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.  

    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.

    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.

    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. 

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.

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.