Mary Ellen Boisvert, RN, MSN, CLC, CCE
Nurse Manager
Family Centered Unit
Southcoast Hospitals Group –
Tobey Hospital


Wareham, Massachusetts

Community Hospital
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Tobey is part of Southcoast Hospitals Group
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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

Skin-to-Skin During C-sections
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Placing the unclothed newborn on the bare chest of the mother and covering them with a blanket
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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
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Skin-to-Skin has been normal practice with vaginal deliveries and in the recovery room after a c-section for many years
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Summer 2010: Time to move to the next level – skin-to-skin during c-sections!

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C-sections are staffed by circulators and scrub techs from the main OR (not OB staff)
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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
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How would the anesthesiologists respond?
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How would we put this into practice?
 Maintaining skin-to-skin during transfer from c-section room to recovery

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Skin-to-skin is a nursing intervention
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OB nurses are in the c-section room to provide newborn care
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OB nurse stays in the OR with the mother and newborn
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RN champions
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Support from obstetrician, CNM & pediatrician
 One anesthesiologist was a champion for skin-to-skin
 “Let’s make a skin-to-skin zone!”
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Nurses can do whatever they need to do as long as one of the OB nurses is caring for the newborn while in the csection room

SKIN TO SKIN
ZONE
HIGH SKIN
AREA


Putting it into practice required teamwork
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Newborn goes to the warmer for the 1 minute apgar
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If newborn and mom are both stable, newborn then goes skin-to-skin with mom
 Mom’s gown is unbuttoned and newborn is unwrapped
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Placed skin-toskin across mom’s upper chest/neck
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Hat and warm blanket over newborn
 Support person helps support newborn
 OB 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

 Our next goal is to maintain “uninterrupted” skin-toskin during transfer and into the recovery room

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Focus on what is best for the patient(s)
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Evidence based care, best practice
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Positive feedback from patients and support person
 Talk about the change
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Identify champions
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Make small changes
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Be willing to negotiate as you work towards your goal
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Share the success
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Talk about your outcomes