Speaker Info
Mary Ellen Boisvert, RN, MSN, CLC, CCE
Nurse Manager
Family Centered Unit
Southcoast Hospitals Group –
Tobey Hospital
Tobey Hospital
Tobey Hospital
Wareham, Massachusetts
Community Hospital
Tobey 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/Background
Skin-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!
Challenges
C-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 It
Skin-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 newborn
RN 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 csection room
SKIN TO SKIN
ZONE
HIGH SKIN
AREA
How We Did It
Putting 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-toskin across mom’s upper chest/neck
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
What’s Next
Our next goal is to maintain “uninterrupted” skin-toskin during transfer and into the recovery room
Lessons Learned
Focus on what is best for the patient(s)
Evidence based care, best practice
Positive feedback from patients and support person
Talk about the change
Identify champions
Make small changes
Be willing to negotiate as you work towards your goal
Share the success
Talk about your outcomes
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