Immediate Skin to Skin Contact and Zero Separation of Mother Infant Dyads Among Healthy Term Infants Delivered Vaginally: A Quality Improvement Initiative in a Tertiary Care Institute in South India

Abstract

Background The neonatal resuscitation program (NRP) recommends immediate skin-to-skin contact (SSC) of the neonate with the mother’s abdomen. Early establishment of SSC has increased the duration of breastfeeding and decreased neonatal morbidity significantly. Objective To achieve immediate SSC and zero separation of infant–mother dyads for a minimum of 30 min in vaginally born healthy term babies from 0% to 50% over 3 months by implementing a quality improvement (QI) initiative. Methods A QI initiative was undertaken at the maternity-newborn care unit of a tertiary-care hospital between March 2022 and December 2022. A team including neonatologists, obstetricians, pediatric postgraduates, and nurses (both neonatal and obstetric) in the concerned areas was identified. Using 5-why technique and fishbone analysis, the root cause analysis was done. Two plan-do-study-act (PDSA) cycles were undertaken. First, sensitization of healthcare personnel was done, and a written policy was made. Efforts were made to sustain the QI. Continuous surveillance, internal audits, and regular interprofessional team meetings were carried out. Results Prior to this QI, baseline data showed that no babies received SSC for 30 min. During the first PDSA cycle, 16.6% (4/24) of babies received SSC and zero separation for 30 min. During the II PDSA cycle, among 46 eligible neonates, 50% (23/46) received SSC >30 min. During the sustenance phase, among 262 eligible neonates, 75.2 % (197/262) received >30 min of SSC immediately after delivery. Conclusion Immediate SSC and zero separation for 30 min could be achieved by implementing simple measures through this QI initiative. The major hurdles, including the knowledge gap, fear, and safety of neonates, were tackled through simple strategies like education sessions, ergonomic modification, and sensitization of the healthcare team.