#19 Immediate Skin to Skin: AWHONN Practice Brief 14

Today on this episode we are going to go over A1’s practice brief number 14, which is immediate and sustained skin-to-skin contact for healthy, late pre-term, and term newborns after birth. What is a practice brief you might ask? So the definition of a practice brief is that it’s a short-form scholarly article, which is so true in this sense, because A1, if you don’t know, has practice briefs, and currently they have 11 on their site, and Sarah’s going to list them for us in a second. But they are so easy to read, and so easy to put into practice, because the research is there, it’s short and concise. You can understand it. What are some of the ones they have, Sarah?

Well, and I see these as almost like policies and procedures. I know I came from a facility that didn’t have policies and procedures. They’re not going to necessarily replace your policies and procedures, but they’re as quick and to the point as a policy and procedure should be. And on A1, A1 literally says that these can be used as a quick reference guide, and they need to be incorporated into our practice. So they have practice briefs on various things. Skin-to-skin is one of them. That’s what we’re going to talk about today, and talk about practical application, get an idea of what people are doing all over the place with skin-to-skin in the vaginal delivery rooms, and in the operating room.

They have a quantification of blood loss, guidelines for active management of the third stage of labor using oxytocin, so postpartum for us labor and delivery nurses, lower extremity nerve injury, which I think that one is really interesting and something that we need to be more aware of. Prevention of newborn falls, nitrous oxide, sudden unexpected postnatal collapse, which is going to come up in this episode, because that is a risk when they’re skin to skin. Venous thromboembolism, breastfeeding, et cetera. So we will actually link the direct link to their practice briefs on the show notes and then on the website as well. So you can check those out and start clicking through. Know what exists, especially for any kind of change. That’s definitely going to come up in today’s episode, when we talk about skin to skin in the OR, because we know that not everybody’s doing that but A1’s recommendation is that it should be happening. And so this gives ammo to your fire, to your-

Cause?

Thank you. It gives oomph to the situation. That’s what I was going for-

I like that.

… but that’s not a real word.

I don’t know.

So let’s talk about skin to skin. Let’s get into this practice brief, Number 14. We’ll also link this down below. If you are an A1 member, first of all, if you’re not an A1 member you need to be an A1 member. So we’ll also link details down there, because I know they’ve given us a promo code for you guys for the next couple of months. And then on top of that, we need to be referencing our scholarly articles. This is one of the reasons why we’re doing this, is to help show you how to find them, that they exist. And they can help guide our practice, because for us to all just be floating around, not knowing what we’re doing, or not knowing what the recommendation is from our governing body is not best practice. So we’re going to be best practice and go over it quickly today.

So at the top of the practice brief, you’ll open it up and you’ll notice they’re one to five pages, and they’ll say immediately the recommendation. So if you are quickly reading through, on this one specifically, it’ll say, “All stable, vigorous newborns born vaginally or by cesarean should be placed immediate skin to skin for at least an hour of life, or until the first breastfeeding is complete.” And I feel like overall, based on talking to nurses all the time, skin to skin is very common in the labor room for sure. With some of the issues being babies taken to get weighed first, or babies taken for eyes and thighs first, or a diaper, measurements, and that’s dependent on facility to facility, we should be advocating for those vigorous newborns to stay on the birthing person, skin to skin. But I will say in this practice brief, Sarah, did you see that they did a study on if it was delayed a little bit and it was okay?

Mm-hmm. Wow.

Overall?

Wow. It said, I know exactly where this is at. It said, “When immediate skin to skin contact could not be safely facilitated, early skin to skin contact within the first hour of birth had similar outcomes,” in one study. So I think that it’s easy, it’s almost trial stuff, where you hear something, you’re like, “Ooh, now I can do my eyes and thighs, because it’s easier for me, and I want to get the weight so I don’t have to come back to the room.” Let’s be honest, if we’re not leaving them skin to skin, it’s one of two things or both, that we want to be done with our workflow, or just culturally that’s how it’s done and we’ve never questioned it otherwise.

When we want to be clear that A1’s guidelines and across the board what is best for mom and baby, or birthing person and baby, is that they go immediately skin to skin. Given that they’re stable and they stay there. And we as nurses need to learn how to do our assessments, and do our eyes and thighs, and do everything that we need to do, other than the weights, while they’re skin to skin.

I love what you say about work clothes. I feel like every episode you are coming down with it.

I know I am.

Like, “Let’s be honest, you want to check off the box.” I get it, we do.

I mean that’s what we say. We’re like, “I’m not trying to beat around the bush.” That’s what it is and we all know it. We might as well just say it. And again, there’s no harm done. It’s like we all do it. There have been so many times when I’ve been like, “Oh my God, please just let me weigh the baby.” And it’s about how you approach it, right? It’s like, “Would you like me to weigh the baby so that you can text that out with your announcement?” So that, “Then you can know how big the baby is,” and it’s all about your presentation.

Versus not even offering to be honest. And they’ll ask if they really want a weight, “Can you just weigh them now?” But most of the time they’re not asking, and they’re not going to want to give up their baby. And we know from the evidence that keeping them skin to skin with that immediate, and by immediate it’s on the chest or the belly, depending on how long the cord is, and dry them off, put them skin to skin and then leave them there. Just let them be. And that may be uncomfortable for those of you that don’t do it regularly. But honestly once you start to make this shift, I remember when this shift happened in my practice, it then is like, “Why wouldn’t I? Whatever, so much, I can do the same thing.”

I think too on the flip side of that, because you mentioned the presentation of, “Don’t you want to send it with your announcement?” If we’re trying to get baby off of them, which we shouldn’t be doing.

Completely.

But on the opposite side of that, they might not know the benefits of it. They might just be like, “Oh …” Or even our patients that don’t want to breastfeed, or declining breastfeeding, they might not realize there’re other benefits to skin to skin then breastfeeding with your baby.

Completely.

So they do list that out in this practice brief. So it does say the initial benefits of immediate skin to skin are decreased incident of neonatal hypoglycemia, improved thermo-regulation and improved cardiopulmonary stabilization. Who doesn’t want all of that? I want that as a baby nurse.

Well, and I think we weigh things out in our brains all the time, based on what we see. The baby will be fine, it’ll be fine. It’s like it’s five seconds which really turns out to be at least 10 minutes. But we have to look at the evidence, and know that this is a practice brief for a reason, because there’s overwhelming evidence that it’s better for mom, baby, and partner to do skin to skin. On top of that, when we talk about breastfeeding, if we’re encouraging breastfeeding they have better suckling, better short and long-term improvements in feeding, longer duration of exclusive breastfeeding.

And then when we start talking about OR, which we will talk about the OR, because that’s a whole other beast, but improved mother’s satisfaction and confidence, which I think all of this, they say it, they studied it in the OR, but all of this very much applies to a vaginal birth as well, “Provided a more natural experience and sense of control. It facilitated bonding and attachment.” Another study, “Shorter durations of crying, more stable heart rates and temperatures, longer durations of breastfeeding.” And then the fathers who provided skin to skin for their newborns had lower anxiety and depression scores, and enhanced role attainment.

That is so important. That’s crazy right there.

Mm-hmm. Well, and again, it’s these psychosocial sides of things, that I think from a medical perspective, we like data, we like numbers, like, “Oh the temperature was 96.3, and then we put them skin to skin and now it’s 98.6.” Those numbers feel much more comforting. But we cannot forget the psychosocial side of the empowerment that can happen in the postpartum setting for labor and delivery, or LDR depending on what your facility says. I know we had a breastfeeding call last night, and it was talking about that whole empowerment piece.

That we have an opportunity in the postpartum period to set them up for their parenting experience through bonding and through empowering them of like, “Look at your instinct. Wow that’s amazing. Your baby is, look at how they look at you. He turned towards your voice,” or whatever. Those little comments they stick, because in that immediate postpartum period, first of all we have a hormonal cascade that helps with all of that. But also it’s their first experience as parents. And we have authority in the room, we have credibility that when I say that, “Wow, look at your instinct. That was amazing. Look at how they did this. This was totally normal for a newborn, or advanced. I haven’t seen that very much. And that’s amazing.” They’re going to hear that and go like, “Oh my gosh, I’m so advanced.”

Yes. See? And that’s so great for their confidence.

And then we also know that earlier and longer sessions of skin to skin contact were associated with exclusive and extended breastfeeding, and reduced symptoms of depression and physiological stress in the postpartum period. So this is preventative medicine through skin to skin. What a simple intervention for us, with overwhelming evidence of its benefit.

There’s also the increased feelings of bonding and attachment. And you know here if you’ve listened to Why Your Job Matters, that attachment between our patient and their baby is so important. And so two, say the birth plan didn’t go as expected, and say maybe they were induced and really wanted to go into labor, they got an epidural and didn’t really want to, this is an area where we can start rebuilding their experience and bettering their memory, because they got that skin to skin time with their baby. I think it’s important to know, backtracking a little bit, Sarah, when I mentioned, “If you wait a little bit it’s fine.” The keywords, what they say is when immediate skin to skin cannot be, “Safely facilitated.” And that’s where I think if you’re listening to this too, you are on a journey, I’m assuming, to be better and do better. And that’s why you’re spending your time listening to a labor and delivery nurse podcast, right?

So I can assume that you want to be, and so I think it’s checking ourselves against, is this unsafe? Is that why I’m taking baby away? Or am I doing it to do my tasks? And taking that extra time. And like you said, it gets easier. I did not know how to do eyes and thighs until I became a clinical instructor, and that terrified me, because we don’t deal with babies at my hospital. So I was like, “Oh I’ve got to learn real quick.” And so I learned doing it while during skin to skin. And so I think that was really a huge advantage. And I make all my students do it with baby skin to skin, and they freak out. They’re like, “What are you doing?” Not all, most of the time it’s skin to skin, but it’s so much better for a baby that way. If they can be breastfeeding while you give the vitamin K, guys, that is so good for baby, and isn’t there, you taught us in mentorship, there’s the pain response while skin to skin, right? What was that?

They have less pain, less crying, less-

You guys, so cool.

… anxiety from the experience. It’s a comforting measure. It’s definitely not the equivalent, but the idea behind giving dextrose on a pacifier, that instead just do skin to skin, and it helps with that natural coping.

And there is there truth, is this, we should have fact-checked this? Maybe I’ll edit this out. Is there truth to the fact that the breasts releases amniotic fluid, and they smell home when they’re skin to skin?

So the breast does not release amniotic fluid. They’re like shooting amniotic fluid out of their breasts.

So how would I word that?

That’s so good. So the areola smells like the amniotic fluid, yes.

Okay, that’s awesome.

Which is one of the ways that they start rooting towards the breasts. They’re like, “Mm, familiar smell. Oh, dark color. Let me go there.” Because they can only really see dark and light, and so it helps them find the breast.

It’s so funny.

Yeah, it doesn’t-

So funny.

I’m going to quote you for that.

So fun fact, I am terrible when it comes to breastfeeding, so.

You are not.

But I am okay with being a learner, a beginner at this. This is fine. We all have our weak spots, and this one is for me.

Yeah, but how many moms have you helped breastfeed?

Quite a few.

Right? Successfully. So you’ve got to give yourself some credit.

We’ll see. So we do not shoot out amniotic fluid, which seems so silly when I say that. Obviously, I’m not telling them, “They might be swallowing amniotic fluid.” So another reason then for skin to skin would be that baby can smell home to them, and they smell Mom, or that’s just really beautiful how our body works.

Well, yeah, it’s the physiologic response, that’s I usually, how I usually teach it in class, is the moments, first of all they go from warm, dark, quiet, confined space, not so quiet, it’s from the placenta, but different noises. And then they go smoosh through the vagina, or out a cesarean opening, and then they like, “Boo,” and they’re like, “Whoa it’s a lot cold and bright and loud. And where’s the uterine wall?” And this is all so new. You put them skin to skin, they know their parents’ heartbeat, they know the smell. They’re warm, that touch and all of the natural hormone release from touch, they can breastfeed when they want. So it just automatically calms their nervous system by putting them skin to skin.

And also the proper way of doing skin to skin is tummy to tummy, is usually what I say. And it’s not on the parent’s tummy, it’s like on their chest. But that the tummy is touching fully the skin. Not turned up to the side, you know can turn them up to the side, or their head to the side when you do the eyes. But otherwise it’s tummy to tummy with their knees on either side, in a squat position kind of, I say frogged. And then their hands out touching, so they have the most surface area possible. That’s also why sometimes our babies get cold. If there isn’t enough skin to skin touching, that helps that the thermo-regulation. So you turn them in that way and that helps. I mean just being close to mom helps with their nervous system. But that’s usually how I approach it

To help with visualization. So baby is between the breasts up and down. So if you’re having a hard time visualizing that. And two on the other side, it’s going to help our patient contract and release oxytocin and help their bleeding. So it’s helpful in that way too. So if you’re in vaginal birth and this isn’t a standard practice for you, maybe this is the hill that you start to climb to die on.

Hopefully not die. Please don’t die.

But let’s talk about C-section. So in my OR, we do not do skin to skin. That is a new thing I’m going to try to push for eventually. But you have Sarah, so let’s talk about your experience and what works?

Well I was a part of the task force that created the loosely policy, and implemented the changes and trained the staff and got it to become more common standard practice for us. So if you are looking to make a change, I will plug our leading change class that’s available on demand on the Bundle Birth Nurses site. We can link it down below because this would supplement a lot of the evidence-based practices that we all care about and we all ideally want for our patients, we want to practice in a best practice way, evidence-based way. And so this class will help you facilitate that process of leading change on your unit. Regardless, and actually the person that created it was a part of the task force with me. And this was one of the big things that we brought to the hospital, and is still happening.

Which is awesome because you can lead change but you need to sustain change as well. And so I guess what I’ll say is the workflow for a skin to skin in the OR. And then leading change, you have to watch the class, because that we could be here forever, with some strategies for that, or maybe that’s an episode. Let’s bring Mykel on and we can talk through some leading change strategies. So stay tuned for that. So baby comes out, went to … This was how we did it and there are potentially other ways. Would go to the receiving nurse who was scrubbed in, go to the warmer for a dry stimulate eyeballs on. If they looked stable they would go from warmer to skin.

Now we had a hiccup there in the process of change, where they wanted an initial temperature before they went to mom. That’s usually what everyone’s worried about. We talked about or temps, the OR temp, we didn’t change. I think it was 68 to 72 is where ORs were set. And so they would dry stimulate and then go on mom. Now there’s some prep that has to be done in order to know that you’re going to be able to go skin to skin on the patient. And so they do need to be braless, they do need to be unsnapped. So it’s an easy transfer. And we would take them in warm blankets, wrapped around tightly but also loosely. And then they would be actually placed more in across the chest/cradling the boob a little bit, because you need to avoid the abdomen. So it’s a little bit more awkward to be honest. It’s not the perfect froggy vaginal birth skin to skin. It’s more of a lay across, and the head is going to be a lot closer to the patient.

And I think that’s where they can’t even see the baby. They can’t even, it’s not the same, or they’re feeling like awkward. And this was a common complaint from the patient, where they’d go like, “Oh I don’t know. I feel stressed from it.” And so that’s where your education came in. And I learned the hard way that in order to prep for skin to skin, to talk them through what to expect when their baby comes. And then assure them that we are watching the safety of the baby, they don’t need to hold the baby on them. They don’t need to be responsible for baby not falling, because especially when they’re flat versus sitting up a little bit, it’s way more awkward for them. And so we would come in, lay the baby skin to skin, and then take off the wet, if there’s any wet, and then put a worm blanket on top with a hat.

Some people would put the hat on before, some after. It’s all happening so quickly that it really didn’t matter in my experience. And then if I was the baby nurse in that case, I would throw the thermometer in my pocket, I’d have my stethoscope on. So when I’d go to put skin to skin, I’d get them settled, I’d reassure the parents, I’d maybe have the dad or the partner lay a hand on the back, so they also felt in control and a part of it. You always want to visualize the airway. So I’d turn the head usually towards the patient, and you’re assessing the whole time you’re watching there. This is what we would do in theory in a vaginal birth as well. So I’m watching, and then I have all my supplies to do my vital signs. So once they’re there, and eventually when I got really good, I’d like throw the ID bands in my pocket as well so I could ID the baby there.

I can do a full set of vital signs there. And then I’m not even having to turn away from the patient. Usually from my experience, they might be done with skin to skin after five minutes, maybe 10. Sometimes they’d want to be there the whole time. Sometimes baby would start looking for the breast, and then you can always help facilitate breastfeeding. And to be honest, the patients that breastfeed in the OR, I hear about it later currently. It is so impactful if baby’s ready. And this is where with breastfeeding education, we do have a whole breastfeeding class as a part of our mentorship. It may be available soon-ish. So stay tuned for on demand. We might have a black Friday or something coming. But with that, it’s like you don’t want to stress about getting the baby on the breast. Skin to skin is enough.

Skin to skin is the first step in successful breastfeeding, and any minutes of skin to skin with the patient, matter. So I want to leave that with you in the OR, even if it’s two minutes. Even if your workflow only allows for you to place skin to skin, do the vital signs, ID the baby, maybe you have your eyes and thighs there, that you can give also as just a grab and give. Whatever you can do, and then they’re off three minutes later and then maybe that you finish, they go skin to skin with the partner in that case. And this is where in my childbirth classes, I would always prep the dads to wear a button up shirt or something easy access with nothing underneath. So they could just unzip their little bunny suit and whoop, throw the baby in and they can sit there with skin to skin too.

So that also was another thing that we would facilitate. One of the, this is such a random side tip, but how a lot of the stools for the partner have wheels and no back. A lot of times it’s one of those round stools, the providers pull up for repairs and stuff. We ended up switching out our secondary chairs to lock and have a back, so that they could do a little lean back and we weren’t worried about them rolling and falling back with the baby.

So just another random, you have to think through all of the factors, and all of the objections that someone might have to you doing something like this. Once again, it is the recommendation from A1. So it’s just a matter of changing up your workflow. And when your workflow is, everything’s in the warmer, and wham bam, thank you, mam. Wrap up, swaddle, hand to partner, “Yay, here’s your baby,” it’s a different workflow. But the benefit to me, so outrisks the inconvenience, and the awkwardness that it is until you figure it out. And then once you figure it out, it was like, “Oh, this is just how it’s done.” Which is sort of the case of any kind of change.

And this is why you need to take the Leading Change class because you can think about all the people you need on your team. It can’t just be like you making this policy and want it to go through. You need everyone and also you need the naysayers. You need. So it could be really overwhelming sometimes, but it’s nice to break it down in the chunks, and totally doable. I’m going to do it.

I can’t wait.

So I believe it is.

Well, let’s follow up and hear how it goes for you. We’ll hold accountable, Justine.

I know, the goal. And so the reason why for full transparency. The goal is to get people to be more skin to skin right away in vaginal births before we jump to the OR. And then our NICU is moving to another building. And so right now NICU catches our babies in the OR, and that’s not going to be a thing anymore. It’s going to be other nurses. And so it’s a good opportunity to change the workflow and what we do, but we actually have a policy on it.

Oh great.

So that’s neat called Gentle Cesarean and we just, no one does it.

So well then you just start.

Yeah.

The next time you’re in an operating room, decide for yourself. I’m just going to try it out, and see how it goes. There’s a policy on it. Great.

Yeah. But then so it sounds easier. So I got to get the NICU nurse to want to do it right. And then usually if I’m going to the operating room, it’s at night, and it’s usually a crash. And so it’s like, “Well, there’s factors.” So I will say too, this is much easier to plan when you’re doing your scheduled C-sections. And I wanted to clarify with you, did you put a blanket under them? Did you do that method versus some people do belly bands to hold baby in there on their chest. Do you know what I’m talking about?

Not between the skin though. You’re talking about on top of them?

I’m talking about. So someone told me that what they do, is they have a blanket folded hotdog style, for lack of better description, on the OR table. And then the patient lays down and so then they can wrap the rest of the blanket over them and baby, is that what you guys did?

Yeah. So if we were prepped for it, we didn’t really have a standard for how the bed was set up, but you do want to have something to secure the baby. And that was what I would do, was I’d take a warm blanket, lay it across patient and baby, and then I would tuck it into the side so it was tucked behind. So there was a little bit of snugness to help with that support, so that the baby … If I did need to turn around and grab something, then I felt like I safely could.

So some work flow there, is you have to be like, “Okay, what are we going to make the bed different for scheduled sections?” Who needs to do that? Is that housekeeping? Is that scrub tech? For tucking in the blanket in my OR, I’m thinking I could tuck in one side, but I would need the anesthesiologist to tuck in the other side, based on space. And so it is, when you’re trying to make change, you have to really think about all of it. There’s a lot, it’s not just like, “Let’s just do it.”

Mm-hmm. So well in that piece, I would say that wasn’t as important to my workflow as some other things. Definitely helpful when I could get them tucked in nicely, and all perfectly for their photos, and then I could take photos for them too, while they were just chilling together. But if that doesn’t happen, just make sure that there’s something warm on top of them, and nothing wet in between, because you are in a colder environment. And if you haven’t done the dry off, remove the wet blankets, they will get cold. But if you do it without, I didn’t really have cold babies in the operating room. Okay, so for a less fun topic, let’s talk about close observation due to sudden infant collapse.

Mm-hmm.

Yeah, and the risks.

So you’ve had this happen?

I have, that was eventually what they diagnosed it as. And this was in a vaginal birth. So if you don’t know what sudden unexpected postnatal collapse is, it or SUCP.

Do we say SUPC, or SUP-

SUPC, it just feels like very awkward on my mouth. So SUPC. That’s what I remember saying in mentorship of SUPC, which is probably bad, don’t say that in front of your neonatologist, you will sound really dumb. But the idea is sudden unexpected postnatal collapse, which just means that the newborn looks good, and then they basically code. And they stop breathing on the breast. So they don’t totally know why it is. It’s almost like to me, I think of it as the skin to skin/postpartum equivalent of SIDS, where you’re just like, “Why are you coding? You were good.” And this is in the immediate postpartum period. So my circumstance, I actually left the room to go get a gurney to transfer, and I came back, I don’t even know how long I was gone.

She’d been breastfeeding, baby was skin to skin. And I looked down and I was like, that color is not good. And I remember saying, “Hey buddy,” used the word, “Buddy.” But now I always associate with that case. And I pulled his face back, and he was not breathing and totally blue. And I rubbed his back, no response. And I grabbed him, and then we yelled in our facility, I know this seems very primal and barbaric, but we’d yell for like, “Delivery,” and people would be like, “Delivery, delivery,” and a doctor wouldn’t show up. And so I just yelled, I was like, “I need the neonatal crash cart,” and yelled out the door, and grabbed baby, put him in the warmer.

But at this point I’d cleaned up the room, I still luckily had my oxygen ready, so I just flipped on the oxygen and then started bagging the kid. But it was literally sitting there, how is this even possible? What in the world? And then the charge nurse showed up, and got a pulse, started chest compressions, we coded the baby till NICU, got there, NICU took over, went to the NICU for full workup, and they found nothing. And so they eventually ruled it in as this SUCP.

But it was very scary and very unexpected. And I will say this baby was also 37 and change. So their terms, she went into labor on her own, so you assume like, “Oh we’re good.” But it can happen. And so I think we need to be aware. This is also why A1 recommends, and I’ll pull it up, that in the first two hours after birth, all newborns in skin to skin contact and/or breastfeeding should be continuously monitored by a qualified professional personnel. This goes back to our staffing standards episodes. So you can go there, but A1 is saying, this is partially why, because we need to have eyes on these kids so that if they were to suddenly collapse for no reason, we could respond. And this baby is totally fine. I actually still have loose contact with that family, and get updates and stuff.

So super scary. It was my first neonatal code, and it happened to be an hour and 15 minutes after birth, should not have happened that way. So though that is going to be the biggest safety consideration that A1’s going to mention in this practice brief. The other one is just risk of falling with the maternal exhaustion that happens after birth. We all see this, and if you can picture, I now have coined it as the narcolepsy postpartum narcolepsy. Because they’ll be talking to you, and they’ll be like, and their eyes are getting heavy and they’re totally glaze over, and you’re like, “And they’re done.”

And they’re done.

They had all this adrenaline and now it’s like, “And now I literally cannot stay awake to save my life.”

So true.

And so less education in that moment, and you’re watching that somebody is paying attention. That could be the partner, they could stay skin to skin. And we all know that if they’re reclined well enough and tucked in, and there’s pillows there, if their hands go limp, I always have them test that, that they’re probably okay so long as there’s somebody watching. That could be you, that could be a partner. And then that’s where the education comes in to the partners to say, “Hey, we want to stay skin to skin. This is great for baby, but I need a hand close by that you’re watching the baby doesn’t slide and fall off.” And then that education for the color of the baby too, visualizing the airway, all stuff that we should be teaching our patients regardless. But is it particularly important when we’re doing sustained uninterrupted skin to skin.

I liked how you just threw that out there, sustained uninterrupted skin to skin.

When I said it, I was like, “Wow, I sound so-

That was good.

… so professional.”

I heard it. I’m sure everyone did too.

It came out.

It did

Oh, it’s like little like dominatrix here.

So what’s the point? The point is that skin to skin, sustained and immediate, is the standard of practice, and is evidence-based. And we have the data for that. We have A1 has made it super easy for you to go on their website, it’s free the practice briefs, and to grab this. This is something that you’re like, “This has to happen at my hospital.” They’re absolutely right. If you’re someone that’s listening to this and is like, “I know it’s the right thing, but it’s really hard and I have a lot to do,” maybe challenge yourself in that. Lean into that and read this article, read all the benefits, and maybe that can change your mind and soften your heart to that, because it is the best thing. And we want to help these patients have great memories. Because yeah, we’ll say healthy mom, healthy baby, that’s all that matters. But here at Bundle Birth we added the healthy memory, birth memory, and this helps with that. This solidifies that birth memory on the postpartum side.

And something that we always talk about here at Bundle Birth as well is putting yourself in the shoes of the patient of what would you want? What do they want? What’s important to them? Ask them those questions. And if they don’t know, then you can say, “This is what the evidence says.” So I think there’s that beautiful balance between the evidence, you know in your head, the evidence is clear, and that our governing body, A1 is saying, “This is what the recommendation is.” And then really by being the opposite, you’re going against the evidence by doing that. And on top of that, there’s the psychological benefit to the patient of their experience. And think of what a simple thing this could be to enhance their birth experience and contribute to that healthy birth memory.

What’s interesting is when you said that, I thought of how many times do we get irritated with providers that go against the evidence for their own, to make their lives easier. And this is somewhere that we might be doing that, because we have a lot of say in this. So-

Yeah, this is our intervention. This is a nursing intervention. This is not an MD order.

Right. So something to think about. Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram.

Now it’s your turn to go find this practice brief. Read it for yourself. You can skim it for yourself. Sign up as a member on A1, because we should be doing that. And then go and try it in whatever format. If you’re already doing this skin to skin, be encouraged in your practice, and have the evidence to assure that you’re doing the right thing for your patient. And then think about what’s the next step for me, of how I encourage this cultural shift and movement towards standardizing skin to skin for both vaginal births and cesarean. Thanks for listening and we’ll see you next time.