Initiative to Increase Skin-to-Skin Contact in the Operating Room After Cesarean

Objective: To measure the increase in rates of skin-to-skin contact (SSC) for at least 15 minutes within the first hour of life in the operating room (OR) after cesarean birth after implementation of an SSC initiative. Our goal was to improve the rate of SSC from 20.3% to 50% for eligible newborns. Design: Quality improvement initiative with a pre-post-practice implementation design using surveys. Setting/Local Problem: A tertiary academic hospital in the U.S. Midwest with more than 12,500 births annually. Participants: Nursing staff on a labor and delivery unit (N = 40). Interventions/Measurements: We implemented nurse education, included SSC as part of the interdisciplinary team time-out (TTO) before procedures, and developed a new practice guideline to initiate SSC for at least 15 minutes within the first hour of life in the OR after cesarean birth. We measured nurses'; knowledge and self-reported SSC practices with preimplementation and postimplementation surveys. We measured nurses' inclusion of SSC in the TTO and actual SSC practices in the OR with an audit tool. Results: We analyzed a total of 394 audit tool forms from the initiative. Nurses reported more use of SSC after implementation of the SSC initiative. Skin-to-skin contact was verbalized in 75.3% (70/93) of the TTOs after implementation, and SSC for 15 minutes in the OR was completed in 20.3% (16/79) of preimplementation and 24.7% (23/93) of postimplementation phases. Total SSC for any length of time within the first hour in the OR increased from 30.4% (24/79) to 61.3% (57/93) in eligible women and newborns after implementation of the initiative. Conclusion: SSC in the OR increased after a 4-month initiative to increase SSC through nurse education, inclusion of SSC in the TTO, and a new guideline to initiate SSC in the OR at least 15 minutes within the first hour of life.