All "ways of knowing" take place during a birthing. Using Quality Improvement tools such as PDSA, NKE+ provides family centered communication and better teamwork to meet the patient and family goals.

1. Mother Infant Recovery
Family Centered Care
MARGARET DEAN
SHANNON ARCHULETA
DANELLE SCHWEIGER
TIFFANY WARD

2. Promoting Early Breastfeeding & Skin to Skin Contact for
Caesarean Deliveries at Walnut Creek Kaiser.

3. 2012 Hospital Goal
Exclusive breast milk feeding is a clearly established
goal of the World Health Organization (WHO),
American Academy of Pediatrics (AAP), the
Department of Health and Human Services (DHHS),
and the Centers for Disease Control and Prevention
(CDC) and as of April, 2010, is a Joint Commission
Perinatal Core Measure (Flaherman & Newman,
2011).
The goal is a rate of 70% exclusive breastfeeding
upon discharge.

4. Educating Staff and Families
Benefits of skin to skin contact include:
 Regulation of infants heart rate, respiratory rate, temperature, and
glucose levels.
 Elicits maternal hormones that aid in milk production.
 Infants remain calmer and ready to breastfeed.
 More likely to exclusively breastfeed at discharge.

5. The Natural Habitat
Skin to skin- Your
skin the natural
habitat where baby
should transition and
begin his own
regulations of
breathing, heart rate,
temperature etc…

6. Our Mission
Establish a family centered approach for our
cesarean section deliveries.
To keep mom’s and babies together throughout
recovery.
Promote skin to skin in the operating room and
continued bonding in our mother infant recovery
area.
Allow for significant other to experience skin to skin
contact if mother’s is unavailable.
Improve our skin to skin and exclusive breastfeeding
results to 70% at discharge by the end of 2012.

9. Collaborative Team Effort
We involved members of our breastfeeding
collaborative, NICU and well baby staff, L&D
nurse’s, respiratory therapy, anesthesia,
doctors, and midwives.

10. Our Process
The RN assigned to the infant in the OR (usually the
ALS or NICU shift leader) initiate and document skin
to skin in the operating room.
The infant is brought into our mother infant
recovery area. The significant other accompanies the
infant and the mother joins them there.
If the mother is unstable the significant other is
given the opportunity to do skin to skin.
The infant spends the first hour of recovery skin to
skin and supported with breastfeeding assistance.

11. The Transitional Care Center
We converted one
gurney bay into our
transitional care center.
The infant is recovered
next to it’s mother’s side.
The infant spends the
first hour of recovery
skin to skin and
supported with
breastfeeding assistance.
In the last 30 min the
infant receives an
assessment, vital signs,
bath, and medications
prior to the family
moving to our mother
baby unit.

12. Our Success
February 27, 2012, marked our first day of the
mother & infant recovery post cesarean section. It
was a giant step forward in recovering our moms and
babies together. A huge thank you for all who
worked on the process: Monina Jose, well baby
nurse for the day, Natasha Pottish ALS, Deb Newson
SL NICU, Mary Clancy NICU RN, Jody Knight, Jen
Holthaus, Deb Wood L&D RN’s, Amy Bode CRNA,
and Dr. Nan OB.

13. Begins to search…

14. Comments From Families
The patient was amazed at the experience stating, “I
was only expecting him to be with me, skin to skin,
not actually be nursing in recovery!”
Father was overheard telling family, "No, the baby is
isn't in the nursery he's with us. They believe in
keeping the families together here.“
Mother said, "Last time the baby went to the nursery
and I was left here all alone. This is sooo much
better having the baby with me!"

15. Summary
We used a tracking log to capture and review records
for those patients who were recovered together.
We established a communication binder for
constructive feedback and used this information to
enhance the process.
We are currently looking to expand to evening and
night shift unscheduled cesarean sections.

17. A moment in time, a world of difference.