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EBP: SSC and Breastfeeding

Rhodalyn Bonifacio Western Governors University C361 EBP and Applied Nursing Research January 02, 2021

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EBP: SSC and Breastfeeding Mother-infant skin-to-skin contact (SSC) immediately after birth promotes breastfeeding. SSC immediately after birth greatly impacts the initiation of breastfeeding because during SSC, the newborn’s first nursing cues come into play and at the same time, the Mother’s body releases oxytocin for lactogenesis to occur. Thus, promoting effective breastfeeding. In this moment in time, exclusive breastfeeding plays a vital role in national and international policies (Karimi et al., 2020, p. 48). A few organizations to list that support skin-toskin contact to promote breastfeeding are La Leche League International and the World Health Organization (WHO). The patient/population/problem of the clinical practice problem targets newborns and mothers. The intervention and comparison are as follows: how effective is skin to skin immediately after birth compared to delaying the practice for the purpose of evaluating the newborn, giving newborn medications, and/or the mother needs perineal repairs. The outcome is that skin to skin contact between mother and neonate exert beneficial effects on breastfeeding. The evidence-based practice question: In mothers and newborns, does skin to skin contact immediately after birth as compared to delaying skin to skin contact have beneficial effects on breastfeeding? A research-based article that I chose that answers my EBP question is “The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: a systematic review and meta-analysis” by F. Karimi, H. Miri, T. Khadivzadeh, and N. MalekiSaghooni. The purpose of this article is to convey research of skin to skin contact promoting breastfeeding. The article will show that skin to skin immediately after birth thus, in fact, promote breastfeeding. SSC is when the naked newborn is immediately placed on the mother’s

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EBP: SSC and Breastfeeding bare chest in prone position after birth. During this time, the interaction between the mother and infant intensifies, leading to an increase in the newborn’s response to the mother’s body language. It also increases the newborn’s development of nutritional behaviors such as the rooting reflex. The more likely hood of exclusive breastfeeding will increase significantly (Karimi et al., 2020, p. 55). The methodology that were used were studies with a randomized control trial, placing the naked neonate in the prone position on the mother’s bare chest within 10 minutes of birth, and the participants consisted of mothers and healthy infants between 37- and 42-weeks gestational age. The outcome of the study was “exclusive breastfeeding up to six months after birth” (Karimi et al., 2020, p. 55). Using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this article uses level I evidence. The data was analyzed independently by two authors for eligibility and discussed until consensus was reached. The evaluators used the Cochrane Collaboration’s tool to examine the risk of bias. A third researcher was used if there was a disagreement between the two evaluators. Using the mentioned tool, 6 types of biases were assessed: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other sources of biases (Karimi et al., 2020, p. 55). Depending on the degree of each type of bias, the studies were evaluated and ranked with low, high, and uncertain risks. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the overall strength of the evidence. The data analysis was performed using the STATA 14.1 program. After, a meta-analysis was performed. Publication bias among the RCTs were assessed statistically using Egger’s and Begg’s tests, and visually using a funnel plot (Karimi et al., 2020, p. 55).

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EBP: SSC and Breastfeeding Ethical considerations of the research-based article include informed consent, respecting confidentiality and privacy, communicating results, and anonymity. According to the JHNEBP model, the quality rating of this research-based article is high quality. In these 12 randomized-control trials (RCTs), the results indicated that mother-infant SSC had more statistically significant effects on exclusive breastfeeding than delaying SSC to do routine care. Also, the analysis of the subgroups performed based on vaginal or cesarean delivery, it was determined that mother-infant SSC had a statistically significant effect on exclusive breastfeeding (Karimi et al., 2020, p. 55). A non-research article that helps answer my EBP question is “Skin-To-Skin Care and Breastfeeding in the Perioperative Suite” by A.C. Burke-Aaronson. The purpose of this non-research article is to discuss the safety and potential health benefits of using SSC after vaginal and cesarean births (Burke-Aaronson, 2015, p. 108). This non-research article’s type of evidence is a clinical practice guideline. Based on the JHNEBP model, this evidence is a level IV. Based on the JHNEBP model, the quality rating of this non-research-based article is good quality. The author’s recommendation in the article supports my EBP question. SSC after vaginal and cesarean births increase early initiation of breastfeeding and promotes exclusivity. The author also lists implementation of practice and changes to certain practices to facilitate early initiation of breastfeeding. The author also describes a case where she helped a mother with SSC in the post anesthesia care unit (PACU) after a cesarean section. She then states that within 5

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EBP: SSC and Breastfeeding minutes of SSC, the infant began pre-feeding behaviors. She then helped the mother to breastfeed her infant (Burke-Aaronson, 2015, p. 108). A practice change that I would recommend that addresses my EBP question is to promote doing care activities on the newborn while he or she is on Mom. For example, obtaining vital signs and administering medications such as vitamin K and erythromycin while baby is Mom won’t disrupt SSC. This can also be done while the newborn is breastfeeding. Research has shown that separating the newborn from the mother to do initial newborn care could cause adverse effects on both the mother and baby. This could result in decreasing the interaction between the mother and baby, leading to failure of the newborn displaying nutritional behaviors, causing delays in breastfeeding, and ultimately leading to the use of other foods such as formula. The outcomes of this study could be used in practice by policy makers in the maternal-child healthcare as a guide to encourage performing hospital practices on the newborn while on SSC with the mother, promoting exclusive breastfeeding (Karimi et al., 2020, p. 55). BurkeAaronson’s non-research article states that uninterrupted SSC immediately after birth supports mother- and baby-friendly practices in literature because it enhances physiologic and emotional transition, as well as early initiation of breastfeeding leading to exclusive breastfeeding at least in the first six months of life (Burke-Aaronson, 2015, p. 108). Three key stakeholders I would involve in supporting my practice change recommendation are Lactation Consultants, Childbirth Educators, and Nurse Midwives. These stakeholders would be the prime educators for women to learn about SSC after delivery in promoting breastfeeding. I would consult with these healthcare workers to come up with a plan to effectively promote the idea. For example, I would suggest a pamphlet that goes along with an

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EBP: SSC and Breastfeeding admission packet. The RN that is responsible for the care of the patient in the Labor and Delivery unit would then give education regarding SSC and breastfeeding. Two specific barriers I may encounter when implementing the practice change recommendation are family members wanting to hold the newborn and the mother feeling sick after giving birth. The two strategies I could use to overcome the barriers are to educate the family members about the benefits of SSC for the first hour of life to promote breastfeeding. If the mother is feeling sick, I would educate and encourage the father of the newborn to do SSC until the mother is stable. To measure the outcome from my EBP question, I can take statistical data from my unit to see if there is an increase rate in the correlation between SSC and breastfeeding. We can use a questionnaire before discharge regarding this topic to collect the data.

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EBP: SSC and Breastfeeding References

Burke-Aaronson, A. C. (2015). Skin-To-Skin Care and Breastfeeding in the Perioperative Suite. MCN, The American Journal of Maternal/Child Nursing, 40(2), 105–109. https://doi.org/10.1097/nmc.0000000000000113

Karimi, F. Z., Miri, H. H., Khadivzadeh, T., & Maleki-Saghooni, N. (2020). The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: a systematic review and meta-analysis. Journal of the Turkish-German Gynecological Association, 21(1), 46–56. https://doi.org/10.4274/jtgga.galenos.2019.2018.0138

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