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Newborn Benefits

Reinforces the immune system

Supports a healthy digestive tract

Associated with a lowered risk of childhood obesity, diabetes, and heart disease

Maternal Benefits

Stimulates uterine contraction and involution

Associated with a lowered risk of postpartum stress and depression

Associated with a lowered risk of ovarian, endometrial, and breast cancer

Mother-Infant Couplet Benefits

Decreased lifetime costs associated with lowered risk of maternal and childhood illnesses

Strengthened maternal-newborn bond

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Nursing practices are often deeply rooted in routine. In order to continually progress in nursing care, this challenge must be addressed by providing comprehensive nursing education. As reported by Turney et al. (2019), an examination of the evidence supporting a delayed newborn bath was an important component that resulted in a significant practice change. This is because the nurse’s perception of delaying the bath was viewed less as a task and more as an intervention to improve maternal and newborn outcomes. By changing the attitude of the nurse through the presentation of facts, compliance of practice changes is improved (Nelson & Grossniklaus, 2019).

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Provider of Family-Centered Care

The nurse is dedicated to providing safe and quality care that satisfies the family’s physical and psychosocial needs throughout the childbearing process to promote maternal and newborn health and wellness (Ricci, 2017). This includes collaborating with the family and the interdisciplinary team and maintaining a supportive and empowering environment. Depending on the interventions that he or she prioritizes, plans, and advocates for, the nurse can positively influence health outcomes.

Healthcare Professional Aware of Evidence-Based Practices

Important aims of maternal, newborn, and women’s health nursing include improving the childbearing experience, improving health outcomes, and reducing the costs of care (Ricci, 2017). The most effective way to achieve these goals is to integrate evidence-based practices; therefore, the nurse must be cognizant of new studies that could affect his or her care. When the interventions implemented are current and validated by research, the nurse increases the quality of care he or she provides and positively influences health outcomes.

Educator of Care Management

The nurse helps the family manage their own care by providing information, sharing knowledge, and demonstrating skills (Ricci, 2017). By developing individualized teaching strategies, the nurse gives the family the confidence to identify issues and solve problems as they navigate toward their goals. Prevention is an essential concept that must be communicated to the family in order to decrease negative health outcomes.

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Nurses should take advantage of every opportunity during the childbearing process to provide patient education. The earlier the information is provided, the more chances nurses have to build upon existing beliefs and to recommend participation in interventions that can improve maternal and newborn outcomes. According to Turney et al. (2019), “nurses observed that the women who received education before childbirth, or those who had time to review the recommendation, were more likely to agree with delaying the first bath” (para. 24). Brogan and Rapkin (2017) advise reaching out to prenatal and childbirth class instructors to reinforce teachings. Huang et al. (2019) state that involving another family member in these teachings is also helpful.

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Exclusive breastfeeding provides many benefits that promote positive health outcomes.

Low exclusive breastfeeding rates need to be improved.

Current literature supports a delayed first newborn bath as an intervention that can encourage exclusive breastfeeding.

As a trusted healthcare provider in birthing hospitals, the nurse can influence evidence-based practice change to promote exclusive breastfeeding.

Nurse education, parent education, and the Baby-Friendly Hospital Initiative are methods that can be used to support the role of the nurse to successfully implement a delayed first newborn bath in practice.

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In order to promote the best outcomes, the American Academy of Pediatrics (AAP) and the American Dietetic Association (ADA) recommend mothers to exclusively breastfeed for the first six months of life and then to continue to breastfeed at least until the first year of life. Exclusive breastfeeding is the use of only human milk. According to the Office of the Surgeon General (2011), this diet is easily tolerated by infants and offers the best nutrition because it is species-specific.

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Delaying the First Newborn Bath for 24 Hours

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Delaying the First Newborn Bath for 24 Hours

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Warren et al. (2020) completed a retrospective cohort study that explored whether delaying the first newborn bath to 24 hours or more after birth would increase the prevalence of breastfeeding initiation as well as the prevalence of exclusive breastfeeding at discharge. Before the intervention, the first newborn bath was completed at an average of 3.5 hours after birth. This bath was typically performed by the nurse in the nursery. After the intervention, the first newborn bath was completed at an average of 30 hours after birth. This bath was performed by the parents in the mother’s room under the guidance of the nurse. Furthermore, mothers were encouraged to perform skin-to-skin or hold the baby after the bath.

Results

There was a significant increase in the prevalence of breastfeeding initiation for average-risk newborns associated with the intervention. The differences reported for the total sample and high-risk newborns were insignificant. For high-risk newborns, this was an expected finding due to common breastfeeding difficulties and interruptions. Overall, the odds of breastfeeding initiation did not change after the intervention.

There was a significant increase in the prevalence of exclusive breastfeeding at discharge for the total sample and average-risk newborns associated with the intervention. The difference reported for high-risk newborns was insignificant. For high-risk newborns, this was an expected finding due to common breastfeeding difficulties and interruptions. Overall, the odds of exclusive breastfeeding at discharge increased by 33% after the intervention.

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Delaying the First Newborn Bath for 12 Hours

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Delaying the First Newborn Bath for 12 Hours

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DiCioccio et al. (2019) completed a retrospective cohort study that explored whether delaying the first newborn bath to 12 hours or more after birth would increase exclusive breastfeeding rates in the hospital as well as plans to use human milk at discharge. Before the intervention, the hospital’s policy was to complete the first newborn bath two hours after birth if vital signs were stable. The median time from birth to the first newborn bath was 1.9 hours. After the intervention, the hospital implemented a practice change that delayed the first newborn bath to 12 hours after birth; however, nurses were encouraged to delay the bath closer to 24 hours. The median time from birth to the first newborn bath was 17.9 hours.

Results

There was no significant difference in the rate of any breastfeeding in the hospital, and the odds of any breastfeeding in the hospital did not change after the intervention.

There was a significant increase in the rate of exclusive breastfeeding in the hospital associated with the intervention. The odds of exclusive breastfeeding in the hospital increased by 60% after the intervention.

There was a significant decrease in the percentage of discharge feeding plans including only formula or a combination of human milk and formula as well as a significant increase in the percentage of discharge feeding plans including only human milk associated with the intervention. Overall, the odds of discharge feeding plans including only human milk increased by 38% after the intervention.

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Delaying the First Newborn Bath for 9 Hours

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Delaying the First Newborn Bath for 9 Hours

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Turney et al. (2019) completed a retrospective cohort study that explored whether delaying the first newborn bath to 9 hours or more after birth would increase exclusive breastfeeding rates at discharge. Before the intervention, the unit’s policy was to complete the first newborn bath once vital signs were stable. The average time from birth to the first newborn bath was 6.88 hours. After the intervention, the unit implemented a practice change that delayed the first newborn bath to 9 hours after birth. The average time from birth to the first newborn bath was 13.17 hours.

Results

There was no significant difference in the rate of exclusive breastfeeding at discharge after the intervention. The authors did note that they had implemented other evidence-based practices that successfully increased exclusive breastfeeding rates such as breastfeeding education for both nurses and mothers and immediate skin-to-skin contact. These practices could have affected exclusive breastfeeding rates before this study and also suggest that combining evidence-based practices is the best way to promote change.

I wanted to include this study in my review to illustrate how there are still variable findings in the literature regarding the outcomes of a delayed first newborn bath. An additional observation that other authors believe have affected the statistical significance of their results is the fact that their birthing facility already had high exclusive breastfeeding rates prior to an intervention. Despite this, many organizations find value in delaying the first newborn bath and have developed guidelines for its implementation.

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The nurse is directly involved in the planning and implementation of the interventions for the mother-newborn couplet. Additionally, the nurse can advocate for evidence-based practice changes that promote maternal and newborn health and wellness. By integrating interventions that are consistent with new research findings, the nurse can improve low exclusive breastfeeding rates. One such intervention is delaying the first newborn bath.

Furthermore, the nurse is a trusted resource for the family because he or she has an active role in the entire childbearing process. This helps the nurse build rapport with the family which in turn motivates the family to value the nurse’s knowledge and expertise. Consequently, the nurse can improve low exclusive breastfeeding rates by providing education that encompasses the importance of breastfeeding as well as the rationale behind interventions like delaying the first newborn bath that can promote its practice.

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Need for Nurse Education

Because a delayed newborn bath has varying results in literature, many nurses are unsure about its benefits. Non-comprehensive education about why there are differing findings for this intervention can be a challenge when trying to implement a practice change. If an intervention is not perceived as valuable by nurses, nurses will be hesitant to integrate the intervention in their care.

Need for Parent Education

According to a survey conducted by Brogan and Rapkin (2017), 72% of parents were unsure about the importance of a delayed newborn bath. This finding illustrates that the education provided to parents about this intervention is inadequate. If an intervention is not perceived as valuable by parents, nurses will not be able to integrate the intervention in their care as expected.

Need for Action from the Administrative Level

It is not enough for nurses and parents to be aware of the importance of a practice change. Action from an administrative level is also needed to develop policies and procedures that are implemented by the institution as a whole. If an intervention is not perceived as valuable by the institution, nurses will lack the support and resources required to successfully integrate a delayed newborn bath in their care.

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Advocating for action from the administrative level is a seemingly daunting but necessary means to ensure that nurses work in an environment that supports their role when it comes to implementing practice changes to improve breastfeeding rates. As reported by Nelson and Grossniklaus (2019), “hospitals with written breastfeeding policies have improved breastfeeding support services, which, in turn, lead to improved breastfeeding outcomes” (para. 1). This is because a written breastfeeding policy supports the effort of the nurse on the unit and communicates the importance of these efforts to healthcare professionals and staff outside of the unit.

The Baby-Friendly Hospital Initiative (BFHI) is a global effort that was launched in 1991 by the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) that addresses these needs. The success of this initiative can be illustrated in a study by Feldman-Winter et al. (2017). In this study, 90 hospitals with low breastfeeding rates were selected to participate in a quality improvement project called Best Fed Beginnings. The goal was to enable these hospitals to earn Baby-Friendly designation or have an assessment for this designation by the end of the project. By April 2016, 80% of these hospitals achieved Baby-Friendly designation and their exclusive breastfeeding rates had significantly increased. Birthing hospitals who wish to achieve Baby-Friendly designation must follow the evidence-based practice guide, Ten Steps to Successful Breastfeeding, which promotes breastfeeding initiation, exclusivity, and duration. The first step outlined in this guide is “[to] have a written breastfeeding policy that is routinely communicated to health care staff” (Baby-Friendly USA, 2021).

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Only a small percentage of children in the United States are breastfed according to the recommended guidelines. The Centers for Disease Control and Prevention (CDC) (2020) report that of the infants born in 2017, about 25% were exclusively breastfed through six months. In fact, there is a Healthy People objective to increase this proportion of infants to over 42% by 2030 (Office of Disease Prevention and Health Promotion, n.d.). These low exclusive breastfeeding rates could be attributed to many factors including the influence of social norms, a lack of breastfeeding knowledge, and inadequate support and promotion in the hospital setting.

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Delayed First Newborn Bath: A Helpful Intervention

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Delayed First Newborn Bath: A Helpful Intervention

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One intervention that can support and promote exclusive breastfeeding in the hospital setting is delaying the first newborn bath. It should be noted that exclusive breastfeeding is not a direct effect of a delayed bath. Rather, a delayed bath presents the opportunity to increase skin-to-skin contact and allows amniotic fluid and vernix caseosa to carry out their natural processes.

Studies have shown an association between skin-to-skin contact and breastfeeding initiation, exclusivity, and duration because it reduces newborn stress (DiCioccio et al., 2019).

Amniotic fluid and vernix caseosa are biological substances that promote maternal-newborn signaling and may help the newborn adapt to the extrauterine environment (Warren et al., 2020).

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1. Baby-Friendly USA. (2021). The Ten Steps to Successful Breastfeeding. https://www.babyfriendlyusa.org/for-facilities/practice-guidelines/10-steps-and-international-code/

2. Brogan, J. & Rapkin, G. (2017). Implementing evidence-based neonatal skin care with parent-performed, delayed immersion baths. Nursing for Women’s Health, 12(6), 442-450. https://doi.org/10.1016/j.nwh.2017.10.009

3. Centers for Disease Control and Prevention. (2020, September 29). Results: Breastfeeding rates. https://www.cdc.gov/breastfeeding/data/nis_data/results.html

4. DiCioccio, H. C., Ady, C., Bena, J. F., & Albert, N. M. (2019). Initiative to improve exclusive breastfeeding by delaying the newborn bath. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 48(2), 189-196. https://doi.org/10.1016/j.jogn.2018.12.008

5. Feldman-Winter, L., Ustianov, J., Anastasio, J., Butts-Dion, S., Heinreich, P., Merewood, A., Bugg, K., Donohue-Rolfe, S., & Homer, C. J. (2017). Best fed beginnings: A nationwide quality improvement initiative to increase breastfeeding. Pediatrics, 140(1). https://doi.org/10.1542/peds.2016-3121

6. Huang, P., Yao, J., Liu, X., & Luo, B. (2019). Individualized intervention to improve rates of exclusive breastfeeding: A randomized controlled trial. Medicine, 98(47). http://dx.doi.org/10.1097/MD.0000000000017822

7. Nelson, J. M. & Grossniklaus, D. A. (2019). Trends in hospital breastfeeding policies in the United States from 2009-2015: Results from the maternity practices in infant nutrition and care survey. Breastfeeding Medicine, 14(3), 165-171. https://doi.org/10.1089/bfm.2018.0224

8. Office of Disease Prevention and Health Promotion. (n.d.). Infants. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants

9. Office of the Surgeon General. (2011). The surgeon general’s call to action to support breastfeeding. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK52682/

10. Ricci, S. S. (2017). Essentials of maternity, newborn, and women’s health nursing (4th ed.). Wolters Kluwer.

11. Turney, J., Lowther, A., Pyka, J., Mollon, D., and Fields, W. (2019). Delayed newborn first bath and exclusive breastfeeding rates. Nursing for Women’s Health, 23(1), 31-37. https://dor.org/10.1016/j.nwh.2018.12.003

12. Warren, S., Midodzi, W. K., Newhook, L. A., Murphy, P., & Twells, L. (2020). Effects of delayed newborn bathing on breastfeeding, hypothermia, and hypoglycemia. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 49(2), 181-189. https://doi.org/10.1016/j.jogn.2019.12.004

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World Health Organization (WHO)

Delay the first newborn bath to 24 hours after birth or to at least six hours if culture dictates a different practice.

Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN)

Delay the first newborn bath to two to four hours after birth or until the vital signs are stable.

Baby-Friendly Hospital Initiative (BFHI)

Delay the first newborn bath and other routine procedures until skin-to-skin contact and the first breastfeeding session has been completed.

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Family-Centered Care

Family-centered care is an important component of holistic care, especially when it comes to the childbearing process. This model of nursing practice recognizes and adapts to the needs of the family unit while valuing their individual beliefs, traditions, and culture. By respecting the uniqueness of the family unit and encouraging their strengths and capabilities, the nurse creates and maintains an environment that motivates each member to learn and have an active part in the childbearing process.

Evidence-Based Care

Evidence-based care is a model of nursing practice that utilizes research-derived findings to achieve the best possible outcomes. The integration of interventions supported by evidence allows the nurse to provide high-quality care that does not deviate from the ultimate goal of improving health. By staying current in his or her clinical practice, the nurse can ensure the safest and most effective care delivery.

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After learning about family-based care and evidence-based care in the classroom, I found that these concepts often complement each other in the clinical setting. During my preceptorship in the Special Care Nursery, I utilized these approaches to develop my leadership skills. Family-based care allowed me to establish a positive working relationship with the parents. I was a role model as they navigated through this new transition. Evidence-based care allowed me to take the initiative to solve problems. By being resourceful in how I implemented best practices, I further expanded my critical thinking skills. Both of these concepts allowed me to become a better educator. I needed to be confident in my knowledge and expertise and often had to experiment with different teaching techniques to better relate to each of the family units I encountered.