Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates.
OBJECTIVE
Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge.


METHODS
For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010).


RESULTS
In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change.


CONCLUSIONS
The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.
College of Nursing, University of Texas at Arlington, 411 South Nedderman Drive, Arlington, TX 76019, USA. crenshaw@uta.edu
Jeannette T
JT
Crenshaw
Karin
K
Cadwell
Kajsa
K
Brimdyr
Ann-Marie
AM
Widström
Kristin
K
Svensson
Jane Dimmitt
JD
Champion
Richard E
RE
Gilder
Elizabeth H
EH
Winslow
D000328:Adult; D000884:Anthropology, Cultural; D001942:Breast Feeding / Q000208:ethnology / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D009769:Object Attachment; D017060:Patient Satisfaction; D058996:Quality Improvement; D013997:Time Factors; D014110:Touch; D014481:United States; D014741:Video Recording; D055815:Young Adult