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Cesarean Skin to Skin Outcomes Evidence TablePICO Statement:P = PopulationIn newborn patientsI = Interventionis immediate skin-to-skin contact post C-sectionC = Comparisonas effective as usual careO = Outcomein promoting infant stability and overall satisfaction?Study: author,YearStudy DesignStudy QuestionSubjectsInterventions/ Control GroupsOutcome MeasuresSignificant Results* include p valuesGouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., & Giulio, P.D. (2012)Randomized control trialLevel IAre there any differences in newborn and mother temperatures after c-section when skin-to-skin contact (SSC) is used when compared to routine care?N=34 mother/baby pairs at the Mother and Child Department of Pinerolo Hospital in Italy.-scheduled elective C-sections-utilizing loco-regional anesthesia-full term infants (38-42 weeks) with apgars greater than 7 and weight greater than 2500kg.Intervention group: N=17 mother/baby pairs utilizing skin-to-skinControl group: N=17 mother/baby pairs utilizing routine carePost-op temperatureEffectiveness of first breast-feedingBreastfeeding exclusivityPatient (mother and father) satisfactionNo statistically significant difference in post-op temperatures.Intervention group were fed earlier than control groupIntervention group was more exclusively breastfed at discharge (13 vs. 11)Intervention group more exclusively breastfed at 3 months (11 vs. 8)Majority of intervention women were very satisfied (12), felt skin to skin improved bonding (10)Beiranvand, S., Valizadeh, F., Hosseinabadi, R., & Pournia, Y. (2014)Randomized control trialLevel IDoes skin-to-skin contact after c-sections have an effect on infant temperature and breastfeeding success when compared to usual care?N=96 mother-infant pairs at the Asali Hospital in Iran-singleton pregnancy-full term (gestational age 38-42 weeks)-scheduled elective c-section-utilizing spinal anesthesiaIntervention group: N=48 mother/baby pairs utilizing skin to skinControl group: N=48 mother/baby pairs utilizing usual carePost-op temperaturesBreastfeeding successfulnessNo statistically significant differences in newborn post-op temperatures (immediately post-op p=0.86, 0.5 hours p=0.31, 1 hour p=0.5)Overall breastfeeding assessment show no statistical significance between groups (p=0.048) however skin to skin group was statistically significant at readiness to breastfeed (P=0.021), effectiveness of sucking (p=0.03) than control group. Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014)Review of LiteratureLevel II-1Review of literature in order to provide evidence for the use of early skin to skin contact during Cesarean sections.7 studies focused on immediate or early skin to skin post Cesarean delivery and other various inclusion criteriaNot all RCT’sN/AMaternal painMaternal-newborn stabilityNewborn feeding outcomesWomen’s statements post delivery indicate decreased pain levels; however, pain scores did not show a statistical significanceNo statistically significant differences between skin to skin and control groups for maternal and newborn thermoregulation. Newborns with early skin to skin had significantly lower respiratory rates and higher temperatures at 1hr post-opSkin to skin newborns latched on an average of 21 minutes earlier than control; artificial formula supplementation was decreased by 41% with early skin to skin; no significant difference found in exclusivity of breastfeedingFrederick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M., & Schneider, K. M. (2014)Qualitative study “medical ethnographic design”Level II-1Mother’s perceptions of immediate skin to skin contact during the intra and post operative Cesarean section periods.N=11 pregnant women, full term (39-42weeks), delivery via Cesarean section from Texas Medical Center-no preexisting medical needs-utilizing spinal anesthesia-Newborn APGARs greater than 7 and 8N/AThemes:Mothers’ perception of experiencePractitioners observations of experiencesThemes:-helped distract from OR environment-calming effect for both mother and infant-early communication between mother-newborn-reported feelings of strong bonding between mother-newborn-pro-feeding behaviors observed, not latch achieved-surgical environment hindered comfort/ease of skin to skin contactErlandsson, K., Dsilna, A., Fagerberg, I., & Christenson, K. (2007)Randomized control trialLevel IHow does skin to skin contact with a paternal substitute post c section effect pro-feeding behavior and infant crying compared to usual care?N=29 infant-father pairs from surgical and maternity ward at Karolinska University Hospital in Stockholm, Sweden-full term infants (37-41 weeks)-utilizing spinal anesthesia-undergoing elective caesarean sectionIntervention group: N=15 utilizing skin to skin a paternal substituteControl group: N=14 usual careInfant pre-feeding behaviorsInfant cryingSkin to skin infants cried significantly less than usual care infants (p less than 0.001)Sucking (p=less than 0.001) and rooting (p less than 0.01) behaviors and length of wakefulness (p less than 0.01) were less in the intervention group indicating greater infant comfort.Sundin, C. S., & Mazac, L. B. (2015)Qualitative studyLevel II-1Study maternal satisfaction and pain levels during caesarean sections with immediate skin to skin use intra-operativelyN=46 repeat cesarean section patients receiving skin to skin contact in the operating room.N/APatient satisfaction compared to previous cesarean sectionsPatients perception to pain compared to precious c section“maternal satisfaction was higher and perception of pain was lower for women who experienced STS [skin to skin] in the OR when compared to women where STS was not performed”Velandia, M., Matthisen, A. S., Uvans-Moberg, K., & Nissen, E. (2010)Randomized control trialLevel IAre effects of early skin to skin contact influenced by the parent performing the skin to skin contact?N=37 healthy infants with primipara’s and their partners-healthy uncomplicated pregnancyRandomly assigned to either skin to skin contact with either mother or father. Parent not conducting skin to skin contact served as control; all infants received skin to skin conact.Parent newborn vocal interaction Infants behaviors Parent performing skin to skin contact communicated with infant more than control (Overall promotes vocalization between infant-parents)Infants skin to skin with father cried significantly less (p=0.002) and entered a relaxed state quicker (p=0.029) than those with their motherHung, K. J., & Berg, O. (2011) Quality Improvement projectLevel II-2Does implementation of early skin to skin contact during cesarean section increase breastfeeding rates?Healthy mothers and infants delivered via cesarean section in a large California teaching hospital over a 9 month periodN/ALATCH scores (Latch, Audibleswallowing, Type of nipple, Comfort, Hold)Formula supplementationAfter implementation of protocols for earlier skin to skin contact post-cesarean section resulted in increased average LATCH scores and decreased infant formula supplementation during hospital sayNolan, A., & Lawrence, C. (2009)Randomized control trialLevel IDoes initiation of protocols to reduce maternal-infant separation including skin to skin contact influence maternal and infant outcomes compared to usual care/infant-mother separation?N=50 women and newborns-singleton-full term-repeat cesarean deliveryIntervention group: n=25 receiving protocol treatment including skin to skin contactControl Group: n= 25 usual care (infant mother separation)Infant outcomes:-respiratory rate, temperature, stress, breastfeeding ratesMaternal outcomes:-pain, anxiety-Intervention infants had significantly lower mean respiratory rates (p<0.05), significantly higher temperatures (p>0.05), significantly higher salivary cortisol levels (p>0.05)-greater intervention dyads initiated breastfeeding than control group-others reported less pain and anxiety however it was not statistically significantMoore, E. R., Anderson, G. C., Bergman, N., Dowswell, T. (2012)Review of Literature: Meta-analysisLevel IReview the effects early skin to skin contact post-delivery compared to usual hospital care.Review limited to healthy newborns either full term or late preterm (34-37weeks) -receiving skin to skin contact within 24hrs after birth-either vaginal or cesarean section delivery34 randomized control trials containing 2177 mother-infant dyadsIntervention: receiving skin to skin contactControl group: receiving standard hospital careStudy covered many areas but for the purposes of this table this author focused on breastfeeding rates, infant thermoregulation, maternal-infant bonding, post-cesarean section delivery maternal outcomesEarly skin to skin contact is associated with increased incidence and length of breastfeeding, more effective infant thermoregulation, increased maternal sensitivity to infant cues, decreased reports of post-operative maternal pain, and strong desires to repeat skin to skin care.ReferencesBeiranvand, S., Valizadeh, F., Hosseinabadi, R., & Pournia, Y. (2014). The effects of skin-to-skin contact on temperature and breastfeeding successfulness in full-term newborns after cesarean delivery. International Journal of Pediatrics, 2014, 846486. doi:10.1155/2014/846486Erlandsson, K., Dsilna, A., Fagerberg, I., & Christenson, K. (2007). Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior. Birth: Issues in Perinatal Care, 34(2), 105-114. doi:10.1111/j.1523-536X.2007.00162.xFrederick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M., & Schneider, K. M. (2014). Exploring the skin-to-skin contact experience during cesarean section. Journal of the American Association of Nurse Practitioners. doi: 10.1002/2327-6924.12229Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., & Di Giulio, P. (2010). Skin-to-skin contact after cesarean delivery: An experimental study. Nursing Research, 59(2), 78-84. doi:10.1097/NNR.0b013e3181d1a8bcHung, K. J., & Berg, O. (2011). Early skin-to-skin after cesarean to improve breastfeeding. The American Journal of Maternal/Child Nursing, 36(5), 318-324. doi: 10.1097/NMC.0b013e3182266314Moore, E. R., Anderson, G. C., Bergman, N., Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants (review). Cochrane Database of Systematic Reviews, 5. doi: 10.1002/14651858.CD003519.pub3Nolan, A., & Lawrence, C. (2009). A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(4), 430-442. doi: 10.1111/j.1552-6909.2009.01039.xStevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin‐to‐skin contact after a caesarean section: A review of the literature. Maternal & Child Nutrition, 10(4), 456-473. doi:10.1111/mcn.12128Sundin, C. S., & Mazac, L. B. (2015). Implementing skin-to-skin care in the operating room after cesarean birth. The American Journal of Maternal/Child Nursing, 40(2), 249-255. doi: 10.1097/NMC.0000000000000142U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed.). Baltimore: Williams and Wilkins.Velandia, M., Matthisen, A. S., Uvans-Moberg, K., & Nissen, E. (2010). Onset of vocal interaction between parents and newborns in skin-to-skin contact immediately after elective cesarean section. Birth: Issues in Perinatal Care, 37(3), 192-201. doi:10.1111/j.1523-536X.2010.00406.xAppendix A: U.S. Preventive Services Task Force. Levels of EvidenceI: Evidence obtained from at least one properly designed randomized, controlled trial or meta‐analysis of randomized, controlled trials. II‐1: Evidence obtained from well‐designed controlled trials without randomization. II‐2: Evidence obtained from II well‐designed cohort or case–control analytic studies, preferably from more than one center or research group. II‐3: Evidence from multiple time series with or without the intervention. III: Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed.). Baltimore: Williams and Wilkins. ................
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