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Barriers to Skin-to-Skin Contact after Cesarean Birth

Balatero, Joelene S., DNP, RN, FNP-C, PHN; Spilker, Arlene F., DNP, RN, FNP-C, CNE; McNiesh, Susan G., PhD, RNC-OB

MCN: The American Journal of Maternal/Child Nursing: May/June 2019 - Volume 44 - Issue 3 - p 137–143
doi: 10.1097/NMC.0000000000000521
Feature: CE Connection

Objectives: The aim of this research was to understand obstetric nurses' perceived barriers to immediate skin-to-skin contact (SSC) in the operating room (OR) after cesarean birth.

Methods: Semistructured, open-ended interviews were conducted via videoconferencing. Conventional content analysis methods were used to analyze the data for common themes. Investigation team consensus was reached to validate the analysis findings.

Results: Ten nurses who care for women during labor and birth were interviewed. The primary overarching theme was performing safe and effective SSC after cesarean birth. Nurses strongly believe in the benefits of SSC after cesarean and try to implement it as often as possible, but various factors prevented SSC in the OR from occurring on a regular basis. Providing immediate SSC is not considered a priority during the cesarean by all members of the team. All participants reported that there were no formal policies and procedures in their facilities for SSC in the OR. Challenges with safety, nurse staffing, and logistics were described as well as professional barriers, and varying practices between geographical location and facilities. Nurses discussed concepts that were facilitators for changing their current practices to support SSC after cesarean.

Clinical Implications: Implications: Developing effective policies and procedures that support SSC in the OR after cesarean and changing practice accordingly is recommended. Adequate nurse staffing in the OR is essential.

Women usually have skin-to-skin contact with their healthy newborns immediately after vaginal birth, however this is not routine practice in the surgical suite after cesarean birth. In this study, nurses who care for women during labor and birth discuss their perceptions of barriers to skin-to-skin after cesarean birth and what can be done to promote the practice.

Joelene S. Balatero is a Manager of Clinical Relations, West Coast University, Irvine, CA. The author can be reached via e-mail at

Arlene F. Spilker is an Assistant Professor, The Valley Foundation School of Nursing, San Jose State University, San Jose, CA.

Susan G. McNiesh is a Professor Emerita, The Valley Foundation School of Nursing, San Jose State University, San Jose, CA.

The authors declare no conflicts of interest.

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