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Posted: February 27th, 2022

EBP project paper

This week is the first time you turn in the EBP project paper. Many weeks you will be adding to the paper so by the time you arrive at week 14, you will only have minimal work to do.
Ignore the directions for Assignment # 2. Use the file for model headings with explanations instead (attached below). Prepare the cover page and insert the date of submission, which you will change each time you submit the paper. The title on the cover page should be for the entire proposal and not the name of the assignment for that week. Each time you complete another assignment for the EBP project, you add it to what is already written. The word document with the model headings and explanations is formatted according to APA manual 7th edition. You can use the document to write the paper. Simply replace my instructions with your information. If you choose to start a new document, be sure to use the model headings file to guide your use of APA headings. (this section talks about the outline of what is expected, the instructions start in the next section)
You will add to this paper for future assignments. This week, you write the introduction, background, and EBP model. The EBP question can be placed at the end of the background. The focus is on the problem: what is the problem? The articles or other documents you use to establish and explain the problem and its significance are NOT the studies you include in the matrix. For example, if you choose to focus on patient falls, you would locate sources that provide you with up to date information on falls, how many patients fall in the US when hospitalized, of those how many are injured, what types of injuries, and percent leading to death. What is the cost of hospitalization due to falls that occur during hospitalization? As of 2009, Centers for Medicare and Medicaid no longer reimburse for the extra cost of hospitalization and other treatments due to a fall. It is this type of information that belongs in the background. Additionally, you can give your personal reasons for selecting the problem. It may be that on the unit where you work, falls are increasing or not decreasing even though many strategies have been added to the bundle for preventing falls.
Do not include the sources you use for this part of the paper in the matrix. The matrix is for articles that provide you with results of studies as to how to solve the problem. The matrix is for the studies you will be using for the literature review.
For assignment # 1, you initiate the search for studies on solving the problem and start to fill out the literature review matrix. This is where you summarize key information for each study. Add plenty of detail especially for findings. Findings are the results of the statistical tests and not the conclusion: Having patients sign a contract to commit to asking for help with ambulation decreased falls. Rather, give the number of falls before the intervention and then after the intervention. When you write the literature review, you will use the matrix to help you summarize/synthesize the information in the paper. The matrix is the middle step between the articles and writing the paper. This week you only fill out the matrix, not yet writing the review within the paper. When looking for studies, attempt to locate at least a few qualitative studies though for EBP, experimental designs provide the best evidence. If you locate a systematic review, you may use it but you cannot use studies in addition that are included in the review. If you find two systematic reviews, check to be sure that there is no overlap of studies included. If 10% overlap, no problem, but the more studies they have in common, you are basically reading the same evidence so can’t use both reviews as if they are independent. Not all problems have been thoroughly researched so you may not find enough studies to have evidence to review. It is very important that you make an attempt to locate as many studies or EBP/QI projects as you can, or you may end up having to select a new problem later on. If you find the required eight studies, then add at least the title and year to the matrix. The requirement for this week is to minimally fill out the columns for the two studies you include.

This is the topic I choose.
Does the use of patient centered care for preventing falls decrease fall rates?

I have attached the Outline of the EBP project with headings and explanations. You will replace the instructions with your information.

Title of Paper
Name of Student
Scientific Inquiry Evidence Based
Date of Submission

Title of Paper
Following the title of the paper, write an introduction. An APA introduction introduces the main topic of the paper and its significance. The significance is always from cited information, not something you write from your own knowledge. This usually takes the form of a short paragraph. Either as the last line of the paragraph or in a new paragraph, you provide a roadmap for the reader as to what to expect, i.e. the purpose and what will be covered. Since you cover the problem under background, you don’t need to include much about the main topic. Rather, you can introduce the paper as a proposal for an evidence-based practice (EBP) project and what you cite is why it is important for you to know about EBP. Then simply state the problem you have selected without any further information. Alternatively, you can introduce the topic and give your personal reasons for selecting it. Then write the purpose of the paper (the EBP proposal). For most APA papers, you would not write a personal introduction but for this one you do provide a substantive explanation of the problem under background. For the final sentence you can state your guiding question, also referred to as a PICOT question. Example: For this evidence-based practice proposal, the focus will be on use of silicone dressings to prevent pressure injuries. (If you don’t add your specific focus here, then place it at end of background)
This elaborates on the problem and is similar to what you will be reading in the first part of the studies you will be using. It is highly preferred to use primary sources and not use information cited in your studies. If the authors of studies cite the WHO or CDC, then look up those documents and read for yourselves and cite the information. The background refers to the problem you want to solve. If the issue you have selected is patient falls, you want to locate information that presents national statistics for patient falls in hospitals and consequences for patients and for hospitals (non-reimbursement). If you find a systematic review on the incidence of falls, that would be OK to use. Otherwise, use either a national government agency or professional organization. Check out this webpage to see what I’m referring to: https://psnet.ahrq.gov/primer/falls. The sources you use in this section are NOT part of your review of literature. This section is establishing the problem, not the solution. The articles or other documents you cite under background should not be placed in the table where you list the studies you will be reviewing.
If the focus of your paper will be on video monitoring of patients to prevent falls, that information does not belong in this section, only the problem of falls themselves, or readmission within 30 days, or pressure injuries, or nurse burnout. In the introduction you should have focused on the purpose of the paper and that will include both the problem and the solution.
Evidence-Based Practice Model
For this section, describe the Iowa model you will be following for the proposal. You will find this in your readings. There are many models for EBP, this is only one, but it is the most popular. If you decide to use a different model, that is OK. But in this section give a good description of the model. This section should be at least one long paragraph up to a page.
Review of Literature
The review of literature includes studies conducted to prevent falls (or solution for the problem you have selected). The goal is to synthesize the information from the studies to present the evidence for strategies that have been shown to be effective. The strategies that are supported by the findings are what you will be using for the next section. The first paragraph in this section should describe your search process: which databases did you use, which library, what were the search words, did you add specific inclusion and exclusion criteria. How many studies did you find and did you exclude any? If so, why did you exclude the study? It’s Ok to exclude a study if the method was weak or the sample is very different from your population of interest. It’s not OK to exclude a study because the findings are negative: there was no impact from the intervention. That is considered unethical and poor science.
There are two approaches to writing a review: summary or synthesis. Synthesis is the best approach but can only be used when the studies are very similar to each other related to variables: independent and dependent. For example, if your question is regarding the effectiveness of foam dressings to prevent pressure injuries (PIs) especially to the coccyx area then all will be experiments that use the same exact treatment for reducing PIs at the same body location. For such studies, a synthesis method is best. But when the studies are quite different from each other in design, how intervention is developed, and include more than one dependent variable, you may need to use the summary method: presenting each study one by one. There is NO one method to use. It depends on the studies. Once you submit the matrix with all of your studies included, I can provide a recommendation as to the method to use. Either way, you will need to use sub-headings to organize the review. For now, check out Appendix B and C for examples of both types.
Proposed Change
In this section, you present the change in practice that will be implemented. The section includes both the description of the new practice and steps you will use to implement the change. Use change theory to guide the steps: https://www.kotterinc.com/8-steps-process-for-leading-change/.
This section of the paper describes the setting and patient population for the change as well as a description of the planned change and the plan for implementation.
Setting and Population
This refers to your setting and patient population, not those you find in your studies. Notice that the heading is at the margin, all major words capitalized and in bold. Second level headings are for sub-topics within a centered heading.
Practice Change
Here you describe the new practice, not why it’s important as this has already been covered in the paper. If the practice change is to add hourly rounding to the existing fall prevention protocol, you would describe hourly rounding as it will happen in your setting: who, when, how, where (not why). The easiest approach is to select the practice change from one of your articles or a combination. This is evidence-based practice so your practice change should look like the ones from your studies.
Implementation Plan
Organizations implement change frequently. The Eight Step Change Model helps guide organizations to carry out changes in such a way that success is much more likely. The following are the eight steps that should be carried out. Write a short paragraph following each of the level 3 headings: what you would do to achieve the step. I entered information under the first one so you would see that following a level 3 heading, you start on the next line. Level 3 headings are sub-concepts under level 2. Note that the heading is similar to level 2 except that it is in italics. That is what distinguishes level 3 from level 2. See following web page to learn about the eight steps: https://www.kotterinc.com/8-steps-process-for-leading-change/ I added an example that fits under create a sense of urgency.
Create a Sense of Urgency
Though the number of falls are posted on the unit for everyone to see, the impact on patients and families is not always clear. During morning huddles, the clinical nurse leader will tell a story of a patient who fell and what happened as a result of the injury: patient was transferred to a rehabilitation unit instead of going home. While there the patient developed pneumonia which required a second hospitalization. Since the pneumonia was linked to the fall, the costs for the second hospitalization could not be charged to Medicare and the hospital had to cover the stay. The patient who fell was the main caretaker for her husband who has Alzheimer’s and because of her extended absence he was moved to a nursing home on the dementia unit. (Real-life stories help to motivate nurses who are already exhausted and have experienced change fatigue due to COVID.)
Build a Guiding Coalition
Form a Strategic Vision and Initiatives
Enlist a Volunteer Army
Enable Action by Removing Barriers
Generate Short-Term Wins
Enlist a Volunteer Army
Sustain Acceleration
Institute Change
In this section you describe the outcomes you expect to achieve. Outcomes refer to improvement in patient outcomes. For patient falls, you would want to reduce the overall fall rate but also specifically injurious falls. To be measurable, outcomes need to have numbers attached: The average fall rate will be reduced by 50%. EBP projects usually require a change in how care is delivered, that is referred to as process and not outcomes. For example, use of bedside report could be a strategy you decide is what is needed as most falls occur during change of shift and bedside report is expected to reduce falls. You can have a secondary outcome that relates to the process change: bedside reporting will be accomplished according to the protocol 100% of the time. The outcome section should be no more than one short paragraph.
Evaluation Plan
In this section, you describe the data that will be collected, when, how, and by whom to measure outcome(s) from last section..
Dissemination Plan
This refers to how you will communicate the project to others after it is completed. This could take the form of a poster day for projects at your work, presenting at a local, state, or national professional meeting, or publish the results in a journal dedicated to EBP or QI projects.
Since this is supposed to be proposal for funding, need to include what you expect the practice change to cost. For any change a cost-benefit analysis is done. For example, if the plan is to reduce readmission for heart failure and the hospital is losing one million dollars per year, then a project that would cost $50,000 is worth the cost. If you add a home visit or several follow-up calls, how much would that cost?
An APA conclusion is presenting the key findings from the paper and any insights you have gained. There should not be any new information presented and nothing cited.

I have set up this page so the hanging indent is automatic. As soon as I get to the end of the line, it will automatically indent the page until I hit return/enter for the next one. Just erase these comments and insert your first reference to see how it works. This is an option in word: to do this for yourself, look up to tool bar and look for paragraph, just above it are lines with blue arrows, click on that link and then choose line spacing options, this opens other options. Look for special, click on it and select hanging. I inserted a page break after the heading before adding the next page (appendix) so the next page should not continue with the automatic indent.
Appendix A: Literature Review Matrix
To have both portrait and landscape pages within the same document view this video: https://support.microsoft.com/en-us/office/video-use-landscape-and-portrait-in-the-same-document-ddd80cb6-c9ae-4493-ba75-c663074031a0

Appendix B: Headings if Using Synthesis Method
The synthesis method means that you merge your information for all studies together rather than describe one by one. When you do this, you don’t cite the studies over and over, you start the section describing your search process and then provide an overview of purpose of the studies, and their locations geographically/type of institution. The following paragraph would be placed after your description of the search process.
The search yielded six randomized-controlled designs and two quasi-experiments. The purpose of each study was to test the effectiveness of the use of silicone dressings to prevent pressure injuries. The RCTs were conducted in one ICU in Turkey, in ICU and two medical-surgical units in England (2 studies), on four medical-surgical units in Korea, and in two US hospitals, one in California and one in Georgia. The quasi-experiments were conducted in Iran and Norway.
In all, 680 patients participated in the studies with approximately half receiving the intervention and the others in control groups. For all studies, but one, patients who scored at moderate or high risk were invited to participate. In one study (the one in Korea), all patients with even minor risk were included. All patients received the usual care to prevent pressure injuries and for the experimental groups, silicone dressings were placed either in the ED prior to transport to a unit or on the units where the studies took place. The dressings were left in place unless soiled or wet. All studies included placement on the coccyx area and three studies had additional sites as well (heels and areas where equipment placed pressure). Though dressings were applied by staff nurses, researchers or research assistants monitored the care and participated in the daily assessment of patients for any sign of pressure injury using standard measurements. (Describe method).
Findings from all RCTs demonstrate that when silicone dressings are used, there is a decrease in the incidence of pressure injuries. The effect size varied from study to study and may be due to the level of risk in various samples. The study that had the strongest effect was the study in Iran: PIs were reduced by 80% for the experimental group. The weakest effect was a reduction of 30% and for the other studies, the incidence was reduced by 40%, 50%, 55% and 60%. For the quasi-experimental studies where incidence was compared to the prior two months, the rates were also decreased: 50% in one study and 60% in the other. These results are for the coccyx location. In addition, the studies that also used dressings on heels had similar results. The most dramatic differences were for PIs that occurred on the face due to use of equipment. With use of dressings, the incidence decreased by 85%.
(other findings that could be included would be analyzing the studies to see if there is any reason why some studies had better findings than others).
In summary, all eight studies indicate that when silicone dressings are used prophylactically, PIs are decreased by at least 30% and as high as 85% for facial injuries. One thing that was not controlled in the study (usual care not monitored) is the quality of care received by patients regarding other strategies usually in place. It may be that when care is not optimal, the silicone dressings have a stronger effect. A strength of the studies is that they were carried out on different units and in different locations, to include countries. I conclude that use of silicone dressings reduces the incidence of pressure injuries and should be integrated into the care of patients on the unit where I work.

Appendix C
In this appendix, I provide examples of use of sub-headings to introduce studies one by one. This is the better choice if the studies are different in various ways. An example would be use of mindfulness exercises to reduce burnout and compassion fatigue in nurses and to improve wellness. Examples of differences could be the tools used to measure the various dependent variables: tools that measure quality of life, compassion fatigue, stress level, burnout, etc. When the tools are very different, it is difficult to try to merge the findings. Additionally studies on mindfulness use many different approaches to include online support, face-to-face training and training that is short (a few hours) to weekly meetings for many weeks. Mindfulness can also take many forms: meditation, breathing, refocusing, yoga, tai-chi. For studies that have many variations though a central idea (to improve nurses’ status by some form of mindfulness, describing each study one by one works best. Following the description of the search process, you would end by stating the number of studies found and included then go on to summarize each in turn.
Study 1
The key to clarity is to describe each study in the exact same order and use of same wording. Do not alternate wording just to make it different. Writing in scholarly fashion requires use of the most precise terms and to use parallel construction for things that are the same.
So and so (year) conducted a quasi-experimental study to (give purpose). Each person in the study acted as his or her own control by pre- and post-tests on the ProQOL. The study was conducted in Japan in an urban medical center and staff nurses from all units were invited to participate by receiving an email message. Those who indicated interest were included. A total of 78 nurses agreed to participate and were enrolled in the study. Their ages ranged from ?? to ??. Only two men participated in the study. According to the authors, men in nursing make up no more than 3% of the nursing workforce in Japan and a great majority work in administration. Ten of the nurses had associate degree level nursing education while the rest had BSN.
Data was collected using the ProQOL which is a tool most commonly used to measure both compassion fatigue and burnout. The ProQOL also measures compassion satisfaction but this score was not included within the study. According to the authors, the reliability for the ProQOL is 92. It was developed by the theorist and there is evidence for its validity. Prior to receiving the mindfulness training, the mean score on the ProQOL for the sample was 52, a moderately high compassion fatigue score and 50 for burnout, also moderately high.
The intervention consisted of (describe the specific intervention for the study).
Then describe the findings and any limitations you identify.
Study 2
Study 3
And so on
When you summarize study by study, you need to present an overall interpretation of the study findings. Some information you could include are your overall conclusions of the strength of evidence for use of mindfulness. But what is most important is your interpretation of which studies produced the best evidence due to quality of the study and the strength of the effect. This is what allow you to decide upon the practice change: what mindfulness training and how it was done you think was most effective AND also not too costly. In this section, you can also identify the strengths and limitations of the studies as a whole. An example would be if all of the studies were conducted either in Asia or the Middle-East, would the findings apply to US nurses? No matter what you conclude, you would still develop a practice change but it’s important for you to judge the overall strength of evidence. Don’t exaggerate.

The effectiveness of using skin-to-skin care to increase the rate of breastfeeding is being investigated.
The effectiveness of using skin-to-skin care to increase the rate of breastfeeding is being investigated.
In the United States, women have the option of giving birth in a variety of settings, including at home, in a birth center, or in a hospital maternity ward. The majority of women in the United States give birth in a hospital (98.4 percent), followed by home birth (0.99 percent), and 0.52 percent at birth centers (see chart) (MacDorman & Declercq, 2019). The policies and procedures that govern maternal and newborn health care differ from one institution or facility to the next. Breastfeeding is recommended by the Centers for Disease Control and Prevention (CDC, 2020) and evidence-based hospital policies and procedures surrounding maternal and newborn care are important to assist in the initiation and maintenance of breastfeeding. SSC, also known as kangaroo care, is one of the most beneficial practices for extending and increasing the duration and rate of breastfeed initiation and continuation (Bramson et al., 2010; Agudelo et al., 2021). SSC is the practice of placing a newborn baby naked on the mother’s bare chest and then covering them with a protective blanket to keep them safe (Sharma, 2016). According to the findings of this evidence-based project, skin-to-skin contact and its application to increase breastfeeding rates will be researched and presented in detail.
Infants in the United States began breastfeeding at an early age, with 84.1 percent of infants starting at six months of age and only 58.3 percent of infants continuing to breastfeed at six months of age (CDC, 2020). In general, it is recommended that infants be breastfed exclusively for the first six months of their lives and that they continue to breastfeed as solid foods are introduced until they are 12 months old (American Academy of Pediatrics, 2012). Breastfeeding is a public health issue, according to the World Health Organization (WHO, 2021), because it is the most effective way to ensure a child’s health and survival. However, two out of every three infants are not exclusively breastfed for the recommended period of six months (para. 1). When it comes to infants, breastfeeding has a number of advantages. Infants who are not breastfed have a higher mortality rate in their first few years of life than those who are (Lancet, 2000). Breastfed infants less than six months of age have a lower risk of lower respiratory infections than their bottle-fed counterparts (Yu & Bee, 2015). The use of this supplement has been shown to reduce the incidence of necrotizing enterocolitis and to protect against Helicobacter pylori infection (O’Ryan et al., 2015). Several studies have concluded that breast milk is associated with higher IQ and cognitive development, lower risk of childhood obesity, lower risk of type II diabetes, and a small protective factor against high systolic blood pressure (Horta & Victoria, 2013). Breastfeeding is beneficial to both the mother and the child. It was determined whether there were dose-response relationships between length of lactation and risk factors for cardiovascular disease using data from the Women’s Health Initiative Study. Women who breastfed for more than 12 months had a lower risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease, according to the findings of the study (Schwarz et al., 2009). According to some research, breast-feeding mothers have a lower risk of ovarian cancer (Danforth et al., 2007), premenopausal breast cancer (Stuebe et al., 2009), and postpartum depression (Stuebe et al., 2009). (Mohamad et al., 2015). Breastfeeding has a number of significant long-term benefits for both infants and their mothers. Although breastfeeding has been shown to have many beneficial effects, the United States has low rates of exclusive breastfeeding after women leave the hospital, according to the World Health Organization. Because the vast majority of women in the United States give birth in hospitals, it is critical to develop interventions that will help to increase the number of women who breastfeed. In order to answer the following question, the purpose of this EBP project is to critically review and synthesize the most recent research studies that have been conducted to date. Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?
Evidence-Based Practice Model (also known as EBP Model)
The Iowa Model of Evidence-Based Practice is being followed in the development of this project proposal. This model was developed to assist nurses and other healthcare professionals in incorporating best evidence into clinical practice (Brown, 2014). For the purpose of developing a proposal, Gray and Grove (2021) outline the following steps of the Iowa Model. It is necessary to identify an issue in a clinical setting where there is an opportunity to effect change before moving forward. It is necessary to determine whether the problem is a priority for the organization in order to proceed. Depending on the cost of the project, the organization may need to determine the project’s priority. The EBP change can then be developed, evaluated, and implemented by a team of individuals. The team then conducts a thorough review of the literature and evidence to ensure that there is sufficient evidence-based knowledge to effect a change in practice. Implement the change by establishing a Pilot Program, which begins with smaller areas of the organization and progresses to larger areas as the change is evaluated. Evaluate the results of the Pilot Program to determine whether or not the change should be implemented throughout the organization or department as a whole.
Study of the Literature in Review It was a correlational study with a nurse-driven, hospital-based cohort, and the participants were all nurses. The information was gathered from 19 hospitals in the state of California. Mothers who gave birth to a singleton, full-term infant (37-40 weeks) and who could not be separated from their infant for more than an hour during their hospital stay made up the sample of 21,842. Baseline data was collected at the time of admission in order to obtain sociodemographic information as well as information on preferred infant feeding techniques. Interviews were conducted again intrapartum and postpartum to obtain additional information, including the type of delivery, the use of intrapartum analgesia, the amount of time spent skin to skin with the infant, and the type of feeding the infant received while in the hospital. The data was collected on a one-page Perinatal Services Network form and was then scrubbed to remove all identifying information after the patient was discharged from the hospital. According to the findings of the study, 72 percent of women who exclusively breastfed experienced 1-3 hours of skin-to-skin contact after giving birth. A multivariate analysis revealed that the odds ratio for exclusive breastfeeding increased with the length of time an infant was left skin to skin with its mother. In other words, every additional hour of skin-to-skin contact increased the likelihood of exclusive breastfeeding. In the study, researchers looked at skin-to-skin contact with a variety of covariates such as the type of delivery, the use of anesthetics, the use of tobacco, ethnicity, education, age, and the intention to breastfeed. They discovered that each co variant had no effect on the rates of breastfeeding in the study. The most significant variable associated with increased breastfeeding rates was skin-to-skin contact immediately after birth, which increased with the length of time spent doing so. One of the study’s limitations was that it was conducted over a relatively short period of time. It would be beneficial to conduct longer studies to determine the effect of prolonged uninterrupted early skin-to-skin care on the duration of breastfeeding after discharge.
All of the other studies included in this literature review were conducted as experiments. Six out of the seven studies were randomized controlled trials, which are the gold standard (Level II evidence). A Level III, quasi-experimental study was the only other one that was conducted. These studies were carried out in a variety of countries around the world, including Iran (in two studies), the United States, Spain, Iraq, and India, among others (2). In all studies, women 18 years and older who were giving birth in a hospital at full term and expecting a vaginal delivery were included, as were newborns who didn’t require resuscitation and the women who planned to breastfeed. All of the studies included a control group that received routine postpartum care for the infant. Following the cutting of the umbilical cord, routine care included being transported to warmers as soon as possible. Infants were measured (length, head circumference, and weight) and had their vital signs taken (pulse, respirations, and temperature) at the warmer. They also received standard medication at the warmer (Vitamin K, erythromycin, and Hepatitis B vaccine). In one study, the baby was placed in a warmer immediately after birth, but routine care was not started for another 2 hours. In another study, the baby was placed at the mother’s side right away, without any skin-to-skin contact with the mother. Following the birth of the baby, participants in the intervention group had skin-to-skin contact with him or her. It was immediately decided to place the baby prone and naked on the mother’s chest, a hat was placed on the child, and their back was covered with a warmed blanket. Immediately after birth, one study baby was dried and wrapped in a warm blanket before being transferred to the warmer for medication administration, vital signs, and measurements before being returned to the incubator and placed skin-to-skin with another baby. The length of time a baby was left skin-to-skin varied from study to study. The majority of the studies performed two hours of skin-to-skin contact after birth before performing routine newborn care. According to one study, skin-to-skin contact lasted 45 minutes. According to one study, it takes one hour. One study found that routine newborn care should be performed 45-120 minutes after the first breastfeed was completed, according to the results of the study.
A variety of instruments were used to assess effective successful breastfeeding scores, including the infant breastfeeding assessment tool (IBFAT), the LATCH scoring system, and the breastfeeding self-efficacy scale (BSES). The IBFAT and LATCH scoring systems are both valid and compatible tools that can be used to evaluate the efficacy of breastfeeding interventions (Altuntas et al., 2014). The time taken to initiate breastfeeding was measured in minutes from the time of birth until breastfeeding was initiated, and then the number of minutes it took until successful breastfeeding was achieved was measured in minutes. The studies used self-reporting to determine whether or not a participant was exclusively breastfeeding. The timing of determining whether or not a participant was exclusively breastfeeding varied among the studies and included: at the time of discharge, at 48 hours after birth, at 4 weeks after birth, and at 6 weeks after birth.
Exclusive breastfeeding rates were significantly higher in all of the SSC groups when compared to the routine care groups, with the exception of Gabriel et al. (2009), who found that exclusive breastfeeding rates were significantly higher at discharge but were not significantly higher at one month after discharge. When comparing the SSC group to the RCG group in all studies, the time to initiate the first feed was significantly shorter in all studies. In addition, when comparing the SSC and the RCG, the average time to achieve effective breastfeeding was significantly shorter in the SSC. Three out of the four studies that measured this variable found that the SSC group had a significantly higher IBFAT score during the first feed when compared to the RCG group during the first feed. In one study, the SSC group used the BSES scale significantly more than the RC group, which was a significant difference (Aghdas et al., 2013). This indicates that SSC encourages exclusive breastfeeding in the hospital and reduces the amount of time it takes to begin breastfeeding and be successful in the early postpartum period after childbirth.
According to the other outcomes that were measured, newborns in the SSC group had better thermal stability in the first five minutes of life when compared to those in the RCG group. When comparing the SSC group to the RCG group, it was discovered that the time it takes to expel the placenta was significantly shorter in the SSC group. Additionally, when comparing the SSC groups to the RC groups, mothers reported significantly lower pain scores during episiotomy repairs in the SSC groups.
Aspects that are advantageous and disadvantageous
The best research evidence is a summary of the highest quality research evidence in a specific area of health care that is developed from the synthesis of high-quality studies in that area, and it is defined as follows: (Gray & Grove, 2021). All of the studies selected for this project are specifically concerned with the impact of SSC on nursing mothers. The findings of the studies were consistent across all regions of the world, lending further support to the positive impact that SSC has on breastfeeding and the health of mothers and their newborns after delivery, as well as the health of mothers and their newborns. The findings of the studies are consistent, which strengthens the evidence for practice change (Gray & Grove, 2021). The quality of the studies that were chosen has been found to be excellent. As a rule, the studies are either randomized controlled trials or quasi experimental designs, which provide evidence at Level II and Level II on the Pyramid of Hierarchical Research Evidence (Gray & Grove, 2021). All studies were ethically approved by the ethics committees of the institutions where they were conducted. All participants gave their informed consent to participate and were given the option to withdraw at any time. The studies gained credibility as a result of this. Another advantage of these studies was the use of large sample sizes, which helped to strengthen the conclusions. SSC is a straightforward, low-cost, non-invasive intervention that has been shown to have a positive impact on breastfeeding. Some studies were limited in their ability to conduct SSCs for an extended period of time because of the heavy workload of hospital staff. If women are not educated during the antenatal period, implementing SSC will be more difficult. As a result, one study had to stop SSC after the first feed in order to accommodate the next pregnant woman waiting for the delivery table, thereby reducing the amount of time available for SSC.
Changes that are being considered
On the basis of a review of the literature, it has been determined that skin-to-skin care has significantly improved breastfeeding among postpartum women and their infants. In accordance with the Iowa Model, following a thorough review and synthesis of the evidence from the literature, the next step is to develop an action plan for the proposed change. It is proposed that the change include a description of the setting and population, a change in practice, as well as the implementation of the plan. The proposed change will explain how the implementation of skin-to-skin care will increase the number of Alaska Native women who breastfeed their children.
The Environment and the Population
The proposed change of practice will take place in the labor and delivery unit of the Alaska Native Medical Center, which is currently under construction. The population targeted by this EBP includes all women who give birth to a child in the labor and delivery unit, whether by vaginal delivery or cesarean delivery. Women whose baby has a known anomaly and who anticipate the need for resuscitation immediately postpartum would be barred from participating in this study. When a baby is evaluated after delivery, it may be determined that skin-to-skin care should be discontinued and the baby should be transferred to the warmer for resuscitation or further evaluation.
Practice Change is a way of life.
Skin-to-skin contact education should take place antenatally, during prenatal appointments, to help prepare the pregnant person and birthing partner for skin-to-skin safety and feeding preferences during the pregnancy. All pregnant women will be asked about their birth plans when they are admitted to the hospital. The nurse will inform the individual about the hospital’s standard practice of implementing skin-to-skin care as soon as possible following delivery. The nurse will go over the advantages of skin-to-skin care as well as the steps involved in putting it into practice after delivery. Skin-to-skin care will include placing the baby on the mother’s abdomen until the umbilical cord is severed, which will take about an hour. The nursery nurse will gently dry the baby and determine whether or not the baby requires resuscitation. Afterwards, the baby will be placed prone on the mother’s chest and covered with a pre-warmed blanket across the baby’s back and a hat over their head to prevent them from crying. Before routine measurements and medications are completed, the baby will remain skin-to-skin with mom for 2 hours or until after the first breastfeed has been taken. During a cesarean section, the baby will be transferred to a warmer and, if stable, will be moved to skin to skin contact with the mother as soon as possible. A nurse or birthing partner will be present at the patient’s side at all times to ensure the safety of the mother and child while in the operating room. Breastfeeding should be started as soon as the baby begins to show signs of being ready to feed. Mom and her birthing partner will receive instruction from the nursery nurse on topics such as hunger cues, positioning, skin-to-skin safety, and proper latch. While the baby is skin-to-skin, the standard vital signs will be taken and medications will be administered. Printed information about skin-to-skin contact will be included in the patient’s admission packet so that she and her birthing partner can review it during their hospital stay.
Plan for Implementation

The authors, N. Altuntas, C. Turkyilmaz, H. Yildiz, F. Kulali, I. Hirfanoglu, E. Altuntas, E. Onal, E. Ergenekon, E. Koç, and Y. Atalay, have published a paper in which they discuss their research (2014). The validity and reliability of the infant breastfeeding assessment tool, the mother-baby assessment tool, and the LATCH scoring system have all been tested and proven. Breastfeeding medicine: the official journal of the Academy of Breastfeeding Medicine, vol. 9, no. 4, pp. 191–195 (2001). https://doi.org/10.1089/bfm.2014.0018
The American Academy of Pediatrics has released a statement (2012). Breastfeeding and the use of human milk are both acceptable. Pediatrics, vol. 129, no. 3, pp. 827-841. Pediatrics (2011) 3552: 10.1542/peds.2011-3552
With contributions from Bystrova, K. Widström, stling-Sren Matthiesen, A-S, Ransjö-Arvidson, A-B, Welles-Nyström, B. C. Wassberg et al. With contributions from Uvnäs-Moberg, K. Uvnäs-Moberg (2003). According to a study on temperature in newborn infants who were subjected to different ward routines in St. Petersburg, skin-to-skin contact may help to reduce the negative consequences of “the stress of being born.” Acta Paediatrica, vol. 92, no. 3, pp. 320–326. http://dx.doi.org/10.1080/08035250310009248
The Centers for Disease Control and Prevention is an acronym that stands for the Centers for Disease Control and Prevention (2020). Breastfeeding: A report card on breast-feeding success. https://www.cdc.gov/breastfeeding/data/reportcard.htm
K.N. Danforth and colleagues A review of the literature by Tworoger et al (1997), Hecht et al (2001), Rosner et al (2001), Colditz et al (2001), Hankinson et al (2001), Tworoger et al (2007). The association between breastfeeding and the risk of ovarian cancer was studied in two prospective cohorts. Cancer Causes and Control, vol. 18, no. 5, pp. 517-523. http://dx.doi.org/10.1007/s10552-007-0130-2
Evidence from a pooled analysis [corrected] on the effect of breastfeeding on infant and child mortality due to infectious diseases in developing countries [An erratum to this article appears in LANCET on March 25, 2000, 355(9209): 1104]. (2000). Journal of the Royal Society of Medicine, 355(9202), 451–455. https://doi.org/10.1016/s0140-6736(00)82011-5
In S. M. Harden’s paper Dee and Sharma (1998), Harden and Sharma (1998), Dee and Sharma (1998), and Sharma (2001), Sharma (2001). (2014). Breastfeeding guidelines compliance and maternal weight six years after delivery were examined. Pediatrics, vol. 134, no. 3, p. S42.
Horta, B., and Victoria, C. (in press) (2013). In this systematic review, we examine the long-term effects of breastfeeding. Organización Mundial de la Salud. https://apps.who.int/iris/bitstream/handle/10665/79198/9789241505307 eng.pdf?sequence=1
M. F. MacDorman and E. Declercq have published a paper in which they argue that (2019). Out-of-hospital births in the United States have increased in recent years, with state variations showing a downward trend from 2004 to 2017. 279–288 in Birth, vol. 46, no. 2. https://doi.org/10.1111/birt.12411
Mohamad Yusuff, A. S., Tang, L., Binns, C. W., and Lee, A. H. Mohamad Yusuff, A. S., Tang, L., Binns, C. W., and Lee, A. H. (2015). A cohort study was conducted to determine the prevalence and risk factors for postnatal depression in Sabah, Malaysia. Women and Childbirth, vol. 28, no. 1, pp. 25-29. https://doi.org/10.1016/j.wombi.2014.11.002
Lucero Y., Rabello M., Mamani N., Salinas A. M., Pea, A., Mejias, J. P., Ramilo O., Suarez N., Reynolds H. E., Orellana A., & Lagomarcino A. J. O’Ryan, M. L., Lucero Y., Rabello M., Mamani, N. (2015). Infections with Helicobacter pylori, both persistent and transient, in early childhood. Clinical Infectious Diseases, vol. 61, no. 2, pp. 211–218, 2002.
A review of the literature by Schwarz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., and Cauley, J. A. Stuebe is an associate professor of mathematics at the University of Minnesota (2009). Lactational duration and risk factors for maternal cardiovascular disease are discussed. Obstetrics and gynecology, volume 113, number 5, pages 974–982. https://doi.org/10.1097/01.AOG.0000346884.67796.ca
In this paper, A.M. Stuebe, W.C. Willett, F. Xue, and K. Michels present their findings (2009). A longitudinal study on the relationship between lactation and the incidence of premenopausal breast cancer. Arch Intern Med., vol. 169, no. 15, pp. 1362-1371. DOI: 10.1001/archinternmed.2009.231 (Archives of Internal Medicine, 2009).
Organización Mundial de la Salud (2021). Breastfeeding: a general overview https://www.who.int/health-topics/breastfeeding#tab=tab 1
Yu, B., Lee, A.H., Yu, B. (2015). In China, a comparison was made between breastfeeding rates and health outcomes for infants who received care from hospital outpatient clinics and community health centers, respectively. doi:10.1177/1367493515587058. Journal of Child Health Care

APA Style Reference

Type of Study for the Research Question

Study Sample, Sample Size, and How Selected Instruments Are Used, Reliability and Validity, Data Collection Methods, and Research Design Sample

Results (including statistical analysis) that are consistent with other literature are presented.

L. Bramson, J.W. Lee, E. Moore, S. Montgomery, C. Neish, K. Bahjri, and colleagues The effect of early skin-to-skin mother-infant contact during the first three hours after birth on exclusive breastfeeding during the maternity hospital stay was investigated. Journal of Human Lactation, vol. 26, no. 2, pp. 130–7, 2010. https://doi.org/10.1177/0890334409355779 Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?

Cohort Study is a type of research that involves a group of people.

Designing with Correlations

There were 21,842 mother-infant dyads.
-Had to give birth in one of the 19 hospitals designated by the Perinatal Services Network (PSN).
A healthy singleton was delivered between 37 and 40 weeks of pregnancy.
-At no point during the hospital stay should the mother be separated from the child for more than an hour.
PSN developed a one-page form that was used to collect the information. The information was gathered by specially trained peripartum staff.
Because this was not a research-based project, the form was not subjected to any reliability testing.
The validity of the infant feeding method data was confirmed by comparing it to data from the 2006 California Newborn Screening Program.
After giving birth, 72 percent of women who exclusively breastfed had 1-3 hours of skin-to-skin contact with their babies.
Multivariable analysis revealed that the likelihood of exclusive breastfeeding increased with the length of time an infant was left skin to skin with its mother. Inferring that every additional hour of skin-to-skin contact increased the likelihood of exclusive breastfeeding is an interesting hypothesis.
The researchers looked at skin-to-skin contact with multiple co variants and discovered that each co variant had no effect on the rate of breastfeeding in the study. The most significant variable that increased breastfeeding rates was skin-to-skin contact immediately after birth, which increased the longer the infant was in the world. It was a short interval study; longer studies would be beneficial to determine the impact of extended uninterrupted early skin-to-skin care on the duration of breastfeeding after discharge after hospitalization. Although not a randomized trial, the information was gathered as part of a quality assurance program established by PSN and used in this study.
I. Mahmood, M. Jamal, and N. Khan. Mahmood, Jamal, and Khan (2011). A randomized controlled trial was conducted to determine the effect of early skin-to-skin contact between a mother and her infant on breastfeeding status. 601. Journal of the College of Physicians and Surgeons of Pakistan, vol. 21, no. 10, pp. 601–605. https://doi.org/10.2011/JCPSP.601605 Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?

Controlled Experiment with Quantitative Randomization In Iran, according to inclusion and exclusion criteria, 114 healthy first-time mothers and their newborns were enrolled in a study.
Mothers in active labor were assigned to either SSC (n=57) or routine care (n=57) in a randomized fashion.
Based on the results of the pilot study, the sample size was calculated.
Placed on mothers’ abdomens immediately after delivery and dried, then prone on mother’s chest with hat and prewarmed blankets over baby’s back. It lasted between 45 and 120 minutes, or after the first feed.
RCG: immediately transferred to the warmer, dried, and swaddled in pre-warmed blankets; then transferred to the PP unit, where the feed was started as soon as the mother was prepared.
From the time of birth to the time of the first feed, the clock was stopped.
IBFAT – all breastfeeds were scored until effective breastfeeding was achieved, and the time from the start of the study to the end of the study was noted.
The level of satisfaction with care was measured.
The preference for the same post-delivery care in the future was rated by the participants.
At one month, exclusive breastfeeding status was assessed and classified as full, partial, or not.
Exclusive breastfeeding from birth to day 28 was observed in 40.4 percent of the SSC participants compared to 20 percent in the control group.
At one month, 85.3 percent of infants in the SSC group were exclusively breastfed, whereas 65.7 percent of infants in the CC group were so fed.
On the 28th day after birth, 70.2 percent of the SSC group were still exclusively BF, compared to 46.7 percent of the control group, according to the 24-hour report.
According to IBFAT scores, the first breastfeed was 26.25 percent more successful in the SSC group than in the CC group; 58.8 percent in the SSC group compared to 32.5 percent in the CC group.
In the SSC group, the average time to begin the first feed was 61.6 minutes shorter than in the control group. 40.62 minutes (SSC) vs. 101.88 minutes (SSC) (CC).

In the SSC group, the average time to achieve effective breastfeeding was 207 minutes shorter than in the control group. (154.69 minutes in SSC versus 357.50 minutes in CC)
SSC was preferred by 53.8 percent of mothers in the future, compared to 5 percent of mothers in the CC group.
This is consistent with what has been written in the literature.
The majority of women requested that SSC continue after the first feed, but this was not possible due to the need to move the women out of the way for the next delivery.
Moore, E., and Anderson, G. (in press) (2010). A randomized controlled trial was conducted to determine the effects of very early mother-infant skin-to-skin contact on breastfeeding status. “Journal of Midwifery and Women’s Health,” volume 52, numbers 116-125. https://doi.org/10.1016/j.jmwh.2006.12.002 Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?

QRCT stands for Quantitative Randomized Controlled Trial.

There are 23 mother-newborn dyads.
In the SSC group, there were 11 people who were analyzed.
ten in the swaddled contact, ten in the analyzed contact
Because of the small sample size, computer programming was used to ensure that variables remained consistent between groups.

18 years or older, primip anticipating a spontaneous vaginal delivery, planning to breastfeed for at least a month, and willing to be assigned to either group are eligible to participate.

Vanderbilt University’s Learning and Development unit is located in Nashville, Tennessee.

Infants in the SSC Group are placed prone on the mother’s abdomen or chest immediately after birth, gently dried, and their backs are covered with a warm blanket and a dry hat. Following the cutting of the cord, the baby was taken for routine care and then placed in SSC for at least 2 hours.

Control group: infant was immediately placed in a warmer, routine care was provided without delay, and after the mother had finished with the repair, the infant was swaddled and returned to the mother.

Breastfeeding Assessment Tool, Time of Effective Breastfeeding in Minutes (in minutes), Breastfeeding Experience Scale, and Breastfeeding Status at 1 month postpartum were among the instruments employed.

During the first 2 hours after birth, researchers looked into the effects of early SSC on the initiation, effectiveness, and duration of breastfeeding.

The number of breastfeeding difficulties experienced during the first month of life

And if exclusive breastfeeding was still taking place at one month after the birth of the child,

SSC had a higher mean sucking competency at the first feed (8.7+/- 2.1 vs. 6.3 =/- 2.6; P =.02) than SSC at the second feed (6.3 =/- 2.6).

When compared to the swaddled group, the SSC group achieved effective breastfeeding more quickly.

At one month follow-up, there was no statistically significant difference in the number of breastfeeding problems or the percentage of time spent exclusively breastfeeding.

Researchers discovered that early SSC increased the likelihood of breastfeeding success in the early postpartum period.

Despite the fact that this was a small study, it met statistical significance.
The following authors have contributed to this work: Gabriel (M.), Martin (L.), Escobar (A.L.), Fernandez Villalba (E.), Blanco (R.), and Pol (T.) (2009). The effects of early skin-to-skin contact on the mother and the newborn were studied in a randomized controlled trial. Acta Paediatrica, vol. 99, no. 11, pp. 1630-1634. https://doi-org.regiscollege.idm.oclc.org/10.1111/j.1651-2227.2009.01597.x Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?

Patients in the Quantitative Randomized Controlled Study included healthy mothers with single pregnancies who had received documented prenatal care and were admitted when their pregnancies were close to term (35-42 weeks)
Madrid is the capital of Spain.
SSC group: babies are placed on their mothers’ abdomens immediately after birth, dried, and dressed in diapers and caps with a warm blanket over their backs. They are then placed in SSC for 2 hours before being removed from their mothers to receive routine care at the warmer. After that, the baby was dressed and returned to the parents.

Control group: they were immediately taken to a warmer, dried, and dressed in diapers and hats as soon as they arrived. At 10 minutes of life, the baby is wrapped in blankets and returned to the parents. Routine care was carried out after 2 hours without the use of SSC. The time between childbirth and the time when the placenta was completely expelled was known as the time of placental delivery.
The visual Analogue Scale (VAS) was used to assess the level of pain experienced by mothers during suturing.
During the final three months of the study, the Hospital Anxiety and Depression Scale was administered at the time of discharge.
At discharge, 84.7 percent of those in the SSC group were exclusively breastfed, compared to 70 percent of those in the control group. In SSC, 99.2 percent of participants were partially BF at the time of DC, compared to 95.8 percent in CG.
At one month, 65 percent of the SSC group were exclusively BF, compared to 65.5 percent of the CG group.
More thermal stability was found in the SSC group during the first 5 minutes of life, with an average temperature rise of 0.07+/-0.58 degrees C observed, compared to an average temperature rise of -0.22+/- 0.52 degrees C in the CG group.
The SSC group had a mean time to expel the placenta of 408.7 +/- 244.8 seconds, while the CG group had a mean time of 475.2 +/- 276.6 seconds.
Because the possible design will not be accurate, it is recommended that another double-blinded random study be conducted.
Treatment groups for pediatricians were assigned by randomization, and the mothers should have been assigned by randomization to treatments for each doctor, thus creating a randomized block design with the doctor as the block, so that each doctor could apply both treatments. The room temperature in the CG group was 30 degrees Celsius, whereas it was 24 degrees Celsius in the SSC group.

When using epidurals, the level of analgesia achieved was variable; it would be beneficial to be able to quantify the painful sensation prior to childbirth.
Safari, K., Saeed, A.A., Hasan, S.S., and Moghaddam-Banaem, L. (2015). Safari, K., Saeed, A.A., Hasan, S.S., and Moghaddam-Banaem, L. (2015). (2018). The effect of early skin-to-skin contact between the mother and her newborn on the initiation of breastfeeding, the temperature of the newborn, and the duration of the third stage of labor. The International Breastfeeding Journal (issue 13) is a peer-reviewed journal that publishes original research on breastfeeding (32). https://doi.org/10.1186/s13006-018-0174-9 Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?



108 women in good health and their newborns
n=56 in the SSC
Care in the Routine n=52
Normal pregnancy, full term 38-42 weeks, anticipated SVD, planned to breastfeed, Apgar score >7, willing to participate in study, and not receiving any pharmacological pain relief at the time of enrollment.
Baby was placed on the mother’s chest in a prone position with his back covered with a blanket and a hat. It began immediately after birth and lasted for one hour. Routine care, such as measurement, was delayed by an additional hour.
The control group was immediately wrapped in blankets and placed under a warmer, after which they were dried. After receiving routine care from a midwife, including being weighed, dressed, and measured, the babies were handed over to their mothers, who were encouraged to start breastfeeding. Breastfeeding sessions were documented using structured interviews and the LATCH Scale, among other methods. Latch scores showed that 48 percent of those in the SSC group had successful breastfeeding, compared to 46 percent of those in the RC group.
Breastfeeding was initiated by newborns in the SSC group within 2.41+/- 1.38 minutes after birth, whereas newborns in the RC group took 5.48 +/- 5.7 minutes after birth.
Mothers in the SSC group had a third stage of labor that lasted 6 +/- 1.7 minutes, whereas the RRC group had a third stage that lasted 8.02 +/-3.6 minutes.
In the RC group, only 2% of newborns experienced hypothermia, compared to 42% in the control group.
There was no information gathered on exclusive breastfeeding or the length of time it lasted.
The inability to initiate SSC was attributed to a lack of instruction during the antenatal period, according to the researchers.
The length of the SSC was limited to one hour due to the high volume of work being done by the hospital’s staff.
Thukral, A., Sankar, M.J., Agarwal, R., Gupta, N., Deorari, A.K., and Paul, V.K. Thukral, A., Sankar, M.J., Agarwal, R., Gupta, N., Deorari, A.K., and Paul, V.K. (2012). A randomized controlled trial of early skin-to-skin contact and breast-feeding behavior in term neonates. Journal of Neonatology, Vol. 102, Nos. 114-119, doi:10.1159/000337839 Is immediate skin-to-skin contact with a newborn associated with increased breastfeeding rates?

Is there a relationship between the length of time a newborn is left skin to skin and the rate and/or duration with which a mother breastfeeds?


Randomized Controlled Trial Term infants born by normal delivery were randomly assigned to either SSC (n=20) or conventional care (n=21) in a randomized trial. SSC immediately after birth prone on mom’s chest, was continuous for at least two hours after birth.
Those in the control group were placed by their mothers’ sides and did not receive any SSC at any point during their stay.
SSC group: the 2 hrs. of SSC after birth was the only SSC during the hospital stay

Birth weight and gestational age were comparable between the groups.

Conducted in India

One BF session was video recorded at 48 hours. A modified Breastfeeding Assessment Tool consisted of infant’s readiness to feed, sucking, rooting, and latching with a score of 0-3. Done by 3 independent masked observers.
Exclusive breastfeeding rates were measured at 48 hrs. and 6 weeks.

Salivary cortisol levels were measured at 6 hours old.

There was not a statistically significant difference in BAT scores between the two groups: a median of 8, interquartile range (IQR) 5-10 vs a median of 9 w/ IQR 5-10; p=0.6.

Exclusive breastfeeding rates were 95% at 48 hrs. and 38.1% at 6 weeks in the SSC group vs 90% at 48 hrs. and 28.6% at 6 weeks in the RC group.
Aghdas, K., Talat, K., & Sepideh, B. (2013). Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomized control trial. Women Birth 27(1) 37-40. DOI: 10.1016/j.wombi.2013.09.004 Does immediate skin to skin contact with the newborn improve breastfeeding rates?

Does the length of time the newborn is left skin to skin make a difference in rate and/or duration a mother breastfeeds?


Randomized Controlled Trial

Conducted in a large tertiary hospital in Iran 92 mother and infant dyads
SSC (n=47); RCG (n=45)
18–35-year-old, primiparous, Iranian, healthy, full-term delivery, intention to breastfeed prior to delivery
SSC: immediately placed naked prone on mother’s chest, hat, and baby’s back covered by warm blanket. Kept in position for 2 hours. Routine care was delayed for 2 hours.
RCG: immediately taken to warmer, routine cares done, and then swaddled and taken back to mother

, Infant Breastfeeding Assessment Tool (IBFAT) was used to measure success in first feed.
Self-efficacy was assessed with a breastfeeding self-efficacy scale (BSES) – it measured confidence with 33 item self-report questionnaire with a 6-point Likert type scale
In the SSC group breastfeeding self-efficacy was significantly higher (p= 0.0003) 53.42 +/- 8.57 SD as compared to the routine care group 49.85 +/- 5.50
Successful breastfeeding initiation rate 56.6% in SSC and 35.6% in RC (p=0.02).
Time to initiate first feed was 21.98 +/- 9.10 SD minutes in the SSC group versus 66.55 +/- 20.76 minutes in the RC group.
Sharma A. (2016). Efficacy of early skin-to-skin contact on the rate of exclusive breastfeeding in term neonates: a randomized controlled trial. African health sciences, 16(3), 790–797. https://doi.org/10.4314/ahs.v16i3.20 Does immediate skin to skin contact with the newborn improve breastfeeding rates?

Does the length of time the newborn is left skin to skin make a difference in rate and/or duration a mother breastfeeds


Randomized Controlled Trial

SSC: n=100; RCG: n=100
Women anticipating a SVD, singleton, healthy, mothers willing to breastfeed.
If neonate met inclusion criteria a sealed envelope was immediately opened and assigned to SSC or RCG
SSC: immediately placed prone on mother’s chest, hat, no diaper, 45 min
RCG: immediately taken to the warmer for 45 minutes, hat, no diaper, swaddled
Numerical visual pain scale was used to assess pain at the end of laceration repair.

Vital signs were measured for infant at birth, 10 min, 30 min, and 6 hrs. of life. Then every 6 hours for first 24 hours.
Routine counseling on breastfeeding was down by a medical social worker blinded to study, prior to discharge.
Mothers recorded exclusive breastfeeding status on printed form and called on a weekly basis
Significantly higher rate of newborns was exclusively breastfed at 6 weeks in the SSC group (72%) compared to 57.6% in the RCG.

Pain score was significantly lower in the SSC group (4.74 =/- 0.85) compared to (5.34 +/- 0.81; P<0.01)

The investigator could not be blinded to the intervention. A large number of neonates were not enrolled because the investigator could not evaluate immediately after birth.
Appendix A: Literature Review Matrix


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