A Quality-Improvement Initiative to Promote Skin-to-Skin Contact in Cesarean Deliveries
Meenakshi Girish, Nilofer Mujawar, Mala Nagrale, Mamta Kamble, Manish Dabhade
Abstract
Background: Nurses often face many obstacles while promoting skin-to-skin contact (SSC), in the recovery room, after a cesarean delivery. Early SSC has a positive correlation with successful breastfeeding outcomes.
Aims: To recognize the hurdles to achieving SSC and improving the rate of SSC among vigorous neonates born through cesarean delivery
Materials and Methods: To improve the rate of SSC, we undertook a quality-improvement initiative at the recovery room of the obstetrics department of a tertiary care hospital. The study included 168 neonates born through cesarean delivery.
A team involving neonatologists, pediatricians, obstetricians, anesthesiologists, and nurses identified problems in their concerned areas using the fishbone analysis. Situational analysis was done through process flow mapping. Plan-Do-Study-Act cycles were undertaken. Firstly, sensitization of the personnel was done, and a written policy was made. Secondly, maternal counseling and procedural modifications were done. Lastly, efforts were made to improve the duration of SSC.
Results: From 172 deliveries that were conducted during the study period (12 wk), 168 neonates born through cesarean delivery were included, of which 4 were ineligible for SSC. We found that the number of neonates who received SSC rose from < 10% to > 90%, and this increase was sustained over the next 2 months.
Conclusion: With sensitization of all health care personnel involved in perinatal care and by implementing simple procedural changes, SSC was feasible. However, prolonging the duration of contact remained a challenge.
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