By Carmen Baxter, MD
Skin to skin is sweeping the nation. Everywhere, hospitals are catching on to the benefits of the “Golden Hour.” It is well accepted now, that full term babies (37 weeks or greater) who come out crying and doing well will do even better just by having skin to skin contact with moms for the first hour of life. A few of these benefits include better temperature regulation, better control of blood sugar and less jaundice. Even mothers do better, as they have less bleeding, an easier time with breastfeeding and better bonding. But for those moms who deliver by c-section, this golden hour can be fragmented and disappointing. Change is hard and if we are going to push for a change, we need to understand the barriers!
Skin-to-skin in the operating room can be challenging for several reasons. First, this is a sterile environment and, in the interest of your safety, protocols have been put into place. Like a pilot preparing for take-off, your OR crew has been trained to communicate, go through checklists, count everything multiple times, carefully hand off instruments and even babies. Changing that routine is difficult and may require new protocols. Understanding this will help you navigate the system. Most people working in the OR love births, but they also have a large responsibility to make sure you, your baby and even your support person are safe while under their care.
The good news is that a lot of Ob/Gyns want to change things too! Here are some tips on how you can do your part in this revolution! If you know you are having a c-section, talk to your doctor early about skin-to-skin in the OR. If the c-section is not planned, you can still ask to be prepared for any situation that comes up. Ask her (or him) if this is done routinely. If not, does she think it can be accomplished during your delivery? Your doctor may start thinking about all the barriers and be hesitant to make promises on behalf of the whole team. Reassure her by saying that you know it’s a complicated request but you have some ideas to make it work. Seeing that you are willing to work together, your doctor will likely be excited to hear what you have to say!
- Getting the Pediatrician on board. When your surgeon pulls your baby out, she can vigorously dry and stimulate your baby. The louder your baby cries, the more comfortable the pediatrician will be to delay an evaluation. (TIP: Reassure her that if your baby is not doing well, you of course understand that baby will need to go to the warmer).
- Sterility must be maintained! Maintaining the sterile field is one of the ways we keep infection rates low in the OR. Unlike in vaginal deliveries, your surgeon can’t just put baby on your chest or the sterile field will be contaminated. But she can hand your baby to someone else sterile who can bring the baby to you. (TIP: On the day of surgery, find out who this person will be and talk to him/her ahead of time. If they feel part of the grand plan, they will be more willing to make it work).
- Be prepared! You don’t want everyone struggling to get baby to your skin! The OR can be cold and without skin-to-skin, your baby’s temp may drop too much (TIP: If the team is concerned about a cold OR, remind them that studies show that mom’s body does a better job regulating baby’s’ temperature than the warmer). So, don’t wear a bra to the OR. Nothing but the gown they give you. This will make it easy to slip baby inside the gown. Your baby will still be a little messy and wet, so ask ahead of time if there are some blankets your support person can have ready to go. Make sure he/she is ready to wipe off any exposed skin and cover it with blankets. (TIP: Ask the anesthesiologist whether your arms will be strapped. If so, as if they would be willing to loosen the straps or take them off once the baby gets to you so you can help hold your baby).
- Be flexible. The OR staff take their jobs seriously and they want you and your baby to be safe! If someone asks to bring the baby to the warmer, don’t be afraid to ask if it’s absolutely necessary. (TIP: Speak their language, and practice the following, “If it is safe, I would prefer to continue skin-to-skin.”) But if it is, understand that there may be something which they see that you don’t and trust your team. Also, if you are not comfortable or you are struggling and don’t feel safe holding your baby in that position, let someone know that you need a break. (TIP: Ask if your partner can hold the baby skin-to-skin if you are unable to.)
- Stay focused. Don’t forget to remind your surgeon and the staff before going to the OR and again, once in the OR. If this is not common practice, it is easy for them to forget because they are used to well-rehearsed steps (TIP: Remember they may be nervous about trying something new, and gentle reminders will help keep anxiety low for everyone. You can say something like, “Thank you all so much for being willing to do skin-to-skin with me!)
“Motivation is the art of getting someone else to do something you want done because she wants to do it.” With these five secret steps, you have the tools to motivate an entire OR team into trying something new. Once they realize how these easy steps make the experience so much better for everyone involved, they will likely want to provide this service to more and more patients. Your efforts can change hospital policy if you have the right attitude and attack it the right way! Make that Golden Hour yours! But above all else, remember that your willingness to try already makes you a great mother!
Dr. Carmen Baxter, MD is a board certified obstetrician and gynecologist. She has a special passion for facilitating ways to make birth a special, natural, bonding experience while maintaining a safe birth environment. She accomplished her medical training at Wright State University, where she also stayed on for her OB/GYN residency training through a joint military program. During her subsequent proud military service at Langley Air Force base, she championed the very first integration of skin-to-skin bonding time between mother and baby at time of cesarean section. She is also an expert in minimally invasive surgery. She currently resides in California with her husband and son while she continues to be a special patient advocate.