Kangaroo care is defined as the way of “holding a preterm or full term infant so that there is skin-to-skin contact between the infant and the person holding it. The baby, wearing only a diaper, is held against the parent’s bare chest. Kangaroo Care (also Kangaroo Maternal [Mother] Care or Skin-to-Skin Contact and Breastfeeding) is a method used to restore the unique mother-infant bond following the sudden separation during the birth experience particularly in premature births”( www.med.umich.edu/nicu/pdf/C.3KangarooCare.pdf, 2010).
Mothers are more likely to be able to practice skin to skin contact or kangaroo care following a vaginal delivery versus a cesarean which is seen as a medical procedure and not a delivery. Infants born to mothers via cesarean are usually whisked away to a nursery and are separated from their mother for as long as two hours. Infants most alert period is the first one to two hours after delivery and most babies born via cesarean spend this time in the nursery away from their mothers and once they are reunited with their mothers they are now in a deeper sleep state and tend to not breastfeed as well as babies that are born vaginally and allowed skin to skin contact immediately. This paper focuses on the need to change the way we take care of mothers and infants that give birth via cesarean and allow them the same bonding experience as mothers that give birth to their infants vaginally.
Step 1: Assess the Need for Change in Practice
The best way to promote change in a healthcare facility is to show how it will benefit the patients and improve the way they view the hospital. Currently during a caesarian section the newborn, immediately after delivery, is handed to the nurses and evaluated and assessed. The mother continues to get treatment as a surgical patient and the time frame of newborn to mother contact can be as long as 40 minutes. Nurses should look into the benefits to both mother and baby in regards to their health when they receive time to do skin to skin contact in the operating room (OR). Evaluate what potential obstacles could hinder the surgical procedure by doing skin to skin contact and come up with potential solutions so that skin to skin contact in the OR does not interfere with the surgical procedure. The PICOT question: P- newborn babies, I- Delayed time in parent/ person skin to skin time after birth, C- Encourage skin to skin time sooner after birth with parent/person, O- Encourage bonding, stabilize newborns heartbeat, temperature, and breathing. T- Within 6 months.
Step 2: Link the Problem, Interventions, and Outcomes
The problem with the delay in skin to skin contact is that for many years physicians have performed Cesarean sections in a certain way and therefore it becomes difficult when changing the way they practice this procedure. Hospital procedures are written and followed for many years and physicians can be very reluctant to change the way they practice. The first step is to show both the OB and Pediatric doctors the benefits to mother and baby skin to skin time.
Some of these benefits include: stabilize the infant’s heartbeat (especially if they are preterm), temperature, and breathing. Researchers also have found that mothers who use kangaroo care often have more success with breastfeeding and also improve their milk supply. Further, researchers have found that infants who experience kangaroo care have longer periods of sleep, gain more weight, decrease their crying, have longer periods of alertness, and earlier hospital discharge (Kangaroo Care, 2010). The benefits to mom are “enhanced maternal-infant attachment & bonding increased maternal self-confidence, increased maternal affectionate behavior, enhanced relaxation and experience less anxiety, less breast engorgement, and more rapid involution (uterus returning to pre-pregnant size)” (Kangaroo Care, 2010). These benefits could be shown to the...
References: Birth. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 40S19 doi:10.1111/j.1552-6909.2011.01242_24. Berg, O., & Hung, K. J. (2011). Early Skin-to-Skin to Improve Breastfeeding After Caesarian
Erlandsson, K., Dsilna, A., Fagerberg, I., & Christensson, K. (2007). Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior. Birth: Issues In Perinatal Care, 34(2), 105-114.
Gouchon, Silvia; Gregori, Dario; Picotto, Amabile; Patrucco, Giovanna; Nangeroni, Marco; Di Giulio, Paola(2010) Skin-to-Skin Contact After Cesarean Delivery: An Experimental Study. Nursing Research, 59(2) 78-84
Morrison, B. (2006) Kangaroo Care: Natures Best for our Little Ones www.preciousimagecreations.com/presentations/kangaroocare.pdf
Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image, 31, 317-322.
University of Michigan, Holden Newborn Intensive Care website. Kangaroo Care www.med.umich.edu/nicu/pdf/C.3KangarooCare.pdf
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