Skin to Skin Contact

Skin to Skin Contact:

Bridget Boeckman Patty Roberts Mallory Gustison Corin Ibarra Skin to Skin Contact

Problem Statement:

What are the clinical implications for skin-to-skin contact for the health of development of infants of all gestational ages. Problem Statement

Nursing Significance :

This research is particularly pertinent to nurses working with OB and pediatric populations and suggests that skin-to-skin contact may prove beneficial in development, temperature regulation, breast feeding and bonding. Nursing Significance

Clinical Implications:

Temperature Breast Feeding Bonding Cost Effective Length of Stay Clinical Implications

Purpose:

To identify the benefits and implications of skin to skin contact on mother infant pairs To increase knowledge of current nursing research To gain experience in critical thinking and application of evidence based practice Purpose

PICO Statement :

Does the duration and prompt implementation of skin-to-skin contact have a positive impact on infants of all gestational ages regarding temperature regulation, bonding, breastfeeding habits when compared with infants who did not receive skin-to-skin contact interventions. PICO Statement

Skin to Skin with Cesarean :

Purpose: to assess the safety of early skin to skin contact after cesarean delivery on newborns’ temperature 1 Skin to Skin with Cesarean

Skin to Skin with Cesarean :

Sample: 34 Italian mother-baby pairs Full term newborns (38-42 weeks) Apgars > 7 Required pre-admission checkup and blood tests 1 Skin to Skin with Cesarean

Skin to Skin with Cesarean:

Level of Evidence III Randomized experimental Skin to Skin with Cesarean

Skin to Skin with Cesarean :

Quality: Fair overall quality Threats that were not considered Threat of attrition Experiment was done on one demographic group Based on previous research One intervention identified Skin to Skin with Cesarean

Skin to Skin with Cesarean :

Results: Newborns’ mean temperatures did not change from interval to interval indicating the SSC in newborns delivered by cesarean section is safe This article illustrates the benefits of SSC, similar to the other articles, while adding a unique intervention such as temperature regulation Skin to Skin with Cesarean

Kangaroo-Care for Preterm Infant & Mother Dyads:

Purpose of Study To investigate the effects of skin to skin care on the breastfeeding practices of mother of premature and very premature infants 2 Kangaroo-Care for Preterm Infant & Mother Dyads

Kangaroo-Care for Preterm Infant & Mother Dyads:

Sample The sample included a 197 infants 32 to 36 weeks of gestation and 103 infants younger than 32 weeks gestation, and their respective mothers 2 Kangaroo-Care for Preterm Infant & Mother Dyads

Kangaroo-Care for Preterm Infant & Mother Dyads:

Level of Evidence This was a level III study It was a longitudinal cohort study Kangaroo-Care for Preterm Infant & Mother Dyads

Kangaroo-Care for Preterm Infant & Mother Dyads:

Quality of the Research Strength: This study had a large number of participants with a total of 300 subjects and it was conducted over 18 months, with no threat of mortality Weaknesses: This study was made up of only Swedish subjects. It lacked diversity in race and socioeconomic status of the subjects Kangaroo-Care for Preterm Infant & Mother Dyads

Kangaroo-Care for Preterm Infant & Mother Dyads:

Relation to Group PICO statement This article addresses the positive effects of skin to skin contact or kangaroo mother care on the breastfeeding habits of this group of mothers. It also addressed other benefits of skin to skin care such as feelings of empowerment expressed by the mothers in the study Kangaroo-Care for Preterm Infant & Mother Dyads

Contact and Maternal/Infant Bonding:

Purpose Maternity ward routines’ influence on the mother–infant interaction at 1 year postpartum Early contact between mother and infant under different conditions 3 Contact and Maternal/Infant Bonding

Contact and Maternal/Infant Bonding:

Sample Women with a normal full-term pregnancy who were admitted to the delivery ward during the daytime 176 mothers were randomly assigned to the eight treatment groups, 23 were excluded for different reasons during their stay in the maternity ward 3 Contact and Maternal/Infant Bonding

Contact and Maternal/Infant Bonding:

Level of Evidence The methods used in this study can definitively describe the factors studied and separate all variables. This studied could be considered a Level 3 study. Contact and Maternal/Infant Bonding

Contact and Maternal/Infant Bonding:

Quality This is a strong study This article does not state any threats but external validity could be an issue as this is one study performed in one hospital with one “traditional” maternity ward and regulations. Contact and Maternal/Infant Bonding

Contact and Maternal/Infant Bonding:

Relation to Group PICO Statement This article explores the connection between skin-to-skin contact and suckling in association with mother-infant bonding. All four of the articles strived to ask similar questions in both methods (skin-to-skin contact) and in results (improved bonding). Contact and Maternal/Infant Bonding

Slide 22:

Synthesis of Articles: Pulling it all together

Level of Evidence:

Two articles are level 2 (Kangaroo Care and Breastfeeding of Mother-Preterm Infant Dyads 0-18 Months: A Randomized, Controlled Trial and Positive effects of kangaroo mother care on long-term breastfeeding in very preterm infants) and two articles are level 3 (Early Contact versus Separation: Effects on Mother–Infant Interaction One Year Later and Skin- to Skin Contact After Cesarean Delivery: An Experimental Study) . Level of Evidence

Results:

The duration and prompt implementation of skin-to-skin contact has shown a positive impact on infants of all gestational ages regarding temperature regulation, bonding and breast feeding habits when compared with infants who did not receive skin-to-skin contact interventions in all articles. Each hypothesis was affirmed in the individual findings. Results

Recommendations For Nursing Practice:

Offer skin to skin contact and the current research on benefits to allow mothers to decide for themselves whether or not to use it All of the results of the research was consistent; Only benefits were seen from the use of skin to skin contact. Recommendations For Nursing Practice

Strengths:

Each research study was performed in different geographical locations and each showed consistent benefits Strengths

Potential Outcomes:

Clinical Improved thermoregulation, improved breastfeeding time and volume, improved success with breastfeeding Quality Satisfaction, improved self esteem of mother, improved bonding up to 18 months after birth Cost No cost associated with encouragement of skin to skin contact, decreased cost of formula Potential Outcomes

Interprofessional Implications:

Lactation specialists OB Doctors and Pediatricians Midwives Interprofessional Implications

Future Research:

Conduct future research on a more diverse population including mothers of differing races, ethnicities, native languages and ages and including infants of varying gestational ages. Further research on fathers and other caregivers may be also beneficial. Future Research

Citations:

1. Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., & Di Giulio, P. (2010). Skin-to-Skin Contact After Cesarean Delivery: An Experimental Study. Nursing Research , 59 (2), 78-84. 2. Flacking, R., Ewald U., Wallin, L. (2011). Positive effects of kangaroo mother care on long-term breastfeeding in very preterm infants. Journal of Obstetric Gynecology and Neonatal Nursing, 40, 190-197. doi:10.1111/j.1552-6909.2011.01226.x 3. Bystrova, K., Ivanova, V., Edhborg, M., Matthiesen, A., Ransjo¨-Arvidson, A., Mukhamedrakhimov, R., et al. (2009). Early Contact versus Separation: Effects on Mother–Infant Interaction One Year Later. Birth, 36(2), 97-109. Citations