ABSTRACT
Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.
Subject(s)
Adaptation, Physiological , Breast Feeding , Cesarean Section/methods , Infant Behavior , Kangaroo-Mother Care Method/methods , Maternal Behavior/physiology , Adult , Breast Feeding/psychology , Breast Feeding/statistics & numerical data , Feasibility Studies , Female , Humans , Hydrocortisone/analysis , Infant, Newborn , Mother-Child Relations/psychology , Pilot Projects , Postoperative Period , Pregnancy , Time FactorsABSTRACT
OBJECTIVE: The aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women's satisfaction with that option. DESIGN: Evidence-based practice change guided by the model for evidence-based practice change. SETTING: Labor and delivery unit in a tertiary medical center in the southwestern United States. PARTICIPANTS: Laboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period. MEASUREMENTS: Process indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women's satisfaction with the choice to use nitrous oxide. RESULTS: Nitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor. CONCLUSION: Our experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor.
