Skin to Skin Minutes After C/S in the OR… Speaking Up and Making it Happen
Submitted for the Healthy Birth Blog Carnival #6: MotherBaby Edition
Skin to Skin immediately after birth is an extremely important part of the continuum of the nurturing of pregnancy, the process of birth and the transition of nurturing from inside mom to outside mom. This is the natural habitat where baby should transition and begin his own regulations of breathing, heart rate, temperature etc… This is recognized by the AAP in their changes to the Neonatal Resuscitation Algorithm back in 2000. The recommendation was to keep baby with mom and provide all initial evaluations and steps with baby on moms chest for all healthy babies! We all know that babies have an inborn innate ability to self attach and nurse right after birth. These recommendations are not just for vaginal births. Kathy Petersen has a beautiful description of the importance of STS after a Cesarean birth on her Woman to Woman Childbirth Education blog in her 5/30/10 post Skin-to-Skin in the O.R. after a C-section.
As soon as I heard about the last edition of Science and Sensibility’s Healthy Birth Blog Carnival with a theme about “keeping moms and babies together after birth”, I wanted to write about my tiny little efforts, struggles and some successes in providing moms and babies with an environment that supports and protects their need to stay together. My recent role in the protection of such an environment and subsequent privilege of watching a baby self attach in the OR 15 min after a C/S birth has re-energized my efforts to get more mother’s and nurses to speak up and make this a standard for healthy babies!
Then….. I saw a link on Laura Keegan’s Facebook fan page for her book Breastfeeding with Comfort and Joy to an awesome video and a beautiful photo posted by the author of Cesarean Parents Blog about her birth. I had heard of Laura’s search for images of STS after C/S and asking for mother’s experiences. Amy Romano from Science and Sensibility alerted Laura of the photo: Kathy blogged about STS after C/S and I was working on this post! Such uncanny timing! I am just in awe of this marvelous networking community! Head over to Laura’s facebook link and share your experience for her info gathering. Here is the fabulous video they are all talking about “Breast is Best” from Norway:
Why is it so hard for the doctors and nurses to get on board? Most of them understand the word “bonding”. But what many don’t realize is that it took a long time for the actual concept to take hold, to allow “time” for bonding to occur. It sounds silly but many times if the baby and mother are still together after 2 hours…the nurses call that “extended bonding”. I have been doing this for over 35 years now and the changes from the 70’s to now are fascinating and frustrating at the same time. To understand the process of change, we have to sometimes remember where we’ve been. I wrote about Medical Science vs Natural Childbirth a year ago because I feel history IS important to help us move forward. Often it is about control… but many times nurses and doctors are simply task oriented/focused and not patient centered. They want to complete all their procedures and charting and move on to the next task. I understand this, there is always a lot to do and document. I work there too! The environment provided to us, the health-care workers, is one in which regulations are abundant and staffing is not always optimal. Flexibility is needed. I know there is a way. This culture just has to change. And it happens in small little doses.
SO–> Skin to Skin immediately after a C/S? I have been told by coworkers, doctors and anesthesia:
“It’s impossible, “
“It can’t be done”
“There’s not enough room”
“This patient (the mom) is in the middle of major surgery!”
“The baby needs to be under the warmer, it’s too cold in the OR.”
Really? Seriously? Watch Me………
I have actually been working on this issue for the past few years…… Ever since I began staff education for World Breastfeeding Week 2007′s theme “Breastfeeding: The first hour — Welcome Baby Softly”. The focus from ILCA was: ‘Establishing a welcoming environment that keeps mothers and babies together.’ It was then that I gently tried to introduce the concepts for C-Sections as well as all vaginal births. I was getting a lot of positive response for vaginal births…not so for C/S.
Anesthesia is our biggest barrier. The chest area of the mother seems to belong to them somehow. The arms too.. I always politely ask the doctor for permission to have at least one arm released so she can touch her baby. (they are secured on armboards to her sides.) Really the OB’s didn’t mind what was happening outside of their draped domain. The Pediatrician is the next barrier because they want to finish a complete exam…. in the nursery…. before they returned to the office or whatever. So I started with the Peds… hoping they would stop expecting the baby to be quickly removed from the OR. I started with just simple requests for prolonged “bonding”… because they all get that. “Look how well this baby is transitioning.. so alert and PINK! ” “I’ll write all the measurements in your exam note…. I’m fine… I know you’re busy….” I’d say. Sometimes mom and baby got to stay together. Soon, for some of the doc’s, the expectation of baby leaving mom was gone. They got tired of waiting around and would leave. More moms and babies got to stay together…even if it was dad doing the holding. My co-workers were not always so understanding because of the work flow on the unit. It would work best when the birth happened any time other than first thing in the morning when it’s busy everywhere. Isn’t that sad? Sitting here writing this I’m thinking of ways to work on that….. another time…..
Anesthesiologists or Nurse Anesthetists are all different. There are some wonderful ones who are releasing both arms and pushing things out of the way for the baby and others who are constantly telling moms they are “under” anesthesia and can’t hold the baby, or they have given meds to mom right after baby is born so mom is now groggy. I talk to each of them respectfully and differently depending on their own approach. I have discussed my plans for STS if baby stable ahead of time. I have discussed how it is up to us to provide this protected environment for moms etc… I have used the patient satisfaction discussion, the scientific evidence discussion, the patient centered care discussion, and the increased patient numbers due to higher satisfaction talk. I have let them know that when a mother requests that–> we must do everything possible to help her experience this.
Slowly, over the last few months, I was able to facilitate some babies really getting skin to skin in the OR for short periods before going to the nursery. There were a variety of factors for why it wasn’t very long each time but at least it was happening!! It’s not a standard of care yet and I’m the only one working on it but others are getting interested… Communication has been very important to create the environment and reduce barriers. We still have a long road ahead. But we did pave a path for this mom….
She came in with an unknown double footling breech presentation in active labor and the doctors wanted to do a C/S right away. She was really upset and had a beautiful birth plan that was already getting discarded. “STS until first breastfeed accomplished” was on her plan and I was determined to help her with that! Things were happening fast. The anesthesiologist wasn’t my best STS supporter.. “oh well” I thought, “I’ll do what I can to help.” The baby was crying and pink when born and without thinking about it, the doctor, nurses and myself had him on the baby unit drying him. Mom went panicky! “Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!”. So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!” Anesthesia saw the immediate transformation of his frantic patient to one with calm maternal bliss, admiration and cooing. He was then helpful to let her other hand out. This little boy stayed with mom, breastfed before he was 15 min old and went to the PACU with mom. She was so incredibly happy. I never got to see her after that since it was near the end of my shift and I wasn’t on shift the next few days. I saw that she exclusively breastfed in the hospital and without complication went home on day 3. At least part of her birth experience went according to plan!
If she hadn’t have been so vocal about what she wanted, so adamant… she would not have experienced what she did.
SPEAK UP AMERICA…. MAKE IT HAPPEN
Want to see more? This stunning video of a baby skin to skin then breastfeeding at birth in the operating room via @MothersUtopia @Laura_Keegan. What were your experiences? Please don’t forget to head on over to Breastfeeding with Comfort and Joy on FB to comment on your experience or opinion about this important topic!! Calling for women to share their experiences with skin to skin here, to help give a voice to the real need to make skin to skin in the OR routine practice in all ORs.
This is so wonderful! Our first son was born via C/S 8 years ago and he needed his body temperature regulated. STS was never mentioned as an option. I never even considered it a possibility in the OR. Our second son was born just two weeks ago also via C/S and they said we were *going* to do STS…without asking me! I was So pleasantly surprised. That little man came into the world quite vocal…..until the moment they put him on me. Even they commented how they hadn’t seen a baby calm so quickly. 🙂 It was a Beautiful experience I only wish I could have had with our firstborn.
Thank you so much! Really! I have had 2 natural births (my first a midwife attended homebirth by choice at 15 yrs old!) and I am now expecting my third ANY day now (due Sept 3 but I “feel” it is closer to Sept 7th…). Unfortunately, she is breech (footling) and that delivery is a lost art these days (my sister and I were breech homebirths…sigh…) so I am scheduled for a c-section Sept 4th.
I have been trying to get her to turn but we found out MUCH too late – just 3 days ago! So trying to empower ourselves with knowledge before we must go in. My husband and I are honestly DISGUSTED by the “business” of birth. Not the miracle, bonding, human-side – we toss that aside and have the fear of lawsuits to blame for some of it.
The video was beautiful! I am calling my hospital in the morning to check their policy on STS, keeping our daughter with us at ALL times, nursing with a C/S, arm restraints, etc. I had no idea about some of these things!
Again…thank you! I already had the voice. I had to stand up for my daughters right to breastfeed without “supplements” while at the hospital last time. I just needed the knowledge…part of which I have gained on your site. Blessings!
Excellent! Good luck to you with your conversations and I hope you won’t have opposition for your plans. Yes the Business of birth is sad. I have observed the breech births of yesteryear (Geez that makes me feel old) and I have had to talk some of TODAY’S OB’s through the delivery of the aftercoming head even in a C/S! It’s something they just don’t get practice or experience with. As an added note, the AWHONN Journal- “Nursing for Women’s Health” has a large section on “Keeping Mothers and Newborns Together after Cesarean”. This change needs to happen all across our country. If they are resistant.. tell them you’d like to be their “trial run” so they can see how it really can be done! Please let me know how it goes! Positive thoughts!!!!
Bless your heart! You are the best. Thank you for helping that mother in the OR! My baby and I had the benefit of STS in the OR for my first birth, via unplanned c-section, thanks to supportive staff, especially the anaesthetiologist, who was just about the coolest guy ever! Both of my hands were free, and I got to hold and nurse my baby. Now have moved to another town, and I’m expecting my second. I have realized how lucky I was…and I’m worried about what could happen this time. I wish this were more commonly accepted.
After 20 hours of pitocin induced labor, I had a csection with our son. It was a “normal” csection in which he was wrapped up in a blanket and shown to me. Shortly after I saw him, I was knocked out. I woke up in recovery, looking at my husband enjoying sts with our son. I was so resentful. That was supposed to be me.
When we got pregnant with our daughter, I knew I wouldn’t accept this again. I was told over and over that sts was not an option. Finally, I found a Dr willing to do it. At the end of my pregnancy, I made it clear that sts was my number 1 request. The nurses kept telling me that it wasn’t an opton, even though my Dr had agreed. I was told the Dr doesn’t know “what has to be done” after birth. I was told “you can do cheek to cheek, but she needs to be in a blanket to be warm”. I responded that I’m a much better temp regulator than a blanket and that she WAS going to be put on me. My husband was prepared to take our daughter from the nurses and place her on me.
When I talked to the or nurse the morning of our surgery, I was prepared for a fight. She was completely on board!! On march 19,2013 at 12:50 pm our brenna came into the world. She was placed on my chest, sts, and it was the most beautiful experience in my life! My husband had to remove her for a few mins at one point because my bp dropped. After I was better, she was returned to me. She remained on me for the next 2 hours.
I am so grateful for this experience and I’m so glad I fought to get what we both deserved. I felt like the nurses thought that my daughter was less deserving of the sts benefits simply because I had a csection.
Please do not be so condescending toward your peers and colleagues. You should understand this is an education issue. Of course some will be resistant because “this is the way we do this” However, if you approach this from a perspective like: neonates have a physiologic need to be with their mothers, breastfeeding rates substantially decrease when mom and baby are separated and that first hour is vital for the newborn. Keeping mom and baby together by providing kangaroo care is important for the infants physiologic transition to extra uterine life. Site AAP, AWHONN and ACOG reccommendations. Nurses and Doctors simply need the information. Then show then how great it can be for everyone. You make the difference in their resistance. So lead the way.
Gosh I’m sorry that’s what you took away from this…. I am leading the way- I am empowering mom to speak up when they are surrounded by negativity and the word NO. I know it is a can do thing. I am respectful to all my colleagues. I have been gently re=educating them for nearly 40 years.. what I have found is that the Mother speaking up for what she wants is going to help make the changes. Thanks! 🙂
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