A new vital sign for maternity care: duration of skin-to-skin contact after birth

If you haven’t heard, the Joint Commission, the organization that accredits U.S. hospitals, has recently rolled out a bundle of perinatal quality measures. These measures are designed for hospitals to track and improve their performance on indicators of perinatal quality, including the proportion of newborns discharged from the hospital having consumed only breast milk during their hospital stay. The US Breastfeeding Committee created a helpful document for hospitals, Implementing the Joint Commission Perinatal Core Measure on Exclusive Breast Milk Feeding (PDF). Right on the first page and repeated two more times, the Committee makes this suggestion:

Compliance with the new core measure may require facilities to modify their paper charts and/or electronic medical records. Thus facilities may want to consider charting modifications that support breastfeeding (such as length of time of skin-to-skin contact, especially immediately following birth). [emphasis is mine]

I don’t know how difficult it is to get hospitals to make changes to their documentation forms. I assume as more hospitals adopt electronic health records, the task is easier. However, even if changing the form is easy and inexpensive, staff will need to be briefed on the rationale for the change and trained to document the new data properly. This all adds to the complexity and cost of providing care, so it’s easy to see how some hospitals would just stick with their old way of documenting.

But if hospitals are serious about improving their exclusive breastfeeding rates, they should get serious about measuring the duration of skin-to-skin care. A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge. The data in fact come from a hospital quality improvement program carried out in 19 hospitals in California – the reason they were able to detect the dose-response relationship is that they were documenting the length of skin-to-skin contact as part of these quality improvement efforts. Using data from nearly 22,000 mothers and their healthy, full-term babies, the researchers found the dose-response relationship even after controlling for whether the woman intended to exclusively breastfeed, education, ethnicity, anesthesia, mode of birth, and other factors. One factor that was not reported and apparently not controlled for was history of prior birth and/or prior breastfeeding experience. This could be a significant confounder, but there is no reason to believe it would negate the strong and consistent findings – the dose-response pattern held up in multiple calculations applying various assumptions.

The quality improvement project that produced this study was supported by the Loma Linda University Perinatal Services Network, a network of hospitals working collaboratively to create policies and practices that keep moms and babies together after birth. Check out these great flyers and handouts they offer to promote early mother-infant attachment and breastfeeding.


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  1. avatar
    April 26th, 2010 at 10:29 | #1

    Hmm… the first link is broken

  2. April 26th, 2010 at 10:38 | #2
  3. avatar
    April 26th, 2010 at 16:00 | #3

    OK, the repost in your comment worked. Thank you!

  4. April 26th, 2010 at 18:24 | #4

    One of my classmates, a midwife from the UK, told me that there they have to document the reason if baby was NOT placed skin-to-skin. Wow!

  5. April 27th, 2010 at 11:38 | #5

    In Belgium there’s a program running to get maternity wards a baby friendly logo. Can you imagine, non baby friendly maternity wards… oh the irony

  6. April 28th, 2010 at 07:55 | #6

    This is excellent! Our hospital has chosen the exclusive breastmilk intake core measure along with elective delivery and Cesarean Sections. We are using only those three as we don’t have our NICU up and running yet. It is challenging to determine how to measure exclusivity without individual chart reviews. We are currently in the middle of perpetual transition (ha ha) where we have a mix of electronic and paper charting. Multiple software upgrades, uplinks and interface patches are in the works.
    The “SOFT” acronym was the 2007 World Breastfeeding Week theme along with The Importance of Breastfeeding in the First Hour, save a million babies worldwide from preventable disease. I wrote an article about this which was published in our local parent magazine to increase awareness and began the campaign for prompt and increased S2S time within our facility. The challenges still exist but I LOVE the idea of documenting the length of S2S time. This will be part of my process improvement project.
    I was really happy to see the article in JHL yesterday!

  7. June 21st, 2010 at 17:32 | #7

    What great recommendations! I wonder if a different term other than “vital signs” would even be in order–considering that historically, the term “sign” often refers to something externally observable that suggests pathology. Perhaps the durations of behaviors such as skin-to-skin holding and breastfeeding could be charted as “Vital Practices” instead, denoting both the vitality (life-giving) as well as the purposeful nature of these choices –parenting practice with observable and recordable results.

  1. April 26th, 2010 at 13:22 | #1
  2. June 14th, 2010 at 08:01 | #2
  3. June 23rd, 2010 at 08:37 | #3