Immediate skin to skin of the well neonate with their mother following caesarean birth – an integrative literature review. Essay Example


Post-caesarian Skin-to-Skin Contact for Mother and Child

Benefits and Risks

Infants born through caesarian delivery encounter the threat of suffering from hypothermia (Beiranvand et al., 2014). The condition emanates from the absence of the shivering mechanism that enables infants to maintain constant body temperature following their exposure to the external environment. It is evident that skin-to-skin contact between mother and infant plays a significant role in preventing the drop in body temperatures among infants. Besides preventing the drop in the body temperature of the infant, skin-to-skin contact between the mother and infant following a caesarian delivery also enhances the child’s breastfeeding successfulness. The contribution of skin-to-skin contact towards preventing the drop in the infant’s body temperature emanates from the fact that the direct contact enables the infant to receive warmth from the mother thereby activating the child’s sensory nerves. The activation of the sensory nerves results in the cutaneous vasodilation thereby increasing the temperature of the child.

Performance of infants subjected to skin-to-skin contact with their mothers on rooting reflex and breastfeeding indicators revealed that the contact enables infants to perform higher on the variables as compared to infants that did not have direct contact with their mothers following delivery. It is evident that children placed on the mother’s abdomen and those placed under a radiant warmer exhibit different breastfeeding characteristics. Infants placed under a radiant warmer immediately after delivery spends a long time before moving to the mother’s breasts and starting to breastfeed. However, the situation is different for children placed under the mother’s abdomen soon after their delivery. Such children start moving towards the breasts of their mothers and head towards the nipples spontaneously (Beiranvand et al., 2014). The result indicates that post-caesarian skin-to-skin contact for mother and child contributes positively towards improving the breastfeeding characteristics of the infant.

Immediate skin-to-skin contact is also important in the sense that it increases the level of maternal satisfaction and reduces maternal anxiety in the event of a caesarian delivery. However, it is important for the healthcare providers to ask the mother about her willingness to initiate skin-to-skin contact rather than basing on the assessment of the healthcare providers. The need to ask the mother emanates from the fact that women subjected to unscheduled caesarian deliveries (UCD) and scheduled caesarian deliveries (SCD) require different levels of sedation after the delivery process (Bavaro et al., 2016). The fact that immediate skin-to-skin contact between the mother and infant improves the breastfeeding characteristics of the child indicates that it also contributes towards reducing the burden that the mother, the family, and the entire society would incur in covering medical costs emanating from the child’s illnesses (Brady et al., 2014).

It is also worth noting that the immediate skin-to-skin contact between the mother and infant benefits both the mother and the child. Few moments after birth, it is evident that the infant is eager to meet the mother. Consequently, newborns exhibit a protective and heightened response towards thermal, odor, and tactile cues. Consequently, initiating skin-to-skin contact between the mother and infant soon after delivery helps to initiate the child’s specific behaviors that enable the infant to meet basic biological needs. The contact also stimulates neuroprotective mechanisms and enables neurobehavioral regulation on the part of the child at the earliest stage possible (Crenshaw, 2014). This indicates that the immediate skin-to-skin contact between the mother and infant is essential in the sense that it stimulates proper neurobehavioral responses on the part of the child thereby reducing the time that the infant requires to put up with the external environment. Gregson (2016) also identified the positive contribution of immediate skin-to-skin contact between the mother and infant towards improved breastfeeding characteristics on the part of the child. According to Gregson, the immediate contact between the mother and infant increased the breastfeeding rates among infants under study. Initiating the contact immediately after delivery contributes towards increasing breastfeeding rates for infants between 48 hours and six weeks thereby contributing towards the general improvement of the infant’s health (Gregson, 2016).

Elliot-Carter and Harper (2012) also identified the significance of the immediate contact between infant and mother after caesarian delivery to the mother and the infant. According to their study findings, it was evident that it is possible and necessary to maintain contact between the mother and infant after caesarian delivery as opposed to the traditional practice of separating the mother from the infant. Elliot-Carter and Harper discovered that the immediate intimacy between the mother and infant after caesarian delivery is essential in enabling early bonding of the mother to the child and vice versa as well as initiating breastfeeding on the part of the child. Consequently, the practice of initiating immediate skin-to-skin contact between the mother and infant after caesarian delivery increases the satisfaction of patients, physicians, and nurses besides enhancing family-centered care. The other advantage of the practice is the fact that the mother attains the advantages without having to incur additional costs associated with improving breastfeeding characteristics and treating the child against illnesses.

According to Frederick and Schneider (2015), the immediate skin-to-skin contact between the infant and mother is beneficial because of its contribution towards improving the emotional and physiological wellbeing of both the mother and the infant. Since caesarian deliveries account for approximately one-third of all deliveries, the initial medical practice recommends separating the infant from the mother for a period of one to four hours immediately after birth. Apparently, the separation grants little opportunity for the interaction between the infant and the mother. Even though there are substantial benefits of the immediate contact between the mother and infant, it is evident that there are certain risks associated with the practice. For instance, the contact has safety implications on the part of the infant in the event that the mother presents a depressed consciousness level during the caesarian delivery (Bavaro et al., 2016). The initial rationale for separating the immediate skin-to-skin contact between the infant and the mother emanated from the need to enable the completion of the operation procedure on the mother. Therefore, immediate contact may prevent the physicians and nurses from completing the surgical procedure effectively. Moreover, the immediate contact could impede patient monitoring exercises on the patient thereby increasing the risk of postoperative complications. This would have an overall negative effect on the postoperative recovery process (Frederick & Schneider, 2015).

Enablers and Barriers of Skin-to-Skin Contact

It is evident that local or medical conditions are the main barrier to the initiation of skin-to-skin contact between the infant and mother immediately after a caesarian delivery. Certain medical and local barriers may result in the delayed initiation of the practice thereby preventing the infant and mother from realizing the benefits associated with utilizing the practice. The barriers of the practice in the Operating Room (OR) are also its enablers. Regardless of the request of the mother to have intimate SSC with the infant, organizational factors and other specific factors presented by the OR environment may impede the mother’s request to establish the intimate contact with the infant (Kollmann et al., 2016). The medical condition of the newborn is among the main barriers of initiating SSC immediately after the caesarian delivery process. In some cases, the condition of the newborn can prevent the immediate placement of the child on the chest of the mother (Grassley & Jones, 2016). One of the solutions to the problem is the adequate preparation of nurses and other healthcare providers.

Besides the condition of the newborn, challenges associated with positioning the newborn on the mother’s chest with regard to the positioning or size of the surgical drape also present significant barriers to the implementation of the practice. In some instances, mothers feel nauseous in the OR after caesarian deliveries. This acts as an impediment to the easy placement of the child on the chest of the mother immediately after delivery. Mothers that feel claustrophobic also prevent the initiation of SSC immediately after the caesarian delivery. Such mothers are afraid of the environment of the operating room (OR). Consequently, they insist on leaving the room soon after the surgical operation. As mentioned above, the condition of the infant is the other enabler or barrier to the immediate initiation of SSC. In some cases, it is imperative for the healthcare providers to conduct an immediate assessment of the child to determine whether the infant requires immediate medical attention. In such an incidence, it is evident that healthcare providers would find it difficult to initiate SSC irrespective of the mother’s insistence on the practice. Finally, caesarian deliveries are short-term events (Grassley & Jones, 2016). The fact that physicians and nurses conduct caesarian deliveries within a short time implies that the mother cannot have prolonged SSC immediately after the delivery. In such a case, it is necessary to transfer the mother to a ward soon after the delivery to resume the bonding process.

The condition of the mother also impedes the successful initiation of SSC in certain cases. In some instances, the mother presents pain sensation and decreased mobility. Apparently, the attributes are impediments to the immediate initiation of SSC following a caesarian delivery. The fact that women that undergo operations in the delivery process imply that they feel more pain thereby increasing the complications associated with placing a child on their bellies. Even though intense pain is not evident in some cases, it is evident that women that deliver through caesarian deliveries are less mobile as compared to women that deliver normally (Zwedberg et al., 2015). Because of the massive role played by immediate SSC on the mother and the infant, midwives and nurses try to resolve the problem by encouraging skin-to-skin contact and using pain-relieving pharmaceuticals. However, the situation is different for nurses and midwives that prioritize the recovery of the mother above the initiation of SSC. To such nurses, it is better to give the mother adequate recovery time before initiating contact between the mother and child. The overall judgment of the nurses depends on balancing the safety of the infant and the wellbeing of the mother.

In some cases, lack of efficient collaboration between staff members and different wards impedes the initiation of immediate SSC between the mother and the infant. In the quest to avoid hindering the tasks of other medical professionals in the OR, midwives and nurses move the newborn to a secluded area of the OR. In essence, midwives have noted with concern the fact that they have little room to offer their services because of the constant pushing force emanating from other professionals that intend to continue with their surgical procedures on the mother. Lack of adequate knowledge about the need for SSC presents the other challenge to nurses and midwives intending to initiate immediate SSC following a caesarian delivery. Some parents are not ready to maintain SSC with their infants 24 hours a day (Zwedberg et al., 2015). In some cases, the cultures of some parents lead them to believe that it is not proper to expose a child to the cold with diapers only after the caesarian delivery.

In order to implement SSC successfully in the OR, one of the enablers of the practice is the development of a process that fits the context of the practice in the healthcare facility. This includes the identification of the potential barriers such as the traditional caesarian delivery process that recommends the separation of the infant from the mother immediately after the caesarian delivery process (Grassley & Jones, 2014). Staff education would play a pivotal role towards implementing the practice in the OR. In the quest to educate the staff, it is necessary to adopt an effective staff education strategy. Effective inter-professional collaboration between physicians, nurses, and other healthcare providers in the OR is necessary for the successful implementation of SSC. The collaboration should also include the delineation of the specific roles of the members of the surgical team. One of the roles is the introduction of a designated nurse for the infant.

The practice requires the immediate placement of the infant on the chest of the mother immediately after the caesarian delivery, followed by the drying exercise, or after an initial assessment. Regardless of whether the healthcare providers initiate SSC before or after the initial assessment of the mother and the infant, it is imperative to initiate SSC immediately to ascertain bonding between the mother and child, prevent the drop in the infant’s body temperature, and initiate breastfeeding. Adequate preparation of the parent and the provision of the maternal choice to the mother are also essential in enabling SSC in the practice. The fact that majority of healthcare institutions recommend the traditional practice of separating the infant from the mother in the OR for some hours following the caesarian delivery necessitates the adoption of a standardized process that is specific to the hospital in initiating SSC. This also requires changing the culture of nurses and physicians from viewing the practice as an infrequent practice to an anticipated and recommended practice (Grassley & Jones, 2014).


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