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Booby Traps Series: Skin-to-skin in the operating room after a cesarean birth is possible, improves breastfeeding rates. Could this be the beginning of a trend? | Best for BabesBest for Babes

Booby Traps Series: Skin-to-skin in the operating room after a cesarean birth is possible, improves breastfeeding rates. Could this be the beginning of a trend?

by Tanya Lieberman, IBCLC | December 2, 2011 7:03 pm

This post is the 25th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

A little while back I wrote about the power of skin-to-skin contact and its relationship to breastfeeding and many other healthy outcomes for babies.

But one thing that kept nagging at me as I wrote it:  If one of three births (and perhaps as many as one in two, if current trends continue) is a cesarean, and if early skin-to-skin seems to be so important, what can be done to improve the chances that a baby born by cesarean has a good shot at this important experience?  A while back, Best for Babes linked to a wonderful video from Norway (shown above) showing skin-to-skin and breastfeeding in the operating room.  But is there evidence that this could work on a large scale here?

I’m very pleased to share a study, just published this fall, on one hospital’s experiment with making skin-to-skin in the operating room the standard of care after a cesarean for healthy, term babies.

So, on to this very exciting study:  A Baby Friendly San Francisco hospital recently initiated a quality improvement project in which skin-to-skin contact in the operating room and during recovery was used as a means of increasing breastfeeding success.  This intervention was prompted by reviewing data for a two week sample of healthy, term infants, which found the following problems:

Over 90% of [healthy, full term] infants born vaginally were exclusively breastfed during their hospital stay (11 out of 12) compared to only 50% of infants born by cesarean (5 out of 10). Furthermore, only 20% of the cesarean infants were [skin-to-skin] STS with their mothers within 90 minutes of birth, and 40% were not STS at all during the first 4 hours after birth. Of these infants who were not STS at all in the first 4 hours, 100% received formula supplementation while in the hospital.

So, the hospital embarked on an intervention to make skin-to-skin the standard practice in the operating room and in recovery.  Here were their findings:

During the first 3 months of our intervention, the rate of early STS among healthy babies born by cesarean increased from 20% to 68%. The rate of infants who did not get STS contact within 4 hours of birth decreased from 40% to 9%.  Nine months after the initiation of the intervention, 60% of healthy cesarean births utilized STS in the [operating room] OR, and 70% involved STS within 90 minutes of birth.

Healthy infants born by cesarean who experienced STS in the OR had lower rates of formula supplementation in the hospital (33%), compared to infants who experienced STS within 90 minutes but not in the OR (42%), and those who did not experience STS in the first 90 minutes of life (74%).

And how did mothers react to having this early skin-to-skin contact?

We received positive feedback regarding mothers’ experience with STS in the OR. Mothers stated that they would like to have STS contact with their babies in the OR if they were to experience a cesarean again, and commonly concluded that STS in the OR made them feel happy.

One woman, when asked how she felt about having her baby STS with her in the OR, responded (translated from Spanish): I felt some pain at the end of the surgery because the effects of the anesthesia were wearing off, but when they put the baby in my arms I forgot about the pain because I was so happy to have him with me. She denied feeling worried about holding her baby STS in the OR and stated: With my last child they took her to the nursery right away [after the cesarean] and she never wanted to latch after that … but this baby latched right away and he nurses really well because I had him with me right away.

Another Spanish-speaking mother shared about her STS in the OR experience: It was nice, feeling her skin on me … She was looking at me with her eyes wide open … and I think we both could feel the attraction.

The authors write that some routines and staffing patterns had to be changed.  They also note that, while there was some initial resistance to change, “We received positive responses after staff received the in-service education on benefits of STS and understood the need for improvement.”

The authors conclude: “We concluded that STS contact was feasible after cesarean and could be provided for healthy mothers and infants immediately after cesarean birth. Perinatal and neonatal nurses should be leaders in changing practice to incorporate early STS contact into routine care after cesarean birth.”

It may be a while before skin-to-skin in the operating room is embraced as the standard of care, but this account of one hospital’s successful experience and the evidence it provides that the practice supports breastfeeding, gives me hope!

Next week I’ll share an interview with a friend and fellow lactation consultant who had skin-to-skin contact in the operating room after her second son was born by cesarean.



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