Carolinas HealthCare System
Policy & Clinical Practice Guidelines
Women & Infant’s Services
CMC-PINEVILLE
“Heart to Heart” (Skin to Skin) Delivery Care for Mothers/Babies
Written: 03/10/10
I.
POLICY
To establish guidelines for the evidence based care practice of placing the
infant skin to skin on mothers chest immediately after birth. Such contact provides
optimal stability, warmth, and opportunities for the first feeding and allows parents
less interruptions for the first and “sacred hour” past birth.
II.
SUMMARY
It is an AAP Guideline that healthy infants should be placed and remain in direct
skin to skin contact with their mothers immediately after birth at least until the
first feeding is accomplished and as much as possible thereafter. The
World Health Organization recommends: “Given the importance of thermoregulation,
skin to skin contact should be promoted and encouraged in the first 24 hours after
birth”. The American Heart Association’s 2006 Neonatal Resuscitation Program
5th edition recommends “for all normal newborns, skin to skin care can be used to
provide routine resuscitation”. When mother and baby separation is prolonged,
infant systems shut down in a “despair” response instinctive for prolonged survival.
This response which is due to withdrawal from mother includes decreased heart rate,
decreased temperature, and a massive rise in stress hormones.
III.
NOTE
The following are guidelines for maternity patients and do not substitute
for clinical judgment always needed on behalf of all patients.
Criteria for inclusion: Infant must be low risk and clinically stable at birth:
Mother must be mentally and clinically stable post delivery.
IV.
PERFORMED BY
RNs, Physicians, Midwives, Neonatal Nurse Practitioners
V.
EQUIPMENT
A. Warm blankets, towels and baby hat
B.
C.
D.
E.
VI.
Bulb syringe
Stethoscope for APGAR scoring assessment.
Thermometer
Resuscitation Equipment and prepared warmer should be maintained until
transitional period is completed.
EDUCATION
A. The Nurse will educate parents and visitors on admission utilizing the nurse
scripts provided (attachment). Education will include using key words such as
the “sacred hour”, “benefits for mother and baby” and “transition to life” with
emphasis on this being our “excellent” practice to assure healthy responses for
mothers and babies at birth “as long as both are stable”. It is spoken of as “heart
to heart” and “skin to skin” care. Education includes not sleeping with infant skin
to skin.
B. During rounding, nursing leadership will assess the patient’s understanding of the
“benefits”, “visitor options” and understanding of key terms such as the “sacred
hour” after birth.
C. During the admission interview, staff will use scripting “How do you plan to feed
your baby?” to allow the opportunity to explain benefits of breastfeeding and
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Carolinas HealthCare System
Policy & Clinical Practice Guidelines
Women & Infant’s Services
encourage mothers to allow heart to heart care at birth. Families will be
educated that this care practice is also beneficial to formula fed babies.
VII.
INTERVENTION
A. Preparations:
1. The nurse will prepare the infant warmer and resuscitation equipment
in the room as per policy “CHS-Infant Care at Birth”.
2. Warm all blankets and towels to be used. Prepare scale prn (see C 6).
B. Birth:
1. Immediately after birth, dry infant with warm towels and apply a
warm blanket. Continue to reapply dry blankets or towels after placing
infant to the mothers chest until infant is completely dry.
2. Place the hat on the infant’s head.
3. When barriers such as Cesarean birth are required, arrange when
possible to assist father or a grandparent to have skin to skin with
infant.
4. Infant should be placed chest-to-chest, upright, with legs and arms in
flexed position. Care should be taken to position the head and neck
in slight sniffing position to prevent airway obstruction. If possible,
position the face of the infant so that the mother can see the infant’s
facial expression. Be alert to mother and infant comfort and safety.
C. Initial Assessments:
1.
Assess breathing and transitional state of infant during APGARs.
Stimulate the infant by gently rubbing back or feet while infant is on the
mother’s chest unless infant requires resuscitation.
2. Gently suction the oropharynx with the bulb syringe.
3. Nasopharyngeal and gastric suction should be done cautiously and
only if necessary.
4. Heartrate and respirations should be assessed and documented
every 30 minutes x 4 following delivery.
5. Temperature will be taken axillary and must be greater than 97.6
axillary in order to take infant off mom’s chest for weight or other family
members to hold once skin to skin is initiated. Reinforce with family
the physiological reasons for not passing the infant around. Optimal
skin to skin should last 1-2 hours. Parents should be instructed not
to sleep skin to skin with infant.
6. Upon provider or parent request prior to birth, prepare the scale with a
warmed blanket on a scale zeroed immediately before birth. After
initial drying of baby, weigh baby and then place infant immediately on
mothers chest as you thoroughly dry the newborn and change the wet
blankets.
7. The complete newborn assessment, weight and measurements should
ideally be postponed until after the “sacred hour” past birth. No infant
should be taken off the skin (except to the warmer) with a temperature
less than 97.6 or greater.
8. Record the 1 and 5 minute APGARs. A 10 minute APGAR will be
done for 5 minute APGAR less then 7.
D. Sacred Hour routines:
1. Observe infant carefully for bleeding, congenital anomalies, voiding,
stooling and odor. Synchronize them with the mothers assessments
in the immediate recovery period.
2. Clamp the cord and trim with scissors as needed.
3. Security Photo should be taken on Mother’s chest with ID bracelet.
Assure infant’s face with crib card identification are clearly visible.
4. Continue to monitor vital signs x 2 hours and as indicated.
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Carolinas HealthCare System
Policy & Clinical Practice Guidelines
Women & Infant’s Services
5.
6.
Eye ointment should be delayed until sacred hour is completed but can
be administered to infant while on the mothers chest.
Delay until after “sacred hour” or give Aquamephyton IM injection to
infant while on mothers chest per medication administration protocol.
Utilize a filter needle to draw it up from the vial and administer
immediately after preparation due to light sensitivity.
7. Provide a private atmosphere for family interaction and bonding.
Educate the family to enjoy time in the family waiting room during the
“sacred hour”. At the parent’s request, you may allow visitors in room.
E. Communication:
1. Initial assessment, weight, measurements and newborn admission
documentation should be completed by the labor nurse or the
mother/baby nurse according to staffing assignments.
2. Infant data is to be added to the delivery record by the nurse who does
the newborn assessment.
3. At all times, the nurse who provides the cares is to document the
activities they complete and report utilizing tools like the SBAR all
outstanding activities. Circumstances may require the newborn
assessment, initial bath or completion of recovery vital signs to be
completed by the receiving nurse.
4. The delivery record should be completed 4 hours past delivery.
5. The newborn bath should be done in the room whenever possible and
may be done by trained maternity staff members. It is optimal to delay
the bath until daytime hours so that parents can participate.
VIII.
DOCUMENTATION
A. Complete all documentation in Cerner and on delivery records.
B. In the ETR, document family and patient teaching.
C. Complete SBAR communication tool to include “heart to heart” care.
IX.
REFERENCES
American Academy of Pediatrics. Breastfeeding and the use of human
milk: policy statement. Pediatrics. 2005;115:496-506.
American Heart Association guidelines for cardiopulmonary resuscitation and
Emergency cardiovascular care. Circulation 112 (IV): 1-203.
Bergman, N., Anderson, G. C., & Moore, E. R. (2007). Early skin-to-skin contact for
mothers and their healthy newborn infants (review). Cleveland: John Wiley and Sons,
Ltd.. (Original work published 2007)
Erlandsson, K. (2007). Skin-to-Skin Care with the Father after Birth, 34(2), 105-114.
Mercer, J., & Erikson-Owens, D. (2010). Evidence for Neonatal Transition and the First
Hour of Life. Essential Midwifery Practice:Intrapartum Care (pp. 81-98). Aimes, Iowa:
Wiley-Blackwell
United States Department of Health and Human Services (2000).
Healthy People 2010. US Stock Number 017-001 Washington, DC: DHHS.
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Carolinas HealthCare System
Policy & Clinical Practice Guidelines
Women & Infant’s Services
Walters, M. (2007). Kangaroo Care at Birth for Full Term Infants: A Pilot Study. MCN,
32(6), 375-381.
Attachment:
Staff script for Heart to Heart Care:
Note importance of using keywords at key times to make this education effective.
Ask Me About Heart 2 Heart
Heart 2 Heart is a name for Skin to Skin Care, or Kangaroo Care for
mothers and babies and is our way of providing excellent care. Numerous
research studies have shown many benefits of keeping babies on mother’s chest
immediately after birth for 1-2 hours or until the first feeding is established.
You can expect baby to be dried at birth and placed skin to skin against your chest and
covered with a warm blanket and hat. Your chest is the best place for your baby to
transition to life outside of your body. Babies who are skin to skin stay warmer
and calmer, cry less, and have better blood sugars. Studies show babies who
maintain STS contact breastfeed better.
For mom, babies who are kept STS produce more oxytocin which stimulates the uterus to
contract and prevent excessive bleeding and better milk production/stimulation for
breastfeeding moms.
We encourage visitors to go to the waiting room during the first hour after birth to allow
bonding of the new family. We will also work to avoid procedures like weights and
measurements until after this first “sacred hour” has been spent skin to skin with your
baby.
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