The first hour after birth is a time of particular sensitivity for the mother. Close contact with her baby during this time facilitates the attachment process. Mother-baby bonding is enhanced when the naked newborn is placed on the mother’s bare chest. The mother begins her examination of her baby by exploring the extremities and head with her fingertips. Thereafter, she caresses her baby’s body with her entire hand before gathering her baby in her arms often in the en face position where eye-to-eye contact can be established. She talks to her baby with great emotion, looking for positive reinforcement from her partner and other birth attendants. This sensitive period of interaction between the mother and baby should promote ideal later development of the baby.
Therefore, it is important after a pregnancy period of nine months, not to separate the baby from his mother immediately after birth unless otherwise contraindicated due to health reasons
A growing volume of research supports skin-to-skin contact between the mother and the newborn in the immediate post-delivery period. Skin to skin contact is defined as placing the naked newborn baby, prone covered across the back with a warm blanket, on the mother’s bare chest instantaneously following birth.
A substantial number of studies showed that early skin-to-skin contact between the mother and the newborn is beneficial to the newborn. Some of the benefits of skin-to-skin contact include stabilization of the newborn’s body temperature through thermoregulation, regulation of heart rate and regulation of respiratory rate (Wallace & Marshal, 2001). Additionally, early skin-to-skin contact facilitates the initiation of breastfeeding, helps neonatal thermoregulation and promotes maternal-infant bonding (Dabrowski, 2007; Wallace & Marshal, 2001). Skin to skin contact may also ensure colonization of the baby with the mother’s own skin flora, for which the child will have some resistance (Wallace & Marshal, 2001).
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Despite its aforementioned benefits and despite the UNICEF’s Baby Friendly best practice campaign which calls for early skin to skin contact. Nowadays, separation of mothers from their newborn babies at delivery has become a usual practice despite the escalating evidence that this may have negative effects on the newborn. This practice is still not being implemented in the labor room in Bahrain. This can be due to lack of labor room nurses knowledge about the benefits of skin-to-skin contact.
To assess the perception of labor room nurses about skin-to-skin contact.
What is the perception of labor room nurses towards skin-to-skin contact between mother and the newborn?
(1) what do labor room nurses know about skin to skin contact?, (2) what are the factors labor room nurses identify as barriers to implementation of skin to skin contact, (3) what are the factors labor room nurses identify as facilitators to implementation of skin to skin contact?
Identifying knowledge level of labor room nurses will help in designing and implementing in-service education programs to educate nurses about the importance of skin-to-skin contact. Additionally, identifying the barriers and facilitators of skin-to-skin contact will help in designing interventions to decrease the barriers and increase the factors that will facilitate skin-to-skin contact. This in turn will increase the implementation of skin-to-skin contact in the labor rooms in Bahrain.
Skin to skin contact: Placing the naked newborn on the mother’s bare chest immediately after birth.
Knowledge: Information about skin to skin contact
Barriers: Factors that decrease the likelihood of implementing skin to skin contact
Facilitators: Factors that encourage the implementation of skin to skin contact
Skin to skin contact: placing the naked newborn baby, on his/her stomach covered across the back with a warm blanket, on the mother’s bare chest for at least 15 minutes starting immediately after birth.
Knowledge: the amount of information labor room nurses have about how to implement skin-to-skin contact and the benefits of skin-to-skin contact.
Barriers: the factors that prevent labor room nurses from implementing skin-to-skin contact.
Facilitators: the factors that help labor room nurses to implement skin-to-skin contact.
Skin-to-skin contact between the mother and her newborn has been extensively researched and debated over the past forty years. A thorough search of the literature revealed a large number of studies that focused on various aspects of skin-to-skin contact including benefits to the mother. However, the focus of this review of the literature is on the benefits of skin-to-skin contact to the newborn and on the effect of increasing nurse’s knowledge on the rate of skin-to-skin implementation in the labor room.
Five relevant articles were selected for inclusion in this paper. These included one meta-analysis, one literature review and three research studies.
Benefits of skin-to skin contact:
Two important benefits of skin-to-skin contact to the newborn are thermoregulation and increased success of breastfeeding. Jonas et al., (2008) investigated the relationship between thermoregulation and breast-feeding two days after birth in a sample of 47 mother-infant pairs. They also wanted to learn if this relationship would be affected by the administration of epidural analgesia (EDA) and oxytocin (OT) during labor. The sample was divided into three groups: OT group (n=9), OT plus EDA group (n=20) and control group (n=18). The researchers monitored the temperature of the babies at 5, 10, 20 and 30 minutes after the newborn was placed skin-to-skin on the mother’s chest and covered with blanket. They found that the infants whose mothers received EDA during labor their temperature increased first but remain same in comparing to OT and control group, which the skin temperature increased significantly.
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Bystrova, et al., (2007) investigated the effects of delivery ward practices and early suckling on maternal axillary and breast temperatures during the first 2 hours postpartum and related them to infant’s foot and axillary temperatures. A sample of 176 mother-infant pairs was randomized as follows: skin-to-skin contact group (n=44), which involved naked infants lying prone on their mother’s bare chest; mother’s arm group (n=44), which involved dressed infants lying prone on their mother’s chest, and infants who were dressed and kept in the nursery (n=88). Maternal axillary and breast temperatures, infants’ axillary, and foot temperatures were measured at 15-minute intervals from 30-120 minutes after birth. The variation in breast temperature was highest in mothers in the skin-to-skin group and lowest in mothers of infants who were placed in the nursery. A positive relationship was found between the maternal axillary temperature and the infant foot and axillary temperature 90 minutes after the start of the experiment in the skin-to-skin and mother’s arms group. No such relationship was established in nursery group. In addition, foot temperature in infants from the skin-to-skin group was 2oC higher than those infants from the mother’s arms group.
Bergstrom et al., (2006) investigated the immediate maternal thermal response to skin-to-skin care of newborn. In a sample of 39 mothers, the researchers measured the maternal skin and axillary temperatures immediately before skin-to-skin contact, then every 2minutes for 20minutes and finally 10minutes after removing the neonate. They also, measured the neonate’s forehead, axillary temperatures immediately before skin-to-skin contact, and twice after initiating skin-to-skin, followed by a measurement 10minutes after newborn has been removed. Researchers found a positive relationship between maternal skin temperatures in response to skin-to-skin contact, as a rapid thermal response established in maternal breast skin immediately after skin-to-skin contact. It rose by o.5Celcius degree on average the first 2minutes after skin-to-skin contact and dropped by 0.5Celcius degree 10minutes after neonate has been removed. Maternal axillary temperature also, raised 2minutes after initiation of skin-to-skin but stayed constant 10minutes after removed of the newborn from skin-to-skin position.
Anderson (2003) examined the relationship between early skin-to-skin contact and breast-feeding and found that skin-to-skin contact had positive effects on breast-feeding. In addition, Anderson (2003) found that skin-to-skin contact improved infant-maternal bonding. Luclington (2004) discussed the positive physiological effects of kangaroo mother care (KMC) on infants’ temperature, weight, heart rate and respiratory rate. The KMC is another terminology that describes skin-to-skin contact. Sloan (1994) found that infants who received KMC were less likely to develop pneumonia compared to the infants who did not receive KMC. Tessier (2003) reported that the infants who received continuous KMC had higher IQ level compared to the other infants who did not receive KMC. Johnston (2003) research showed that infants who received KMC demonstrated less pain and Charpak (2005) showed that infants who receive KMC were discharged earlier than infants who did not receive KMC.
A Meta-analysis of 23 studies was done by Mori, Khanna, Pledge and Nakayama (2009) to examine the physiological effects of skin-to-skin contact on the newborn. Results of this analysis showed that skin-to-skin contact had positive effects on the newborn’s heart rate and body temperature. However, no relationship was found between skin-to-skin contact and the newborn’s oxygen saturations (Mori et al., 2009).
In summary, research on skin-to-skin contact indicates that this practice has several benefits for both the mother and the infant. Some of these benefits include regulation of the infant’s body temperature, increasing maternal-infant bonding, and improving breast-feeding opportunities.
A descriptive, non-experimental design will be used to assess the perception of labor room nurses about skin-to-skin contact between the mother and her newborn.
The sampling method that we will use in selecting our subjects is convenience sampling. The sample will include nurses who work in the labor rooms of government hospitals including Salmaniya Medical Complex and Jidhafs Maternity Hospital. The sample will consist of 50 labor room nurses available on a randomly selected day and shift. The sample will be drawn from the two aforementioned hospitals as follows: Jihafs Maternity Hospital (n=20), and Salmaniya Medical Complex (n=30).
Criteria for inclusion of sample:
The sample for this study will consist of labor room nurses working in government hospitals in Bahrain. Nurses participating in this study must have at least five years labor room experience. Bahraini and non-Bahraini nurses will be included. Nurses with Associate Degree or Bachelors of Science Degree will be included.
Data collation instrument:
A self-report questionnaire consisting of twelve questions on skin-to-skin contact and four demographic data questions will be used to collect data from the sample.
A pilot study will be conducted to test the reliability and validity of the questionnaire. The sample for the pilot study will consist of a convenience sample of 10 labor room nurses from Salmaniya Medical Center.
The study questionnaire will be modified as necessary based on the results of the pilot study.
Data collection procedures:
Permission to conduct the study will be obtained from the chief nursing services for hospital. Following the approval of the study, the chief nursing officer will distribute an approval letter to the nurses who are incharge of the labor rooms in the three hospitals.
The questionnaires will be hand delivered in sealed envelopes to the labor room incharges of the two hospitals who will distribute the questionnaire to their staff nurses. Each one of the researchers will be responsible for delivering the envelopes to one of the three hospitals. The subjects will be given two weeks to complete the questionnaires and return them to the office of the incharge person of the labor room. The nurse incharge will be asked by the researcher to remind her staff to return the envelops with the completed questionnaires to her office. The envelops will then be collected by one of the researchers.
Data analysis procedure:
The statistical package for the social sciences (SPSS-version 17) will be used to analyze the data. Descriptive statistics will be used to describe the sample characteristics. Inferential statistics including Chi square will be used to analyze data regarding knowledge level of labor room nurses of skin-to-skin contact.
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