To Comment:
Skin-to-skin immediately after delivery is the goal for newborns and their mothers. In an article written in 2014, the authors state the importance of initiating skin-to-skin and altering their previous practices after delivery (Grassley & Jones, 2014).
Normally after an uncomplicated vaginal delivery, the hopes would be to place the infant, directly on the mother chest and begin skin-to-skin as early as possible; the same goes for a cesarean delivery. However, many institutions, including my own have different practices that delay skin-to-skin, due to provider preferences, as well as unwillingness to change.
Evidence shows that skin-to-skin, immediately after delivery holds many health benefits for the infant. These include: increase bonding, increase breastfeeding rates, improvements in thermoregulation and glucose control, decreased respiratory rates and well as decreased stress levels (Elsaharty& McConachie, 2017).
All of these finding have been proven for many years, yet still, practices are hesitant to change. In this article, the evidence-based research provided facilities with the statistics and significance behind skin-to-skin initiation (Grassley & Jones, 2014). With this information, facilities are now able to understand and use this information when attempting to initiate skin-to-skin after a cesarean delivery (C-sections).
While performing a C-section, the operating room is cold, the mother is given more anesthetics, and the area between the abdomen and chest is minimal.
These three barriers to change are just a few of many reasons as to why in this study, just like in my hospital, the willingness to change is greatly diminished (Elsaharty& McConachie, 2017; Grassley & Jones, 2014). It is "inconvenient" for the infant to be placed directly on the mother's chest following delivery because many people needed to perform their assessments, the surgeons needed room to operate, and the mother would often times have side effects from the anesthesia that would make it incapable for her to hold her baby.
Anesthesiologists would have a "hard time" giving the mother anesthesia through her IV (Elsaharty& McConachie, 2017). This is not actually the case; this is just an unwillingness to accept change. When people have been performing their duties in a certain way for so long, they are used to their ways and do not want to change; you see this same thing within this study. Another barrier is, assessments on the infant performed by the neonatologist and the nursery nurse. They would have a "hard time" getting measurements and assessments on the infant.
However, with the research and standard of practice, these assessments do not even need to be performed until the first hour of life. This evidence proved to providers that there was no rush in taking the baby, except for their own benefit and convenience. However, with the persistence of research and data, the ultimate decision was skin-to-skin is the best place for the infant to be, and providers would have to work around and with the mother to best assist her (Elsaharty& McConachie, 2017).
The use of Cochrane databases also provided this research with concrete evidence on the importance and significance of skin-to-skin (Elsaharty& McConachie, 2017). The ultimate goal as a health care provider is to provide the best care possible to your patients, not the most convenient. I liked using this article because it used level one evidence, on the Cochrane database, to determine the importance of skin-to-skin upon each mode of delivery (Elsaharty& McConachie, 2017).
Because of the research, improved patient outcomes were achieved. Newborns blood glucose levels were more stable since their stress level was decreased after delivery (Elsaharty& McConachie, 2017). Normally, during a C-section, the newborn is delivery via rigorous pressure and mechanics, instantly placed on a warmer, and immediately assessed and given medications and measurements; all of these factors will add stress to the baby. With this evidence, the researchers were able to prove that decreased stress levels were found if the infant was placed directly on the mother's chest with a hat and warm blanket, for thermoregulation (Elsaharty& McConachie, 2017).
This article is extremely useful to me as a nurse now, and also as I advance my degree. Not only is evidence-based practice key to evolving healthcare, but it is also important in providing the right care. Regardless of this article, evidence researched, provides our patients with the best health outcomes. In this article, it discusses barriers to change, yet these barriers hold no significance. There are no just reasons as to why skin-to-skin should not be performed directly after a C-section.
Many people are afraid and resistant to change. However, if they are given the right information and the understanding behind the importance of changing practices, one would assume change would become more fluent. This article provides me with a small, yet solid explanation as to why evidence is so beneficial to changing practices.
For example, if skin-to-skin lowers the rate of glucose instability and increases thermoregulation, instead of a healthcare practitioner thinking skin-to-skin is more work (because it involves change), one would see the benefits. By stabling the blood sugar, you would have lower rates of infants being hypoglycemic, which would lower the workload including blood sugar checks.
If the blood sugar is low, and breast milk is not produced, the infant would then need formula. This would then spiral into other complications which would not only increase one's workload, but also decrease the health outcomes of the infant you are caring for. If one understands the reasoning behind change, then one would be more supportive of new practices.
As an advanced practice nurse, there will always be new information and practices needing to changed. This is why we are required to keep up with our continuing education to learn about the most up-to-date and evidence-based practices to deliver to our patients (Price & Reichert, 2017).