Synthesis of the Literature

This project aims to implement a new evidence-based policy to improve care and outcomes for mothers and babies in the first hours after birth. A search was conducted comprehensively within Medline, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, and Joanna Briggs Institute. Articles were searched to be published between 2012 – 2019. Decades of evidence have been continuously monitored and reported in the literature regarding baby-friendly initiatives for both vaginal and cesarean section deliveries. The significance of all the evidence provides support to implement and maintain baby-friendly hospitals. The standard of the Golden Hour has been known worldwide. As for trauma in which is now why they’re calling it the Golden hour in OB because of what is implemented in use, there has been shown in the literature and evidence to improve outcomes for both mom and baby significantly. The literature supports that less intervention is needed for both moms and babies when following AWHONN standards. Successful long-term breastfeeding also depends considerably on the care provided to mom and baby during the first hour of life.

Mother and the newborn baby have the physiological benefit to be together at the time of birth and a few weeks that follows. The skin to skin, which is also referred to as kangaroo contact, after standard or cesarean delivery has been observed to have positive outcomes to the infants which include improvement in sleep, increase in blood oxygen levels, improve the ability to breastfeed, and improve alertness and crying in the newborns. Kangaroo care is also creating a bond between the mother and the baby (Conde‐Agudelo & Díaz‐Rossello, 2016). It is conducted by placing the baby on their belly on the parent’s chest and letting the head of the baby face to side, then covering the babies back. The delay of skin to skin contact can have negative outcomes, like less connection between the mother and the baby. There is various evidence given to prove the above statement, which is discussed below.

According to research done on 3850 women and their infants in 21 countries indicated that skin to skin contact women had a higher rate of breastfeeding efficiency than the standard contact breastfeeding. The infants of the kangaroo contact also presented a high ability to breastfeed successfully in their first feed as opposed to the delayed contact babies (Moore et al., 2016). Nevertheless, there existed a limitation in the estimation because of the risk of errors during the trials. The risk ratio (RR) was 1.24 at a 95% confidence interval (CI), amounting to 8887 participants in 14 trials (Moore et al., 2016). The SSC mothers were also observed to breastfeed their babies longer, but there were several uncertainties as well. The mean difference, MD, was found to be 64 days at CI of 95% in 264 participants done six studies and was graded as low quality. The observed result came from sensitivity analysis in the exclusion of a single experimental, constituting heterogeneity in the first report. The infants of immediate SSC showed high strength of the cardio-respiratory structure, signifying improved stabilization on several physiological limitations as opposed to delayed contact babies. In agreement with immediate Kangaroo mother care (KMC) which has been demonstrated to be effective in the reduction of morbidity and mortality in underweight infants (UI) in comparison to delayed kangaroo mother care. Agudelo, Agustin, and Rossello (2016) provided a review of the morbidity and mortality of infants concerning kangaroo care using 21 studies in 3040 infants.

Morbidity and Mortality in UI: KMC versus Conventional Neonatal Care.

The KMC analytically showed a reduction in mortality risk with a RR of 0.60, at CI of 95% done in eight trials in 1736 newborns. A keen observation of KMC presented a significant reduction in mortality risk with a recording of RR of 0.28 at 95% CI 0.32 to 0.69 observed in eight trials for 1463 infants (Deborah Edwards, 2019). Besides, there was an increase in weight for infants who underwent the immediate KMC with MD of 4.1g/d at CI of 95% done in 11 trials for 1198. Nevertheless, the sensitivity study proved that the high-risk errors study inclusion did not alter the expected findings or the length of the treatment effect in outcomes.

Morbidity and Mortality: Early-Onset KMC In Comparison to Delayed KMC

One of the trials compared the immediate KMC in 24 hours with delayed KMC after 24 hours in 73 infants with stable low birth weight. There was no noteworthy difference between the two cases in terms of mortality and morbidity. The immediate KMC only presented a reduction in the period of hospital stay (Agudelo, Agustin, & Rossello, 2016). The review shows that there are no differences in the immediate and delayed kangaroo mother care.

In a review conducted by Kerr et al. (2019) to evaluate the vital components of human interactions, touch and gaze, and their effects on the neurophysiological measures. The review showed that the massage as a type of contact was the most pronounced, which was done in 46 trials in 81% of the touch trials. The SSC done in 5 experiments showed only 9% of the touch trials. The study involved mostly the preterm babies and only a single test on the full-term babies, and in all cases, the mother was in contact. The study showed neurophysiology of healing, caring, and therapy interaction. The trials supported the thesis that immediate SSC provides positive outcomes in comparison to delayed SSC.

The kangaroo mother care provides physical and emotional care to the woman and offers quick discharge from the hospital. In Ghana, 95.5% expressed the readiness to proceed with the KMC at their household after release, 71.8% were willing to do the SSC outdoors. The practice was minimal in Ghana because many mothers feared that the method might be against the community norms (Bayo et al., 2019). Another study done in India identified various challenges such as heat and humidity in summer, lack of privacy, and the dressing culture. According to Bayo, the KMC is crucial as it improves the rate of breastfeeding as well as promoting weight gain, which in totality reduces the cost of medical care. The KMC also supports maximum parental care. In comparison Edwards (2019), analysis determined the impacts affected by an instant or delayed SSC for the newborns in comparison to regular connection on development and conservation of feeding and the composition of the newborn. The study was done on the effects of KMC on physiological stress outcomes in comparison to incubator care. The finding of the review was that SSC increases the short-term cardiorespiratory stress effects. The results of the study also proved that the SCC lowers the level of the hormone cortisol and led to a rise in the level of oxytocin in infants. The review clearly shows the importance of instant skin to skin contact.

According to Croitoru & Piguet’s (2019) review of mother touch, the skin to skincare is related to skin bacteria, which plays a significant role in the human microbiome, which affects the immunity of the host. The healthy microbiome develops in the first few weeks after the delivery. The SSC in the early stages provides resistance to microbes during childhood (Mercuri et al. 2019). The study reviewed also showed that early microbial colonization interferes with the proper functioning of the immune system and results in long term effects. According to the review, it is therefore essential for mothers to practice skin to skincare immediately after delivery.

Community initiated SSC introduced to infants at homes within the 72 hours of delivery and assigned as intervention group and on another group as a control. The babies and the mother in the intervention group were visited at home, and the control group was given regular care and research done in 28 days and 180 days. The study involved 4480 babies in the intervention collection and 3922 babies in the control collection. Ninety infants died in 28 days for the control group, and 73 babies passed on in the intervention group (Mazumder, 2019). The community initiated KMC showed the reduction in mortality for infants whom the practice was done early than the late KMC. In another review, the skin to skincare has been revealed to provide a physiological change from the intrauterine to extrauterine life. The results show that the SSC introduced to infants immediately after birth improves the mother babies’ bond and affects the breastfeeding in comparison to SCC initiated later (Bingham et al., 2019).

In another review of the impact of the skin to skin contact in the first hour after delivery shows that the first hour after birth is very vital to both the mother and the baby. The review shows that the instinctive behavior of the newborn is developed during that period, and the connection between the mother and the infant is built (Widström et al., 2019). The relationship helps to improve parental care. In another review of the surrogate parents and the effect of the kangaroo mother care shows that the SCC should be agreed by the surrogate mother and the intended parent. The parents are in the same room with the surrogate mother, and they can have the SCC both or only one of them depending on the written agreement. The practice is done immediately after birth (Lanning, 2019). The surrogate mother can develop a connection to the baby and may breach the contract and, therefore, important that the practice should be carried out immediately after delivery and not later. In synthesizing the literature, it is support of the best practice recommendation that skin to skin should be done immediately after birth.

References

Bayo, P., Alobo, G., Feyissa, G. T., & Belaid, L. (2019). Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa. JBI Database of Systematic Reviews and Implementation Reports, 17(8), 1558-1564. doi:10.11124/jbisrir-2017-004027

Bingham, D., Boisvert, M. E., Webb, A., & Muri, J. (2019). Feasibility of AWHONN’s Immediate and Continuous Skin-to-Skin Nursing Care Quality Measures. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(5), 516-525. doi:10.1016/j.jogn.2019.07.004

Conde-Agudelo, A., Belizán, J. M., & Diaz-Rossello, J. (2011). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd002771.pub2

Croitoru, D. O., & Piguet, V. (2019). A Mother’s Touch: Emerging Roles in Development of the Cutaneous Microbiome. Journal of Investigative Dermatology, 139(12), 2414-2416. doi:10.1016/j.jid.2019.06.144

Kerr, F., Wiechula, R., Feo, R., Schultz, T., & Kitson, A. (2019). Neurophysiology of human touch and eye gaze in therapeutic relationships and healing. JBI Database of Systematic Reviews and Implementation Reports, 17(2), 209-247. doi:10.11124/jbisrir-2017-003549

Lanning, R. (2019). Doulas and Nurses Partner to Support Skin-to-Skin Care in the Operating Room. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(3), S45. doi:10.1016/j.jogn.2019.04.077

Mazumder, S., Taneja, S., Dube, B., Bhatia, K., Ghosh, R., Shekhar, M., … Bhandari, N. (2019). Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial. The Lancet, 394(10210), 1724-1736. doi:10.1016/s0140-6736(19)32223-8

Medforth, J., Ball, L., Walker, A., Battersby, S., & Stables, S. (2017). Immediate care of the newborn. Oxford Medicine Online. doi:10.1093/med/9780198754787.003.0019

Mercuri, M., Stack, D. M., Trojan, S., Giusti, L., Morandi, F., Mantis, I., & Montirosso, R. (2019). Mothers’ and fathers’ early tactile contact behaviors during triadic and dyadic parent-infant interactions immediately after birth and at 3-months postpartum: Implications for early care behaviors and intervention. Infant Behavior and Development, 57, 101347. doi:10.1016/j.infbeh.2019.101347

Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003519.pub4