Elsevier

Midwifery

Volume 37, June 2016, Pages 41-48
Midwifery

A juxtaposition of birth and surgery: Providing skin-to-skin contact in the operating theatre and recovery

https://doi.org/10.1016/j.midw.2016.03.015Get rights and content

Highlights

Factors which may contribute to overcoming the inherent conflict between birth and surgery and increase the opportunities for SSC:

  • Educate staff and parents on the importance of SSC.

  • Use a policy to set standards for practice and to avoid ambiguity of staff roles.

  • Enable innovative staffing models to improve the facilitation of SSC in the operating theatre.

  • Consider redesigning the operating theatre space.

  • Employ simple changes to make SSC easier to achieve (see Table 5).

Abstract

Objective

to provide insight into the facilitators and barriers of providing skin-to-skin contact in the operating theatre and recovery.

Design

ethnographic study utilising video recordings, field notes, focus groups and interviews.

Setting

a metropolitan public hospital in Sydney, Australia.

Participants

21 low-risk mothers having a repeat caesarean section, 26 support people, >125 staff members involved in their care and 43 staff members involved in focus groups/interviews.

Data collection and analysis

collecting video footage and field notes for up two hours post caesarean section births, interviews at six weeks post partum and staff focus groups/interviews. Data was entered into NVivo10 and analysed using critical ethnographic techniques.

Findings

providing skin-to-skin contact in the operating theatre and recovery presents unique challenges due to the ‘juxtaposition’ of providing social and emotional care in an intrinsically medicalised setting. Staff members suggest that skin-to-skin contact in this environment can be improved by increasing staff and parent knowledge, writing and implementing a policy, addressing staffing issues, improving staff communication, addressing time constraints, adjusting the placement of equipment in the environment and making small changes to the way equipment is utilised.

Conclusions and implications for practice

our findings show that skin-to-skin contact can be successfully implemented in the operating theatre and recovery room with staff members input into adjustments to existing care.

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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