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Running head: SKIN-TO-SKIN VERSUS ROUTINE CARE 1

Immediate Skin-to-Skin Care versus Routine Hospital Care

Madison Pleasants

Nur 320

Cedar Crest College


SKIN-TO-SKIN VERSUS ROUTINE CARE 2

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

newborn to become accustomed to his/her new environment by initiating immediate skin-to-skin

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

specific manner depending on which method of care is being introduced.

Keywords: skin, contact, immediate, routine, care, newborn, mother, well-being


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Immediate Skin-to-Skin Care versus Routine Hospital Care

Following birth, the healthcare team engages in a multitude of manners to complete

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
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(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

delivery process and allows the mother to rest following birth.

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
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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
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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,

Labar, Wall, & Atun, 2016, p. 134).

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

medication administration. Routine care including vitamin K injection and erythromycin


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administration, foot/hand printing, weighing, measuring, and bathing decrease the maternal-

newborn well-being as related to bonding, breastfeeding, and psychological health (Phillips,

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
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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

patient further should be taken.

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

alters the nurses tasks following delivery.


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References

Beiranvand, S., Valizadeh, F., Hosseinabadi, R., & Pournia, Y. (2014). The effects of skin-to-

skin contact on temperature and breastfeeding successfulness in full-term newborns after

cesarean delivery. International Journal of Pediatrics, 2014(846486).

http://dx.doi.org/10.1155/2014/846486

Chan, G. J., Labar, A. S., Wall, S., & Atun, R. (2016). Kangaroo mother care: A systematic

review of barriers and enablers. Bull World Health Organization, 130-141.

http://dx.doi.org/10.2471/BLT.15.157818

Essa, R. M., Ismail, N., & Ismail, A. A. (2015). Effect of early maternal/newborn skin-to-skin

contact after birth on the duration of third stage of labor and initiation of breastfeeding.

Journal of Nursing Education and Practice, 5(4), 99-107. Retrieved from

http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/5698/3834

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us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Documents/peds-

module07-eng.pdf

Kymre, I. G. (2013). Balancing preterm infants developmental needs with parents readiness for

skin-to-skin care: A phenomenological study. International Journal of Qualitative

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Moore, E. R., Anderson, G. C., Bergman, N., & Dowswells, T. (2014). Early skin-to-skin contact

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Napoli, R. A. (2015). Perceived barriers to skin-to-skin contact from maternal and nurse

perspective. SJSU ScholarWorks. Retrieved from

http://scholarworks.sjsu.edu/cgi/viewcontent.cgi?article=1012&context=etd_doctoral

Phillips, R. (2013). The sacred hour: Uninterrupted skin-to-skin contact immediately after birth.

Newborn and Infant Nursing Reviews, 13(2), 67-72. Retrieved from

http://www.medscape.com/viewarticle/806325

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