Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative.

OBJECTIVE: To improve rate of skin-to-skin contact for early initiation of breastfeeding at birth on operation table among healthy term and late pretem babies born by caesarean sections from 0% to 80% in eight weeks.

METHODS: A quality improvement initiative was undertaken at maternity-newborn care unit of a tertiary-care hospital. A team involving Neonatologists/Pediatricians, Obstetricians, Anaesthesiologists, and Nurses in concerned areas identified problem areas using Fish bone analysis. Situational analysis was done through process flow mapping. Three Plan-do-study-act cyles were undertaken. Firstly, sensitization of personnel was done and a written policy was made. Secondly, maternal counselling and procedural modifications were done. Lastly, efforts were made to improve duration of contact.

RESULTS: Rate of early skin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. It was 100% after sustainability phase after four months.

CONCLUSION: Early skin-to-skin contact was achievable through sensitization of all persons involved and simple procedural changes. Prolonging duration of contact remained a challenge.