Innovations in Practice: Supporting the Breastfeeding Dyad in Labor & Delivery

Abstract

Newborn Care Poster Presentation Objective To improve support of the breastfeeding mother–infant dyad by increasing skin-to-skin (STS) care and initiating breastfeeding within the first hour of birth. Design Pre and post intervention design. Exclusive breastfeeding for 6 months of life is endorsed by many healthcare organizations. Both of the proposed interventions have demonstrated improved breastfeeding outcomes. Sample Inclusion criteria included a stable mother–infant dyad not separated after birth. A random sample was selected (minimum of 30 charts/month) of dyads admitted to the mother–baby unit after birth. Methods Retrospective chart review. Implementation Strategies Several nurses in the labor & delivery (L&D) unit initiated this project as one way to increase rates of breastfeeding. The L&D shared governance council committed to improving STS care and early initiation of breastfeeding and this quality improvement initiative. Plan-do-check-act quality improvement methodology was paired with change management theory (Roger's Theory of Innovation) to enhance outcomes. Baseline data were obtained, and a literature review was conducted. Unit champions or innovators were identified. Implementation of STS care and early initiation of breastfeeding was instituted by the L&D nurses. All staff members were educated, and champions assisted other nurses in accomplishing STS care, even at times in the operating room. Monthly audit data were shared with staff. Challenges were encountered along the way, including the introduction of a new electronic medical record. Physician resistance was overcome by education, persistence, and culture change. Slowly change occurred, and anesthesiologists became champions. STS care and early breastfeeding are now part of routine practice on the L&D unit. Results Monthly data audits were completed for each indicator. Use of STS care increased from a baseline of 25% (July 2010, all delivery types) to nearly 90% by July 2013. In this same timeframe, the rate of breastfeeding within the first hour increased from 66% to 90%. Conclusion/Implications for Nursing Practice STS care and early breastfeeding after birth have proven benefits for the mother and infant. Perinatal nurses must find ways to implement these practices. Continual reinforcement is needed to sustain change, and outside factors such as change in documentation system affect care.