Skin to skin contact during breastfeeding as it provides the infant with the naturally existing thermoregulation and facilitates the spread of oxygenation which to other crucial body parts. The reason for the evidence-based article is to establish whether skin to skin psychologically affects the rate of breastfeeding compliance (Body, 2017). The study was based on the following PICO question: Amongst newborns, how does skin to skin, compared to no skin to skin, improve the rate of breastfeeding compliance. Both researchable and non-research articles were appraised to determine the hypothesis indicated above. The study aims at improving breastfeeding compliance amongst newborns while consequently ensure that infant standard care is upheld.
Skin to skin contact during breastfeeding is efficient in providing care to newborns without being concerned about the possible risks involved. It is thus recommended to apply the skin to skin contact when breastfeeding a baby. The practice is considered critical in the promotion of breastfeeding among infants (Brimdyr, Cadwell, Stevens, & Takahashi, 2017). The Baby-Friendly Hospital Initiative (BHFI) has mostly encouraged the use of skin to skin breastfeeding on babies stating that it increases the rate at which the infant is willing to feed and also further strengthens the particular mother and child bond (Bee, Shiroor, & Hill, 2018). As a result, the relationship between the baby and the mother will be more personalized. Therefore, the implications of applying the skin to skin breastfeeding will positively impact the time and initiation of breastfeeding and also the compliance rate.
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Given the increasing rate of deaths of infants within the first seven days known as Neonatal mortality,Mugadza (2018) elaborates that “…Early breastfeeding initiation (EBFI) has a potential protective effect on the reduction of neonatal deaths by 22% (4).” Early breastfeeding Initiation (EBI) is directly proportional to the rate of the growth and development of the child especially if breast milk is administered using the skin to skin technique. Additionally, skin to skin breastfeeding has been known as the most cost-effective method of feeding infants while ascertaining that care and safety are maintained (Hakala et al., 2017). Studies have proven that the skin to skin administration of colostrums has a protective effect on the baby since the body immune system of the infant is revitalized. Thus, it is certain that skin to skin breastfeeding influences the compliance rate amongst infants.
The current constraints faced by breastfeeding include the prejudice the public has dedicated to the practice. In modern society, it is considered a taboo for a mother to breastfeed the baby in public. Body (2017) explains that infants are forced to adapt to the alternative which is harvested breast milk in a bottle as a method of feeding the baby. The society has almost successfully managed to discourage skin to skin breastfeeding with critics claiming that the method was unhygienic and may cause adverse health implications (Redshaw, Hennegan, &Kruske, 2014). Nonetheless, the sensitive issues around skin to skin breastfeeding should be discussed between the medical practitioners and the mother. Although extensive research has been dedicated to the health and social implications of skin to skin breastfeeding, very little focus has been left for the study on the effects of skin to skin breastfeeding on the rate of compliance amongst infants. Thus t has become prudent to study the relevance of and need for skin to skin breastfeeding in the current society.
Redshaw, Hennegan, &Kruske (2014) assert that “A recent systematic review presented evidence for significant positive benefits of skin-to-skin contact and holding in the minutes and hours after childbirth for successful and continued breastfeeding.” Despite the few challenges, skin to skin breastfeeding is said to have immediate benefits to full term infants such as the stabilization of the respiratory system, reduction, and prevention of hypoglycemia, thermal regulation, and the development of appetite of the infant (Brimdyr, Cadwell, Stevens, & Takahashi, 2017). Invulnerable infants, nurses recommend that even fathers provide this type of care that is skin to skin contact. Skin to skin thus helps in increasing maternal behaviors amongst babies such as staring, touching using her hands and identifying the body scent and voice of the mother. Hence, the maternal interactions caused as a result of skin to skin breastfeeding encourage fast growth amongst the babies. In this context, both the mothers and infants are learning about one another.
PICOT Table
| Example: | |
| P (patient/problem) | Infants |
| I (intervention/indicator) | Skin to skin breastfeeding |
| C (comparison) | To no skin to skin breastfeeding |
| O (outcome) | Influences the compliance rate |
Therefore, the PICO statement is: Amongst newborns, how does skin to skin, compared to no skin to skin, improve the rate of breastfeeding compliance. The question adequately satisfies the requirements of a PICO question as it addresses all components.
Keywords
During the study, the keywords used to find extensive articles that vastly discussed the issue of skin to skin breastfeeding included: skin to skin to improve breastfeeding compliance, skin to skin breastfeeding compliance, breastfeeding compliance, quantitative, qualitative, quality improvement, expert opinion, and commentary.The number of articles and types of scholarly sources found using the various search engines ranged from 11,000 to 6,000, to 4,000 to even 600 respectively. I reviewed 10 to 20 of those articles with each narrowed search topic. A majority of the articles used the qualitative research method to provided viable and compelling proof supporting the hypothesis. Also, some of the articles reviewed used qualitative analysis to obtain information that is either supported or contradicted to the subject matter. Thus, in the end, I ended up selecting five research evidence and two non-research evidence. Some of the evidence obtained includes;
JH- Leveling and Quality Evidence appraisal tool
Level 1
Mugadza, G. (2018). The Practices, Perceptions, and Beliefs of Traditional Birth Attendants Regarding Early Breastfeeding Initiation in Zimbabwe: A Qualitative Study. Journal of Midwifery & Reproductive Health , 6 (2), 1202-1207.
The research evidence portrays the implications of early skin-to-skin breastfeeding which has been defined by the EBFI as the provision of breast milk orally. The study population was approached using the purposive sampling technique. The research included one on one interviews with patients, on some of the sensitive issues affecting the matter of early breastfeeding. The article addresses beliefs and perceptions of various individuals concerning the pertinent issue. Additionally, the study looks at the various merits of colostrums at an early age thus encouraging early breastfeeding. In the context in the research, failure for a mother to breastfeed their baby early is considered to be as a result of a promiscuous life. Hence, the article concludes that skin-to-skin breastfeeding encompasses the whole person that is, the social, moral, cultural, spiritual, and physical abilities to rectify. The keywords used in the article include; skin-to-skin, EBFI, breastfeeding, and morality.
Research evidence
Level II
Bee, M., Shiroor, A., & Hill, Z. (2018). Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data. Journal of Health, Population and Nutrition , 37 (1), 2-12.
The scholarly research article uses relevant databases and websites to derive information at the same time contacting national and international academic references of articles that discussed the matter extensively. The article proposes that immediate newborn care included thermal regulation which was initiated by quickly drying and wrapping the baby in soft clothing immediately after birth and early induced skin to skin breastfeeding. The source discerns both qualitative and quantitative data from Sub-Saharan Africa on the various practices preferred on a newborn and the various issues influencing them. Forty-two studies were conducted from 33 countries on the topic of skin to skin breastfeeding. The results discovered a deviation in the prevalence of immediate newborn care from different countries that is various nations had different ways of providing postnatal care. Most of the information provided by the article mostly emanated from five countries namely; Malawi, Tanzania, Uganda, Ethiopia, and Ghana. The keywords used in the article include breastfeeding, Sub-Saharan Africa, thermal care, and newborn. The article concluded that delaying the process of breastfeeding because of the presumption that baby needs to rest will slow the rate of development of the baby.
Level III
Redshaw, M., Hennegan, J., &Kruske, S. (2014). Holding the Baby: Early mother–infant contactafterchildbirth and outcomes. Midwifery , 30 (1), e177-e187.
This is research evidence that is used to provide compelling information on the time and duration in which an infant should wait before the skin to skin breastfeeding and the possible effects of delay or early exposure. The data provided is obtained from a survey conducted on some women who gave birth in Queensland, Australia. The article investigates the nature of the first hold and the characteristics of the demography. A rather profound analysis was conducted to determine the relations and comparisons in the type of birthing facilities and preferred method of childbirth examining the duration it takes before the infant comes into the skin to skin contact with the mother or father in some instances. It is concluded in the research that women who had an assisted vaginal birth were able to hold their babies sooner than those who underwent the c-section. Thus, women who successfully had assisted vaginal births were able to breastfeed their babies earlier as compared to the cesarean patients are advised to refrain from skin to skin breastfeeding due to the nature of their health. The article thus provides a range of infant care practices in Australia and the impact of early skin contact. Keywords used in the study include Caesarean, vaginal birth, and early contact.
Non-research articles only
Level IV
Boyd, M. M. (2017). Implementing Skin-to-Skin Contact for Cesarean Birth. AORN Journal , 105 (6), 579-592. doi:10.1016/j.aorn.2017.04.003
The article is non-research evidence that aims to provide information on the best practices concerned with skin-to-skin contact between a newborn and a mother during and beyond cesarean birth. The article conclusively demonstrates the benefits of initiating early skin-to-skin contact. Additionally, the author also discusses the family-centered maternity care and the various ways to improve care by maintaining a baby-friendly environment. Consequently, the article discusses the various risks involved with skin-to-skin contact amongst infants and the possible remedies to correct the situation. The article was approved by the CNOR and CRNFA and was certified to be providing not only accurate but relevant information. The keywords used in the study include; Iowa Model of Evidence-Based Practice, cesarean birth, new, skin-to-skin contact, and maternity care. The research concludes that nurses are listed for not implementing early skin-to-skin contact on the patients and the infants born. Also, it was concluded that the majority of mothers first encounter skin-to-skin contact with their children while on the OR bed. Those who deliver safely through virginal assisted births spend about 42 minutes with their babies and thus initiate skin-to-skin breastfeeding.
Level V
Brimdyr, K., Cadwell, K., Stevens, J., & Takahashi, Y. (2017).An implementation algorithm to improve skin-to-skin practice in the first hour after birth. Maternal & Child Nutrition , 14 (2), e12571. doi:10.1111/mcn.12571
The non-research evidence argues favorably on the issue of early skin-to-skin contact and early breastfeeding immediately after birth. The article provides compelling evidence as to why immediate skin-to-skin contact between the mother and the baby is critical and also addresses the various causes of delay. The study used data from Japanese research conducted on newborn behavior after a virginal birth from a baby-friend facility in Nishio, Japan. A sample of 14 mothers that is both primipara and multipara are observed for an hour after successfully giving birth to determine the length of time it will take before the mother are permitted skin-to-skin contact with the newborns. The infants were allowed faster skin-to-skin contact only in the condition that they were healthy. Thus, a baby with some medical complications has delayed any contact with their parents. The keywords used in the article included; Shinto skin, vaginal, algorithm, cesarean, and birth. The article concludes that is considered a best care practice to implement skin-to-skin contact between the infants and the mothers within the first hour of birth.
Evidence Matrix
|
Authors |
Journal Name/ WGU Library |
Year of Publication |
Research Design |
Sample Size |
Outcome Variables Measured |
Level (I–III) |
Quality (A, B, C) |
The research investigates the deviation in the prevalence of immediate newborn care in different countries |
Journal of Midwifery and Reproductive Health |
2018 |
Qualitative |
337, 294 people |
Time |
I |
A |
The article Portrays the implications of early skin-to-skin breastfeeding |
|
| Journal of Health, Population and Nutrition | 2018 | Quantitative | 33 countries | Duration of time before skin-to-skin contact | II | A |
The findings of this study could inform Behavior change interventions to improve the uptake of immediate newborn care practices. |
|
| Midwifery | 2014 | Survey | 4574 women | Time | III | B |
Providers should consider extending the period of early contact in routine Care |
|
| AORN Journal | 2017 | Questionnaire | 50 | Reasons nurses don’t implement s | IV | A |
Reasons nurses listed for not implementing STS contact in the OR |
|
| Maternal & Child Nutrition | 2017 | Qualitative | 14 women |
study on newborn behavior after vaginal birth |
V | A | Provides the reasons why nurses do not implement SOS contact early after birth |
Recommended Practice Change
The nurses and practitioners should implement the skin-to-skin contact and breastfeeding, to promote the health of the infant by boosting his mean.
Level 1: Portrays the implications of early skin-to-skin breastfeeding
Level II: The findings of this study could inform behavior change interventions to improve the uptake of immediate newborn care
Level III: Providers should consider extending the period of early contact in routine care
Level IV: The article conclusively demonstrates the benefits of initiating early skin-to-skin contact.
LEVEL V: The infants were allowed faster skin-to-skin contact only in the condition that they were healthy
Key Stakeholders
The primary stakeholders in the matter involve the infants whose lives depend on whether they receive early skin-to-skin breastfeeding or not, the mothers, nurses, and doctors. Additionally, health facilities are also responsible for the implementation of the recommended time for an infant to receive skin-on-skin contact. Others affected by the relevant subject include the father who bears the loss of a child and the government in case of the mortality rate increases. The matter affects almost every member of the society socially, morally, and economically and should thus take of her.
Barriers
Numerous obstacles are preventing the revolution of skin-to-skin contact and early breastfeeding. One of these issues includes the general perception of the public. Postnatal care differs in various parts of the world. Therefore, there are nations like the Middle Eastern countries where breastfeeding is considered a taboo or it is prejudiced against (Brimdyr, Cadwell, Stevens, & Takahashi, 2017). Additionally, some practitioners deliberately delay the implementation of the skin-to-skin contact and early breastfeeding. These factors prevent the newborn from obtaining the nutritional value of colostrums thus impacting its health and increasing the chances of death of the newborn.
Strategies to Eradicate Barriers
One effective strategy that would efficaciously improve the situation would ensure that qualified and professional nurses are employed. Individuals who identify their responsibilities and passionately conduct their duties would not risk the lives of innocent patients unless the compelled to delay the implementation due to complications arising (Aghdas, Talat, &Sepideh, 2014). Also, countries that are still upholding outdated beliefs should be willing to embrace change and keep abreast with the medical and technological changes. In fulfilling these, the rate of mortality on infants would significantly decrease.
Indicators to Measure Outcome
It is clear the concerted efforts put in place to establish development in the matter. After implementing the proposed changes, one may measure the improvement by surveying multiple baby-care facilities. To ensure that the proposed changes are effected, the following indicators are necessary;
There should are no delays by nurses
Mothers are allowed to breastfeed immediately after the baby is born
The society changes its perception on breastfeeding
Various baby-care institutions are educated on the importance of skin-to-skin breastfeeding.
References
Aghdas, K., Talat, K., &Sepideh, B. (2014). Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial. Women and Birth , 27 (1), 37-40.
Bee, M., Shiroor, A., & Hill, Z. (2018). Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data. Journal of Health, Population and Nutrition , 37 (1), 2-12.
Boyd, M. M. (2017). Implementing Skin-to-Skin Contact for Cesarean Birth. AORN Journal , 105 (6), 579-592. doi:10.1016/j.aorn.2017.04.003
Brimdyr, K., Cadwell, K., Stevens, J., & Takahashi, Y. (2017).An implementation algorithm to improve skin-to-skin practice in the first hour after birth. Maternal & Child Nutrition , 14 (2), e12571. doi:10.1111/mcn.12571
Hakala, M., Kaakinen, P., Kääriäinen, M., Bloigu, R., Hannula, L., &Elo, S. (2017). The realization of BFHI Step 4 in Finland – Initial breastfeeding and skin-to-skin contact according to mothers and midwives. Midwifery , 50 (1), 27-35.
Mugadza, G. (2018). The Practices, Perceptions, and Beliefs of Traditional Birth Attendants Regarding Early Breastfeeding Initiation in Zimbabwe: A Qualitative Study. Journal of Midwifery & Reproductive Health , 6 (2), 1202-1207.
Redshaw, M., Hennegan, J., &Kruske, S. (2014). Holding the Baby: Early mother–infant contactafterchildbirth and outcomes. Midwifery , 30 (1), e177-e187.
