Hospital Breaks Barriers for Cesarean Section Couplet

Posted June 23, 2015 by Kristie Velarde

Caesarean Skin-to-skin Rate ImprovementsIt was just minutes after a cesarean section birth at Good Samaritan Hospital Medical Center in West Islip, NY and baby and mom were soon headed to different recovery rooms. But when Janet Stevens, RNC-OB, MSN, CNL, CCRN, saw the newborn’s perfect breastfeeding latch, she knew that they could not be separated. She quickly launched a plan B.

Rita Ferretti, BS, RN, C-NIC, IBCLC, received Stevens’ call for help. After ensuring that both patients were stable and safe, Ferretti, a post-anesthesia care unit nurse and a transporter took the pair to the maternity floor. The baby never left her mother’s chest. Keeping the couplet together from the operating room to the maternity floor became a rare but celebrated victory, also due to the efforts of the maternity floor staff.

“In this situation, we really went outside the box,” Ferretti says. “What impressed me was that the lines between the departments became blurred and we worked together seamlessly.”

Since the fall, Good Samaritan Hospital Medical Center has been participating in the NICHQ-led New York State Breastfeeding Quality Improvement in Hospitals (NYS BQIH) Collaborative, which aims to increase exclusive breastfeeding rates.

The importance of immediate skin-to-skin contact after birth, so long as mother and baby are stable, is an evidenced-based, best maternity care practice. It not only assists mothers with initiating breastfeeding, but it has also been shown to regulate a baby’s temperature, blood glucose level and heartbeat. However, traditionally in most C-section births, babies are immediately taken to separate exam areas while mothers are transported to a post-anesthesia care unit. Once both patients have been deemed stable, they are reunited on the maternity ward. Incorporating system-level changes at hospitals to stop the separation of mother and baby post C-section has been a particularly challenging area for hospitals. But with months of coaching from NICHQ about how to implement system changes under their belt, Ferretti and Stevens said they knew this recent scenario was an opportunity for change.

“The collaborative empowered me to advocate more fiercely for this mom, whereas I may not have before,” says Stevens. “With all of the education and training behind me, I now feel that I have more of a voice.”

Ferretti and Stevens are hopeful that the momentum will continue. Improving the hospital’s rates of skin-to-skin contact immediately after birth has been one of Good Samaritan’s foremost objectives. It’s making progress. When the hospital began the NYS BQIH Collaborative in the fall, zero percent of C-section mothers left the hospital exclusively breastfeeding. Since then, that number has risen to nearly 30 percent.

The team made small changes that were easy to implement. For example, babies are no longer placed in a T-shirt—only a blanket—to make the first skin-to-skin contact easier. It also allows nurses to check the baby’s vital signs while in the mother’s maternity room, whenever possible.

The Good Samaritan improvement team also adopted the concept of small tests of change for additional quality improvements. For example, Ferretti says that the group was finding that babies were arriving on the maternity floor with early signs of hypothermia, even though skin-to-skin contact had become a normal practice. As a result of some small tests, the team implemented the practice of placing a warm blanket on top of the mother and baby during transport.

“This approach was actually something that was discussed on one of the collaborative’s monthly action calls; It was highlighted as a best practice that one of the other hospitals was already doing,” Ferretti says. “These regular action calls are helping us identify best practices so that we can really make a difference quickly.”

When Good Samaritan began the collaborative in September 2014, its overall skin-to-skin rate was just 10 percent. In May 2015, that number soared to almost 90 percent. Babies going skin-to-skin after vaginal births increased from 50 percent to 100 percent as of May.

“We are very proud of the numbers,” Ferretti says. “Our team meets weekly and we encourage everyone to attend. I don’t think there is one person working at this hospital who hasn’t heard the term ‘skin-to-skin.’ We will continue to celebrate victories, but we will not get comfortable and fall back into old habits.”

To learn more about NICHQ's breastfeeding work, visit the breastfeeding section of our website.

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