Professional Documents
Culture Documents
Introduction
Imagine. You discover there is a tiny life growing in you. For nine months you nurture
your womb and imagine the moment you see your baby for the first time. You imagine his face,
his touch, and his smell. After the months of waiting, you get to meet your tiny life, your baby.
Your baby is placed on your bare chest, nothing between you, just like when he grew inside you.
The “golden hour” refers to the sixty minutes immediately following birth. During this
time, the baby transitions from life in utero to life in the outside world. The woman transitions
from a pregnant mother to a postpartum mother (McCulloch, 2016). Now imagine. You spent nine
months growing this life, and a number of hours laboring and birthing this life, and then right at
the moment you have been waiting for, the baby is taken to a radiant warmer, visitors swarm the
room, and the baby is placed in the arms of someone else. The proposed leadership change project
promotes uninterrupted skin to skin contact between mom and baby during this golden hour.
Research supports that this uninterrupted contact improves mother-baby bonding, breastfeeding
success, and the child’s growth and development for years to come (Sanford Health, 2012). Skin
to skin contact between mother and infant causes a reaction in the baby that activates
benefits include improved temperature regulation, blood sugar regulation, promotion of delayed
cord clamping, an improvement in the infant’s immune system from the mother’s bacteria,
happier, calmer and less crying noted in the infant, and more stable heart, respiratory, and oxygen
rates (Women’s Memorial Hermann, 2017). This is what is natural, and this is what should be
Current barriers to including this intervention in practice include a lack of education for
the staff and patients as well as the multitude of interventions and cares for mother and infant
that take place immediately following birth. It has been normal practice for the medical
procedures following the delivery to be the priority in these sixty minutes. Research now shows
that as long as mom and baby are medically stable, certain procedures can either wait for a later
time or be implemented while the infant is skin to skin with mother (Sanford, 2012). These
procedures include physical examination, weight and length, Vitamin K injections, Erythromycin
eye drops, and diapering and swaddling the baby (Sanford, 2012). APGAR scores can be taken
while the infant is with the mother, and priority assessments can be completed. The mother can
have her vital signs taken, vaginal repair, fundal massage, and pain medications administered
Leadership is an integral component in the role of a nurse (Grossman & Valiga, 2013). The nurse
takes on a role of patient advocate, teacher, caregiver, and contributor to policy development
(Grossman & Valiga, 2013). As an advocate for participation in the golden hour, the nurse is
advocating for the baby to have the benefits, educating the mother on the benefits and how to
participate, caring for the mother and baby as they recover from delivery, and developing
Description
The proposed leadership change project includes the implementation of a golden hour
hospital policy. This policy would outline uninterrupted skin to skin contact between mom and
baby for at least the first sixty minutes of life. Breastfeeding should be initiated within these
sixty minutes, and if unsuccessful, hand expression of colostrum should be performed. All
interventions for mom and baby should be performed as usual with the baby skin to skin on the
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mother’s chest. The infant assessment, weight, and bath can all be postponed until a later time
(as long as there is no medical indication). Visitors should be limited to the primary caregivers of
the child, and the infant should remain skin to skin with the mother during this time, not held by
emergencies, or cesarean sections. However, once the mom and/or baby are stable, the baby can
be skin to skin with the mother (Sanford, 2012). In the case of a cesarean section, the stable
infant can be placed skin to skin while the surgery is completed, and can stay with the mother
This sensitive time requires respect, protection, and support from the healthcare provider
(Crenshaw, 2014). In order to initiate skin to skin during the golden hour, a warm blanket should
be placed over the baby, as well as a hat (McCulloch, 2016). A number of hormones can
influence maternal and newborn responses immediately after delivery. Oxytocin greatly
increases during skin-to-skin contact, which promotes attachment, decreases stress in the mother
and infant, and aids the newborn’s transition (Crenshaw, 2014). The mother should stay warm, as
this reduces the production of adrenaline. Adrenaline can interfere with the production oxytocin
and prolactin hormones, which are needed for breastfeeding and milk production (McCulloch,
2016). Anxiety, pain, and stimulation can all produce adrenaline as well. A quiet, calm, and
warm environment should be provided for the mother and baby during this time to reap the
Purpose
The purpose of the leadership change project is to improve the bonding experience
between mom and baby, improve health outcomes for both, and to improve the success of
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breastfeeding. “Research has shown that what happens during the first sixty minutes of a baby’s
life can maximize the bonding experience between mother and child” (Sanford, 2012). Since
skin to skin contact during the golden hour improves breastfeeding, many benefits to both mom
and baby can occur. Benefits to the baby include lower rates of ear infections, asthma, diabetes,
childhood leukemia and Sudden Infant Death Syndrome (SIDS) (Sanford, 2012) Benefits to the
breastfeeding mothers include lower rates of breast cancer, ovarian cancer and diabetes (Sanford,
2012). These benefits to health of mother and infant are the purpose of the project.
Aims
Crosley, Henry, Neff, & Otto, 2012). Research supports that breastfeeding should be initiated
within the first hour of life (Payne, 2012). This can be done during the golden hour. Alternatives
to the first outcome includes skin to skin contact with a primary caregiver if the mother is
unstable or unavailable and initiating skin to skin contact as soon as possible if the infant is
Objectives
The strategies and interventions to achieve the leadership project outcomes include those
I. “Healthy newborns should be placed in skin to skin contact with the mother until the
II. The medical caregiver and the nurses can conduct the first physical assessment of the
IV. Baby and mother should remain together throughout the recovery period” (Sanford,
2012).
These interventions would be outlined in the policy and procedure manual for the golden
hour initiative.
Thesis
The golden hour should be initiated immediately following delivery in the medically
stable mother and baby and maintained for a minimum of sixty minutes.
Current literature states that having mother and baby together immediately after birth and
throughout hospitalization is best for the mother, the newborn, and for breastfeeding success
(Crenshaw, 2014). A physiologic need is present for the mother and newborn to be together after
birth. Having mothers and babies skin to skin after birth is a safe and healthy intervention that
Not only are there positive physical effects to both mom and baby during skin to skin
contact during the golden hour, but some institutions have named this time the “sacred hour”
(Phillips, 2013). Birth is a sacred event, and this time after should be considered sacred as well.
Being skin to skin with the mother is the newborn infant's new natural habitat after leaving the
womb, their natural habitat for the last nine months (Phillips, 2013). This need should be
honored for both the mother and the infant’s emotional and physical health and well-being.
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Theoretical Framework
breastfeeding:
(Acharya & Khanal, 2015). These determinants would need to be addressed and plans
formulated to overcome these factors to ensure success rates in different populations. The article
discusses skin to skin contact during the first hour of birth increasing the likelihood of successful
breastfeeding (Acharya & Khanal, 2015). The article also shows the increase in health benefits
and the decrease in infant mortality when breastfed, proving the importance of the golden hour
Methodology
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Education on the golden hour begins in the obstetric office during prenatal visits. It then
is reiterated during labor and delivery, and then immediately following delivery. Physicians,
nurse practitioners, nurses, childbirth educators, and other professionals have the responsibility
interventions in their practice (Crenshaw, 2014). Research and findings should be published in
books, journals, and online for public access. Reading pamphlets and information on where to
In order to achieve the goal of increased rates of infant patients who experience sixty
minutes of uninterrupted skin to skin contact with the mother and successful breastfeeding within
the institution, an evaluation will need to take place to determine the current rates. Successful
breastfeeding according to the policy should be defined. According to the American Academy of
Pediatrics, exclusive breastfeeding should occur for the first six months of life. This indicates
that no additional foods (except Vitamin D supplementation) or fluids be given to the infant
unless medically indicated (American Academy of Pediatrics, 2012). The policy will use this
recommendation to define success as a diet of exclusive breast milk for the infant until six
months of age. A search would be conducted to evaluate the percentage of institutions that have
a developed policy regarding the golden hour, skin to skin, and breastfeeding. These would be
The timeline for implementation of the golden hour initiative will be one year. First, a
review will be conducted to find the current percentage of patients participating in the golden
hour in the department. Then, an educational program will be developed in order to educate the
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staff. Educators including the Unit Educator on Labor and Delivery for the nurses, Physicians,
Residents, and all staff will be at the forefront of implementing these sessions. This will take two
months to create the program and train the educators. Once the educational program has been
developed, the staff will be trained through a series of sessions, which will occur over six
months. Then for the next six months, the staff will implement the strategies learned in the
sessions to improve the rate of patients participating in the golden hour in all mothers and baby
patients within the department. At the end of the one-year mark, patient statistics will be
analyzed to evaluate the percentage of participants compared to the start of the program.
Stakeholders
Stakeholders for the proposed policy would include the hospital or institution adopting
the policy, along with its Board of Directors. The American Board of Obstetrics and
Obstetrics, Gynecology, and Women’s Health (American Board of Obstetrics and Gynecology,
2017). The golden hour implementation would be held to this standard. This board would
become a stakeholder along with the American Board of Pediatrics and Women, Infants, and
Children (WIC).
with training who are able to provide assistance and support to mothers for breastfeeding.
Different efforts include group meetings, online help, and telephone communication (CDC,
2014). These efforts could be used for promotion and education on the golden hour. An
lactation and breastfeeding (CDC, 2014). Lactation consultants should be available at the
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institution at all times to educate and assist in breastfeeding. La Leche League and IBCLC would
Main Findings
In order to help achieve the goal of increased rates of infant patients who experience sixty
minutes of uninterrupted skin to skin contact and successful breastfeeding, the Baby-Friendly
Hospital Initiative (or “Baby Friendly”) could be implemented at the institution. Baby Friendly
was created to reduce the negative effects that lack of skin to skin, formula feeding, or other
There are ten evidence-based steps in the initiative. Step four includes the use of health care
professionals to help mothers begin breastfeeding within this golden hour, and this step also
recommends that all healthy mothers and babies are placed skin-to-skin immediately after birth
(Crenshaw, 2014).
Recommendations
institution would be staffed with adequately trained Physicians, nurses, and lactation consultants
to achieve success with this new initiative. The policy would be developed and implemented,
then revisited yearly and as needed. Further down the road, the institution could seek Baby
Evaluation Method
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Evaluation of the policy would include a survey for patients to determine whether they
were satisfied with their experience immediately after birth. The survey would include questions
regarding staff assistance, education, and their personal preferences and whether they were
honored. Chart audits would be conducted to look at the documentation of sixty minutes of skin
Research shows that uninterrupted skin to skin contact immediately following birth is
what is best for mother and infant. Does this mean when the sixty-minute timer goes off the baby
gets taken from the mother? Absolutely not. The current recommendation is that the baby spends
six hours a day skin to skin for the first six weeks of life (CDC, 2014). It is important for
healthcare providers to remember their role in childbirth. “What does the baby most need at the
moment of birth? Only mother” (Crenshaw, 2014). This initiative will help improve health
outcomes for mothers and infants. The medical benefits of the golden hour will last a lifetime, as
References
Acharya, P., & Khanal, V. (2015, October). The effect of mother’s educational status on early
initiation of breastfeeding: further analysis of three consecutive Nepal Demographic and
Health Surveys. BMC Public Health.
https://www.researchgate.net/figure/283356448_fig3_Figure-1-Conceptual-framework-
of-determinants-of-early-initiation-of-breastfeeding
American Academy of Pediatrics. (2012, February 27). Breastfeeding and the use of human
milk. Pediatrics, 129, e827–e841. Retrieved from
http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html
American Board of Obstetrics and Gynecology. (2017). Objective & purposes. Retrieved from
https://www.abog.org/new/default.aspx
CDC. (2014). Breastfeeding report card. National Center for Chronic Disease Prevention and
Health Promotion. Retrieved from
https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
Crenshaw, J. T. (2014). Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best
for Mother, Baby, and Breastfeeding. The Journal of Perinatal Education, 23(4), 211–
217. http://doi.org/10.1891/1058-1243.23.4.211
Grossman, S., & Valiga, T. M. (2013). The new leadership challenge: creating the future of
nursing. Philadelphia: F.A. Davis.
Hayman, R., Crosley, M., Henry, L., Neff, M., & Otto, D. (2012). Igniting the midnight shift
passion for breastfeeding support: a unique educational opportunity for the mother-baby
nurse. Journal of Obstetric, Gynecologic & Neonatal Nursing 41.doi:10.1111/j.1552-
6909.2012.01361_9.x
McCulloch, S. (2015, May 10). Seven huge benefits of an undisturbed first hour after birth.
BellyBelly. Retrieved from https://www.bellybelly.com.au/birth/7-benefits-undisturbed-
first-hour-after-birth/
Payne, C. (2012). Igniting change in implementation of nursing and medical practice to increase
exclusive breast milk feeding. Journal of Obstetric, Gynecologic & Neonatal Nursing,
41.doi: 10.1111/j.1552-6909.2012.01361_12.x
Phillips, R. (2013). Uninterrupted skin-to-skin contact immediately after birth. Newborn &
Infant Nursing Reviews. Retrieved from http://www.medscape.com/viewarticle/806325
Sanford Health. (2012, January). The golden hour: giving your newborn the best start. Retrieved
from http://www.sanfordhealth.org/stories/the-golden-hour-giving-your-newborn-the-
best-start
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