A juxtaposition of birth and surgery: Providing skin-to-skin contact in the operating theatre and recovery
Introduction
Skin-to-skin contact (SSC) is where a naked baby, sometimes with a nappy on, is placed directly onto the bare chest of his or her mother or father (UNICEF, 2011). Immediate and continuous SSC between the mother and newborn is recommended as long as the mother is alert and responsive (Baby Friendly Health Initiative, 2012, World Health Organization, & UNICEF, 2009a). SSC between the mother and newborn is ideal because it is biologically normal and promotes the well-being of the mother and newborn (Bergman, 2014). A Cochrane review provided evidence that SSC promotes a longer duration of breast feeding, helps keep newborns physiologically stable and potentially improves the maternal and infant early relationship (Moore et al., 2012). A recent review provided some evidence that SSC immediately or soon after a caesarean section promotes newborn physiological stability, breast feeding and emotional well-being and reduces maternal pain and anxiety (Stevens et al., 2014).
Even though immediate SSC can be safely provided after a caesarean section, there are barriers that need to be overcome (Stevens et al., 2014). In Australia, a policy directive called ‘Breastfeeding in NSW: Promotion, Protection and Support’ (NSW Department of Health, 2011), states that all NSW hospitals need to comply with the Baby Friendly Health Initiative by June 2016, which includes uninterrupted immediate SSC following birth for a least one hour, if the mother is alert and responsive (Baby Friendly Health Initiative, 2012, World Health Organization, & UNICEF, 2009b). These policy imperatives have informed this study. This paper will focus specifically on the organisational and environmental barriers influencing SSC after a caesarean section.
Section snippets
Study design
The aim of this study was to determine the facilitators and barriers of providing immediate skin-to-skin contact (SSC) in the operating theatre (OT), to observe variability in the interactions between the mother and support people with the newborn, and to discover what contact women want with their newborn during this time. An ethnographic research methodology was chosen because it allows the researcher to gain an in-depth understanding of human interaction and culture (, ). This methodology
Findings
Organisational and environmental barriers to the provision of SSC in the OT and recovery were observed and were communicated during FG and interviews. These included the lack of education, staff, time and space and equipment obstacles. Despite this, individual staff members demonstrated and discussed ways to safely overcome these barriers.
Discussion
There are known benefits for babies and mothers when they have immediate SSC. This study has demonstrated the challenges of implementing SSC into a completely medicalised environment, that focuses on surgery and treating ill health. Change in any environment can be difficult (Hayes, 2014), however a multidisciplinary approach to facilitating SSC in the OT has proven to be effective (, ). Health policies in hospital maternity units are increasingly moving from medically dominated to
Limitations
Our study provides information about one metropolitan hospital and has a small number of participants. Each hospital will have its own unique barriers that that may not be addressed in this paper.
Conclusion
This paper has provided insight into organisational and environmental barriers to providing SSC in this heavily medicalised environment where surgery and birth are juxtaposed. The findings are important because they show that barriers can be reduced or overcome through simple measures and that staff members can generate their own ideas on how to overcome these barriers. To improve organisational barriers, staff suggested further education for themselves and support people, utilising a policy
Declaration of conflicting interests
None to declare.
Funding acknowledgement
This research was funded by a Postgraduate Award from Western Sydney University, Australia.
Acknowledgements
The authors would like to acknowledge the women and staff who participated in the study.
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2021, MidwiferyCitation Excerpt :Research has shown barriers to the practice stem from over-stretched resources (Koopman et al., 2016; Mbalinda et al., 2018; Stevens et al., 2016), inadequately trained or knowledgeable staff (Koopman et al., 2016; Zwedberg et al., 2015), hospital practice and policies (Niela-Vilen et al., 2020; Puia, 2018; Stevens et al., 2016) and workplace cultural challenges (Niela-Vilen et al., 2020). Lack of antenatal education on the benefits of skin-to-skin means parents may be unprepared and unexpectant of the importance of skin-to-skin at birth (Stevens et al., 2016; Zwedberg et al., 2015). Particularly at a caesarean birth where women are already physically and emotionally disempowered (Bayes et al., 2012; Coates et al., 2020; Puia, 2018) or feel they are expected to be compliant non-participants in their birth event (Niela-Vilen et al., 2020).
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2019, MidwiferyCitation Excerpt :Results from the caesarean section footage, the health professional interviews and the methodology used has been previously reported (Stevens et al., 2016, Stevens et al., 2017, Stevens et al., 2018). Findings highlighted in these papers indicate that SSC can be safely provided in the operating theatre and recovery with collaboration from all key players and by being each individual woman's advocate (Stevens et al., 2016, Stevens et al., 2018). This paper focuses on the unreported data generated from in-depth interviews with women around six weeks following their CS.
Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section
2018, Women and BirthCitation Excerpt :One mother had a previous normal vaginal birth. The mothers all previously breastfed, however two stated they only breastfed for a short period of time.14 Contact is defined in this paper as holding the baby, therefore excludes touching the baby's hand, a kiss or the father cutting the umbilical cord.
The realization of BFHI Step 4 in Finland – Initial breastfeeding and skin-to-skin contact according to mothers and midwives
2017, MidwiferyCitation Excerpt :We have to try to improve hospital routines, cooperation and educate staff who work in the recovery room on how to best ensure that infants have ample opportunity for initial breastfeeding and skin-to-skin contact there as well. Many studies support benefits of early skin-to-skin contact and initial breastfeeding after caesarean section and possibilities to change routines using good co-operation and adding the knowledge (Brady et al. 2014; Beake et al. 2016; Stevens et al. 2016). So often the prematurity of infants and low Apgar scores tell us of an emergency with an infant which requires the staff to guarantee the infant's safety first and hence delay initial breastfeeding.