EXPANDED HOSPITAL POLICY #5:

INTERVENTION / MANAGEMENT

RATIONALE

RESOURCES

5.1 Assuming baby and mother are stable, the mother and baby should be skin-to-skin during the first several hours following birth. This includes the post-cesarean mother and baby, when alert and stable.

5.1.1 Babies are usually most ready to breastfeed during the first hour following birth. For the normal newborn this should occur prior to such interventions as: the newborn bath, glucose sticks, foot printing, and eye treatments.

5.1.2 During the first day of life, skin-to-skin time and breastfeeding should take priority over other routine events such as infant bathing, pictures, and visitors.

5.1 Mothers should be permitted to engage in this normal physiological process, regardless of birth method, as long as medically stable. Post-cesarean mothers can still engage in breastfeeding. Temperature stabilization will almost always occur best with the baby in skin-to-skin contact on the mother’s chest, with a blanket covering the infant and mother. 1,2,4,5,8,9

5.1.1 The normal infant has a strong suck reflex during the first 20-30 minutes post-birth. Disturbing the mother and infant during this time can make it difficult for the infant to learn the suckling process. 7,11,12


5.1.2 Separation of mother and baby for routine procedures may be distracting and interfere with breastfeeding initiation unnecessarily. Organizing nursing care to focus on keeping the mother and newborn together will increase the opportunities for the newborn to demonstrate feeding readiness. 3,10,13

Ferber SG, Makhoul R; The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial PEDIATRICS Vol. 113 No. 4 April 2004, pp. 858-865 (Full Text)

Christensson K, Siles C, Moreno L, et al. Temperature, metabolic adaptation and crying in healthy, full-term newborns cared for skinto-skin or in a cot. Acta Paediatr. 1992;81:488–493 (Abstract)

5.1.3 If breastfeeding is delayed due to medical condition(s) of mother or baby, the baby should be put skin-to-skin and allowed to approach the breast as soon as possible after they are stable.


5.1.4 The baby should be encouraged to breastfeed without restriction.



5.1.5 Nursing policies and practices should support care of the mother and infant together and should be documented in nursing charting.

(Refer to Policy #9 for safety considerations)

5.1.3 Early suckling allows the infant to receive the immunologic benefits of colostrum. Colostrum also stimulates digestive peristalsis of the infant. Suckling stimulates uterine involution and inhibits bleeding for the mother. 6,7

5.1.4 Restricting breastfeeding may increase the degree of physiological breast engorgement that occurs during the transitional milk phase.

Hanson,L; Immunobiology of Human Milk: How Breastfeeding Protects Infants, 2004, Hale Publishing

Resources on Medications and Breastfeeding:

•  Drugs and Lactation Database (LactMed)
• “Safety of Commonly Used Drugs in Nursing Mothers”: Drug Information Service - Philip O. Anderson, PharmD, FASHP, FCSHP – University of California San Diego Campus.
• Medications and Mothers’ Milk – Thomas Hale, RPh – Book, Palm and Internet access can be purchased through Hale Publishing.

Example of a program Evaluation Tool:

• Nursing (PDF)Best Practice Guidelines Evaluation Tools