastfeeding Medicine (2003) American Academy of Pediatrics (AAP Expert Workgroup on Breastfeeding, 2005) American College of Obstetricians and Gynecologists (ACOG Committee on Health Care for Underserved Women & Committee on Obstetric Practice, 2007) Association of Women's Health, Obstetric and Neonatal Nurses (2000) International Lactation Consultant Association (1999) World Health Organization (1998) National Association of Neonatal Nurses (NANN) The Joint Commission (2011) Who Cares about STS?

AAP/ NRP and STS “A baby who is breathing or crying, has good muscle tone, and a heart rate over 100 bpm should go to the mother (with mother’s permission) for skin-to-skin contact (preferred), routine care, and continued evaluation.”

The experience of cesarean birth can be frightening or stressful to a mother who is strapped to an operating table, and is unable to watch her baby enter the world (WHO & UNICEF, 2009) STS provides a sense of control and empowerment for the mother The purpose of STS is not for the nurse to provide breastfeeding instruction but to focus on the mothers’ ability to provide the perfect environment and stimulation for the infant’s reflexes and self-regulation to come into play, which in turn leads to successful breastfeeding (Radzyminski, 2005)Moore et al (2007) did not find any negative outcomes from early maternal-infant STS contact in a meta-analysis that reviewed 30 randomized-controlled trials involving 1925 mother-infant dyads, including infants born by cesarean. In contrast, there is evidence that the lack of early STS may be harmful. Mother-infant separation during the first 2 hours after birth is associated with: Less infant self-regulation Decreased maternal sensitivity and attachment that is not compensated for by rooming in ( Bystrova et al, 2009) Final thoughts…

The future….

American Academy of Pediatrics, comp. "6th Edition Instructors Manual: An Instructor's Best Friend." NRP Instructor Update 20 2 (Fall 2011): 7. Aap.org. AAP. Web. 24 Apr. 2012. http://www2.aap.org/nrp/newsletter/2011_fallwinter.pdf.Beiranvand, S., Valizadeh, F., Hosseinabadi , R., & Pournia , Y. (2014). The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery. International Journal Of Pediatrics, 1-7. doi:10.1155/2014/846486 Brimdyr , K. (Director). (2011). The Magical Hour: Holding Your Baby Skin to Skin in the First Hour After Birth [DVD]. East Sandwich MA: Healthy Children’s Project . DeChateau PWB. (1977). Long-term effect on mother–infant behaviour of extra contact during the first hour postpartum. Acta Paediatr Scand. 66:145–151 . http:// www.childbirthconnection.org/article.asp?ck=10554&ClickedLink=274&area=27 http://www.skintoskincontact.com/ssc-neuroscience.aspx.Humernick, S. (Fall 2006). The Life-Changing Significance of Normal Birth. Journal of Perinatal Education, 15 (4), 1-3.Hung, K, Ocean, B. (September/October 2011). Early Skin-to-Skin After Cesarean to Improve Breastfeeding. American Journal of Maternal Child Nursing , Volume 36 - Issue 5, 318-324.Ludington-Hoe SM, Lewis T, Morgan K, Cong X, Anderson L, Reese S. Breast and infant temperatures with twins during shared kangaroo care. J Obstet Gynecol Neonatal Nurs. 2006;35: 223–231.Matthiesen A, Ransjö-Arvidson A, Nissen E, Uvnäs-Moberg K. Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth. 2001;28:13–19. References

Moore ER, Anderson G, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012 May 16;5:CD003519. http://dx.doi.org/10.1002/14651858.CD003519.pub3.Saloojee H., Early skin to skin contact for mothers and their healthy newborn infants: RHL commentary (last revised: 4 January 2008). The WHO Reproductive Health Library ; Geneva: World Health Organization Smith J, P. F. (2008). The Natural Caesarean: A Woman-Centred Technique. BJOG An International Journal of Obstetrics and Gynaecology , 1037-1042.  Stevens, J., Schmied , V., Burns, E., & Dahlen , H. (2014). Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. Maternal & Child Nutrition , 10 (4), 456-473. doi:10.1111/mcn.12128. StorkStories , (2010, June 3). Skin to Skin Minutes After C/S in the OR… Speaking Up and Making it Happen. Retrieved March 1, 2012 from http://obnurse35yrs.wordpress.com/3-2/Walters M, Boggs K, Ludington-Hoe S, Price K, Morrison B. Kangaroo care at birth for full term infants: a pilot study. MCN: The American Journal Of Maternal Child Nursing [serial online]. November 2007;32(6):375-381. Available from: CINAHL Complete, Ipswich, MA. Accessed September 26, 2015.Widstrom, A, Lilja, G., Aaltomaa-Michalias, P, Dahllof, A, Lintula, M, Nissen, E. (2010, August) Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatrica ISSN 0803-5253 (79-85). Retrieved February 12, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20712833UNICEF (2011). How to Implement Baby Friendly Standards – A Guide for Maternity Settings. Available at: http://www.unicef.org.uk/Documents/Baby_Friendly/Guidance/Implementation%20Guidance/Implementation_guidance_maternity_web.pdf (Accessed September 24, 2015). References