Abstract
Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications.
Highlights
The WHO/UNICEF Baby‐Friendly Hospital Initiative integrates the “Ten Steps to Successful Breastfeeding” into practice
In light of our experience researching and implementing skin‐to‐skin contact (SSC) (Brimdyr et al, 2015; Brimdyr, Widström, Cadwell, Svensson, & Turner‐Maffei, 2012; Stevens, Schmied, Burns, & Dahlen, 2016; Takahashi et al, 2011) and in consideration of the findings of the Cochrane team (Moore et al, 2016), we present a novel algorithm, Healthy Children Project's Skin‐to‐Skin Implementation Algorithm (HCP‐S2S‐IA; Figure 1), which considers the mothers' condition as she begins the birthing experience according to Robson criteria (Table 2) and using the tool, plots the experience of each dyad in regard to immediate, continuous, and uninterrupted SSC after birth
We examined the data of Australian mothers who gave birth via elective caesarean in relation to the standard of immediate, continuous, uninterrupted SSC with the goal of progressing to self‐ attached suckling followed by sleep
Summary
The WHO/UNICEF Baby‐Friendly Hospital Initiative integrates the “Ten Steps to Successful Breastfeeding” into practice. A 2009 revision offered specified guidance for Step 4, practices in the first hour after birth: place all babies “in skin‐to‐skin contact ... Immediately or within five minutes after birth” and continue “without separation for an hour or more, unless there were medically justifiable reasons” The Baby‐Friendly USA (2016) Step 4 standard specifies immediate, continuous, and uninterrupted skin‐to‐skin contact (SSC) between the mother and her newly born infant after birth “unless there are documented medically justifiable reasons for delayed contact or interruption.”. Health Initiative recommends “immediate skin‐to‐skin contact on the mother's chest after birth and that the baby is allowed to remain there without interruption or separation” unless “a medically initiated procedure is required” The Academy of Breastfeeding Medicine Model Policy states “At birth or soon thereafter all newborns, if baby and mother are stable, will be placed skin‐to‐skin with the mother ... allow uninterrupted mother–infant
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