San Francisco General Hospital and Trauma Center, USA.
MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24; quiz 325-6. doi: 10.1097/NMC.0b013e3182266314.
This article describes a quality improvement project in which early skin-to-skin (STS) contact, in the operating room (OR) and during recovery, was used as an intervention to increase the success of breastfeeding initiation among healthy infants after cesarean, at a large, urban, acute care teaching hospital. The nursing role is key for the intervention, but the program involves the entire perinatal team, including the obstetricians, pediatricians, and anesthesiologists. During the first 3 months of our intervention, the rate of early STS among healthy babies born by cesarean increased from 20% to 68%. The rate of infants who did not get STS contact within 4 hours of birth decreased from 40% to 9%. Nine months after the initiation of the intervention, 60% of healthy cesarean births utilized STS in the OR, and 70% involved STS within 90 minutes of birth. Healthy infants born by cesarean who experienced STS in the OR had lower rates of formula supplementation in the hospital (33%), compared to infants who experienced STS within 90 minutes but not in the OR (42%), and those who did not experience STS in the first 90 minutes of life (74%). We concluded that STS contact was feasible after cesarean and could be provided for healthy mothers and infants immediately after cesarean birth. Perinatal and neonatal nurses should be leaders in changing practice to incorporate early STS contact into routine care after cesarean birth.
本文描述了一项质量改进项目，即在手术室（OR）和恢复期间进行早期皮肤接触（STS），作为干预措施，以提高在大型城市急症教学医院行剖宫产的健康婴儿母乳喂养的成功率。护理人员在干预中起着关键作用，但该计划还涉及整个围产期团队，包括产科医生、儿科医生和麻醉师。在我们干预的头 3 个月，行剖宫产的健康婴儿中早期 STS 的比例从 20%增加到 68%。4 小时内未进行 STS 接触的婴儿比例从 40%下降到 9%。干预开始 9 个月后，60%的健康剖宫产分娩在 OR 中使用 STS，70%的婴儿在出生后 90 分钟内进行 STS。在 OR 中进行 STS 的健康剖宫产婴儿在医院接受配方奶补充的比例较低（33%），与在 90 分钟内但不在 OR 中进行 STS 的婴儿（42%）和在生命的前 90 分钟内未进行 STS 的婴儿（74%）相比。我们得出结论，剖宫产术后进行 STS 接触是可行的，可以立即为健康的母亲和婴儿提供。围产期和新生儿护士应成为领导者，将早期 STS 接触纳入剖宫产产后常规护理中。
