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Centers for Disease Control and Prevention (2014).  Breastfeeding report card: United States/2014. Retrieved April 20, 2017, from http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf

Eidelman, A. K., & Schanler, R. J. (2012).  Breastfeeding and the use of human milk.  Pediatrics, 129(3), 598-601.  doi:10.1542/peds.2011-3552.

Goyal, N. K., Attanasio, L. B., & Kozhimannil, K. B. (2014).  Hospital care and early breastfeeding outcomes among late preterm, early-term, and term infants. Birth: Issues in perinatal care, 41(4), 330-338. doi:10.1111/birth.12135.

Moore, E. R., Anderson, G. C., Bergman, N., Dowswell, T. (2012).  Early skin-to-skin contact for mothers and their healthy newborn infants.  Cochrane Database of Systematic Reviews, Issue 5.  Art. No.:  CD003519.  DOI: 10.1002/14651858.CD003519.pub3.

Ricci, S., Kyle, T., & Carmen, S. (2013).  Maternity and pediatric nursing (2nd ed.).  Philadelphia:  Wolters Kluwer/Lippincott, Williams & Wilkins.

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My first article from the CDC (2014) entitled “Breastfeeding report card: United States/2014,” tabulates the percentage of infants who breastfed:  Ever; At 6 mos; At 1 year; Exclusively through 3 months; and Exclusively through 6 months.  These rates are compared to the Healthy People 2020 goals to see how we are doing in the U.S.  The results revealed that we still lag behind the Healthy People 2020 breastfeeding goals.  The article goes on to conclude that hospital policies and practices significantly affect the decision of the mother to start and continue breastfeeding.

My second article is written by Goyal, Attanasio, and Kozhimannil (2014) entitled “Hospital Care and Early Breastfeeding Outcomes Among Late Preterm, Early-Term, and Term Infants.”  This article showed that regardless of gestational age of a newborn, a dramatic increase in the likelihood of breastfeeding is seen when high levels of support are given at the hospital.  This outcome realizes the need to increase hospital support routinely as the clinical situation allows.

My third article is a systematic review from the Cochrane Database written by Moore, Anderson, Bergman, and Dowswell (2014) entitled, “Early Skin-to-skin Contact for Mothers and Their Healthy Newborn Infants.”  The evidence from analyzing the results of 38 trials with 3472 women and infants revealed that the use of skin-to-skin does indeed promote breastfeeding outcomes.

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The first curricular concept that has prepared me to assume a leadership role in the Mother/Baby unit at Sentara Princess Anne Hospital is advocating for our patients--especially those like the newborns who cannot advocate for themselves.  Being an advocate means that I will act or intercede on behalf of another.  I have done this many times during my preceptorship.  Every time I educated a new mother on the benefits of skin-to-skin/breast crawl, I was advocating for both the newborn and the mother.  Typically the nurse has the most interpersonal contact with the patient of any health care professional so we are in the best position to act as the liaison between patient and family and other team members and departments. To perform this function adequately, the nurse must be knowledgeable about and involved in all aspects of the patient’s care and have a positive working relationship with other team members.  Being the patient’s advocate will gain the respect of our peers and lead them to do the same.

The second curricular concept I will talk about is the need to be culturally competent.  I have learned so much about other cultures during my SCOHS education which I have already used numerous times and will continue to use to assume a leadership role in my new position.  As a nurse we must respect the cultural beliefs of our patients and their families.  Even though those beliefs may not be understood or fully appreciated by the nurse, they must be considered and accepted in all interactions.   These cultural beliefs may have an impact on the patient’s physical and emotional well-being as well as their comfort level.  I had a Vietnamese patient the other day who just delivered a baby boy.  She needed to drink more water to alleviate her mild edema in her extremities, but the nurse had given her ice water.  Some Asian cultures follow the belief that they need to intake warm liquids after delivering because their body is now cold.  I remember this from class and offered to get her some warm water which my patient appreciated. By being culturally competent, I will lead my peers to become aware of other cultural differences as well which will make are whole unit better.

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1.    Education that reaches the whole community is my recommendation to inform prospective moms and dads of the benefits of skin-to-skin/breast crawl.  Nurses could go to OBGYN offices and educate the nursing staff and doctors.  Whenever there is a health fair, nurses could man the booths ready to inform the public.

2.    Add skin-to-skin/breast crawl education for the nurse to give at prenatal appointments and encourage mothers to incorporate skin-to-skin into their birth plans (Moore, Anderson, Bergman, and Dowswell (2012).  Pamphlets could be produced that explains skin-to-skin/breast crawl and these pamphlets could be given to prospective parents.

3.    Labor and delivery nurses could explain the skin-to-skin protocol and its benefits to the parents during early labor or after delivery and add that it is done for all healthy babies.

4.    Skin-to-skin and the breast crawl should be made a priority.  The L&D nurse should wait to call the Nursery nurse until baby has stopped nursing to come and assess the baby.  According to Goyal, Attanasio and Kozhimannil (2014), the more hospital and staff support the mom has regarding breastfeeding, the more likely the infant will be exclusively breastfed.

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The main challenge or barrier blocking the way for many nurses is the fact that their hospitals have not yet changed their policy to allow uninterrupted skin-to-skin.  Other challenges or barriers for nurse involvement in facilitating skin-to-skin and/or the breast crawl, include:  time, energy, and experience and/or education in the new methods to breastfeed for the nursing staff and for the parents.  Also, the nurse may get push back from the mom, dad or family members regarding breastfeeding or allowing the breast crawl to happen naturally.  Some moms will want to speed up the process and try to force the baby on the breast instead of allowing the baby to feed at his/her own pace.  Many moms feel that because their milk has not come in yet, their baby is starving.  So they turn to the bottle.  Education is what is needed to break through these barriers.

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The nurse’s involvement is important in helping facilitate skin-to-skin and the breast crawl.  The nurse can advocate for the couplet in the event obstacles arise that threaten to interrupt the family’s precious time to bond and initiate breastfeeding.  Unless a task is necessary for the well-being of the baby or the mother, it can wait until after the initial breastfeeding.  The nurse can make sure mom and baby have at least one hour, or longer if needed, of uninterrupted skin-to-skin contact.

Another very important piece of the nurse’s involvement is in the education of the mom and dad.  The parents must be educated on the fact that breastfeeding is best for baby for the reasons already mentioned in the introduction and that the best way to initiate breastfeeding is by allowing the baby to lead the way.  The nurse is the person who will explain to the parents all the benefits of skin-to-skin as well as all the pitfalls if skin-to-skin is not performed as well as the latest research regarding the breast crawl so they know what the baby will instinctively do if left uninterrupted.

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It should be normal practice for all hospitals to place newborns without health issues immediately on the mother’s chest, skin-to-skin, after delivering vaginally or c-section.    There is evidence that these babies obtain greater respiratory function, normal temperatures and glucose stability as well as cry a significant amount less which indicates that they are in less stress.  Research has shown that when skin-to-skin and left undisturbed on the mother’s chest, the baby will instinctively scoot him/herself toward the mother’s breast and once baby reaches mom’s sternum, his/her head will move from side to side and bob up and down and in an effort to locate the breast and as he/she approaches the nipple, his/her mouth opens wide and after a few tries, the baby latches on and suckling takes place (Ricci, 2013).  In a studied funded by the CDC, the Women’s Center at Terrebonne General Medical Center in Louisiana changed its practice to placing the newborn skin-to-skin immediately after birth in vaginal and c-section deliveries.  Breastfeeding initiation at this hospital had been only 40% in 2011 and in 2014, it was up to 65% (CDC, 2014).  Only a small percentage of hospitals are currently practicing skin-to-skin which allows the breast crawl to take place and natural latching to happen.  That needs to change.

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At Sentara Princess Anne Hospital, the Labor and Delivery (L&D) nurse places the new baby on the mom’s chest, skin-to-skin, right after the umbilical cord is cut to aid in facilitating breastfeeding and bonding between mother and baby.  Whether it is a vaginal or cesarean section delivery, this is the norm.  The nurse then proceeds to dry the baby with towels and conduct the APGAR test at 1, 5 and, if needed, 10 minutes while the baby remains on the mother’s chest.  If at any time the baby is showing signs of respiratory distress, then interventions will immediately be taken.  As soon as possible, the family is left alone to allow the instinctive nature of the newborn to take over.  The Nursery nurse does not even arrive in the L&D room until after the baby has been experiencing extrauterine life for at least one hour which aids in obtainment of the goal of breastfeeding.  When the Nursery nurse arrives, baby has been on mom’s chest for at least one hour and most of the time, the baby has been suckling at the breast for at least part of that time.  The Nursery nurse does not immediately remove the baby to perform his/her newborn assessments but sets up and waits patiently.

Although the nurse does the right thing by not pulling the baby off the mom’s chest immediately, I believe the fact that the nurse is waiting in the room signals the mom to stop breastfeeding.  An improvement to this process, would be if the L&D nurse would call the Nursery nurse to come over once the mom has stated that the baby was no longer nursing.  Then the mom would not feel like she has to stop the baby while he/she is in the middle of feeding.

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BABY-LED BREASTFEEDING:  PLACING BABY SKIN-TO-SKIN IMMEDIATELY AFTER BIRTH--by Sue Brown

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BABY-LED BREASTFEEDING:  PLACING BABY SKIN-TO-SKIN IMMEDIATELY AFTER BIRTH--by Sue Brown