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Final - Immediate Skin To Skin Care Versus Routine Hospital Care-2
Final - Immediate Skin To Skin Care Versus Routine Hospital Care-2
Madison Pleasants
Nur 320
Abstract
The moments following birth are crucial for the neonate as well as the mother. The care provided
depends not only on the status of mother and/or newborn but the current policy being followed
by the healthcare organization. At one time, routine care was provided for all newborns
regardless of situation. In recent years, that ideology has been altered to provide a time for the
contact with the mother, or father if there was a cesarean birth. Benefits, as well as
disadvantages, can be identified in each means of care. Both methods of care ensure safety of the
newborn, but the nurses role can be dramatically different. The nurses tasks are prioritized in a
assessments and interventions. These moments are essential in the well-being of the mother
and/or neonate. Throughout the years, the general policy of routine care has been reformed,
directly impacting the nurses role in the delivery process. Routine care, or traditional care, for
an infant can be identified the separation of the mother from her newborn following delivery in
order to complete assessments, interventions, and protocols (Keenan, Udaeta, Lpez, &
Niermeyer, 2016, p. 1). Whereas, in immediate skin-to-skin care, or kangaroo care, the dried
newborn would be handed to the mother immediately following birth, if the newborn was
classified as stable by the Apgar scale (Phillips, 2013, p. 2). Both methods of care include actions
necessary for the physiological and psychological welfare of the mother and newborn.
Immediate Skin-to-Skin
Pro
Immediate skin-to-skin contact between the mother and her newborn has proven to have
multiple positive effects. The mothers natural chemistry allows the newborn to establish a stable
respiratory rate, oxygen and glucose level, temperature, and blood pressure (Phillips, 2013, p. 2).
An infants brain is not fully developed on delivery; by initiating skin-to-skin contact the
amygdala would be activated directly maturing brain structure by stimulating the prefronto-
orbital pathway (Phillips, 2013, p. 4). In addition, this initiation allows the newborn to have
decreased stress hormones and crying instinct while increasing his/her quiet alert state (Phillips,
2013, p. 2), creating a natural aura. At this time, the mother and infant are able to establish an
attachment with one another. This attachment has been shown to increase hormones, specifically
oxytocin, increasing relaxation, attraction, facial recognition, and maternal care-giving behaviors
SKIN-TO-SKIN VERSUS ROUTINE CARE 4
(Phillips, 2013, p. 3). Furthermore, the release of oxytocin increases secretion of breast milk
and breast heat (Beiranvand, Valizadeh, Hosseinabadi, & Pournia, 2014, p. 1). Thus, increasing
the success rate of breastfeeding as evidence by the improvement of the rooting and sucking
reflexes in the newborns (Beiranvand, Valizadeh, Hosseinabadi, & Pournia, 2014, p. 1).
During the initial periods of contact, the nurse would be able to educate the mother on
signs of hunger, hypoglycemia, and hypothermia. This technique of care allows the nurse ample
time following initial skin-to-skin contact to complete all necessary assessment, medication
administration, and testing. The specific time frame would be established by each facilities own
policy. This increased time frame decreases the level of stress felt by the nurse during the
Con
The mothers availability and/or the infants well-being in addition to the healthcare staff
at the facility are the prevalent factors when introducing skin-to-skin contact (Chan, Labar, Wall,
& Atun, 2016, p. 131). Kangaroo care is a common practice in full-term infants with natural
deliveries but not as widespread in problematic labors and/or deliveries (Beiranvand, Valizadeh,
Hosseinabadi, & Pournia, 2014, p. 2). Separation between unstable or preterm infants and their
mother creates a physical barrier preventing the initiation of immediate skin-to-skin care (Chan,
Labar, Wall, & Atun, 2016, p. 134). Although many nurses within the neonatal intensive care
unit attempt to introduce skin-to-skin as soon as possible, it not always in a timely manner
(Kymre, 2013, p. 4). Other medical barriers such as maternal fatigue, depression, and
postpartum pain, reduce the ability to complete kangaroo care (Chan, Labar, Wall, & Atun,
2016, p. 134). To continue, access to resources proved impend initial skin-to-skin contact
between the mother and her newborn. The resources required for skin-to-skin care included a
SKIN-TO-SKIN VERSUS ROUTINE CARE 5
private room, wrappers to hold the baby, furniture to comfortably complete skin-to-skin care, and
transportation if the mother was discharge before the newborn (Chan, Labar, Wall, & Atun,
2016, p. 134). The family and healthcare team both must be compliant in order to obtain all
recourses.
It is the nurses role to educate the family about the importance of immediate skin-to-skin
care immediately after birth. Unfortunately, unwritten policy and vague descriptions of the care
prevented nurses in previous years from properly educating all family members (Chan, Labar,
Wall, & Atun, 2016, p. 131). Therefore, even when a medical barrier was not present, the family
may have been hesitant to start skin-to-skin care due to deficient knowledge. There is no direct
disadvantages to immediate skin-to-skin as it relates to the health of the newborn and mother. It
should be noted though, an uneducated and unattended mother may not be able to recognize
signs that her newborn requires critical interventions; this delay could be detrimental.
Routine Care
Pro
Traditional care remains to have many medical benefits. When routine care is
implemented, the healthcare team has the ability to assess all aspects of the newborn
immediately following birth (Keenan, Udaeta, Lpez, & Niermeyer, 2016, p. 6). Recent studies
show no major difference in some physical aspects of the newborn between the two means of
care. For example, a study within the International Journal of Pediatrics stated there was no
statistical difference in the latching aspect of breastfeeding between routine care and skin-to-skin
care (Beiranvand, Valizadeh, Hosseinabadi, & Pournia, 2014, p. 5). In the same study, the
newborns temperature was assessed in half hour increments within each study groups. The
newborns that engaged in traditional care had a mean temperature only 0.2 degrees Celsius less
SKIN-TO-SKIN VERSUS ROUTINE CARE 6
than those in the skin-to-skin care group (Beiranvand, Valizadeh, Hosseinabadi, & Pournia,
2014, p. 5).
Nurses who are engaged in traditional care separate the mother from her newborn by
taking him/her to a warming bed where the newborn would be dried, stimulated, suctioned, and
evaluated using the Apgar scale (Keenan, Udaeta, Lpez, & Niermeyer, 2016, p. 6). If no
problems arise, the mother will then spend uninterrupted time with her newborn. If there was to
be a problematic situation, nurses are able to provide necessary interventions. In this situation,
am unstable or preterm baby would receive the immediate care that may be required (Chan,
Con
The critical aspect that distinguishes routine care from skin-to-skin is the lack of
psychological benefits identified in traditional care (Essa, Ismail, & Ismail, 2015, p. 105). Not
only is the newborn unable to control their glucose levels and blood pressure, but the transition
into the new environment becomes an impending stressor to the newborn. To ideally transition,
the infant is to be placed directly onto the mother where he/she would be familiar with the
heartbeat, breath sounds, smell, and temperature (Phillips, 2013, p. 9). Routine care does not
account for these first moments of transition. Furthermore, the lack of initial contact inhibits the
neonate from being soothed by natural hormones and inhibits the beginning of maternal-newborn
attachment (Phillips, 2013, p. 2). This attachment may be considered crucial in the adaptation of
the newborns ability to self-regulate while maintaining homeostasis (Phillips, 2013, p. 5). The
nurses role in traditional care may be the primary inhibitor of immediate skin-to-skin contact in
the stable newborn. It is well-known that in the stable newborn, breastfeeding is a priority over
administration, foot/hand printing, weighing, measuring, and bathing decrease the maternal-
2013, p. 2).
Nursing Implications
The nurses role in both means of care can be as diverse as it is similar. For the stable
newborn, the initiation of skin-to-skin is simple. After ensuring the infant will pass the Apgar
scale, the healthcare team immediately places the infant on the mothers chest (Phillips, 2013, p.
7). Non-traditional methods of delivery including cesarean births and births of unstable or
preterm infants typically require the initiation of traditional care prior to completing skin-to-skin
contact. After a cesarean birth the infant would be taken the warmer where the nurse would
ensure that infant was not in distress. From there, the infant must be dried and partially wrapped
to avoid the possibility to meconium entering the mothers wound (Phillips, 2013, p. 8). The
process of partially wrapping the infant decreases the benefits of immediate skin-to-skin care as
the newborn would not be directly on the chest of his/her mother. Those that are considered
small newborns may be intubated and cared for within incubators until it is no longer required
(Kymre, 2013, p. 4). Nurses are to initiate skin-to-skin contact when the newborn is able to
tolerate it. To begin this process, the nurse encourages the parents to hold their infant even if
they are afraid, anxious, or worried (Kymre, 2013, p. 5). To effectively encourage the parents,
the nurse must be able to educate them on techniques, benefits, and be able to answer any
questions.
Nursing Education
In all aspects of the healthcare field, the healthcare team and patient must be educated on
methods of care. As a nurse, it would be assumed that one is knowledgeable on the care and
SKIN-TO-SKIN VERSUS ROUTINE CARE 8
tasks being performed and any methods that are similar. Therefore, the benefits and
disadvantages of skin-to-skin care and routine care must be understood in order to accurately
discuss the topic with the patient and family (Chan, Labar, Wall, & Atun, 2016, p. 134). It may
ideal that these routes of care, as described by the facilitys policy, be discussed with the mother
prior to the onset on labor. By providing her with information, pamphlets, and other resources,
she can make the best decision for her delivery process. As previous mentioned, in critical
situations, a mother who once was eager to initiate skin-to-skin care might have an infant in the
neonatal intensive care unit. In this situation, the nurse must educate her and the family on how
to adapt to this situation (Kymre, 2013, p. 5). Any opportunity the nurse has to educate the
Conclusion
Two common techniques of practice following delivery are routine care and immediate
skin-to-skin care. Routine care follows the guidelines that physical assessments, interventions,
and medical administration are prioritized over the psychological and emotional aspect of care.
Opposite that, skin-to-skin care puts non-emergent assessments, evaluations, and medical
administration after a non-interrupted time for the newborn to lay on the chest of his/her mother,
or father if there was a cesarean birth. It should be noted, all research regards that immediate
skin-to-skin is simply intended as a priority after the birth of a stable newborn. Therefore, those
infants who are unstable or preterm require immediate interventions hindering the immediate
Initiation of skin-to-skin. It is obvious, that in these cases, routine care is required. Both types of
care believe that physical and psychological needs are important but the order of events is vastly
different. The difference in care does not only effect the mother and newborn well-being but
References
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