Sensitive Midwifery - Issue 43 - July2019

Anterior Guest voice I wanted to be that midwife who persevered to promote skin-to-skin care at caesarean births, shares Evashnee Naidoo. Skin-to-skin care after C-section W orking in a busy level-one public hospital in the Ethekwini District of KwaZulu-Natal comes with many practice challenges, not least of all pertaining to birth and neonatal care. After reading evidenced-based literature on the benefits of skin-to-skin care (SSC), I understood that it was more than just the opportunity for a mother and her newborn to bond. My greatest desire was to extend the many benefits to babies who were born without complications by C-section. That’s why I set out to achieve this and my experience goes to prove that it can be done, even in a busy level-one public hospital! Serendipity at work Fortunately, because of a quality improvement initiative in our hospital’s neonatal nursery, aimed at reducing their occupancy rates, all neonates born via C-section were no longer admitted to the nursery for observations. Besides reducing the nursery occupancy rate, it ensured that mother-neonate separation time was done away with and, thankfully for my goal, offered a perfect opportunity to practise routine SSC intra-operatively and in the recovery room. Initially, I had to convince the anaesthetic and scrub teams that I would not pose a hindrance to them while they performed their duties. Soon, it became accepted as part of my routine practice, without much discussion or reservation from those who had initially been concerned. Care and considerations Preoperatively, I inform the expectant mother of the protocol to implement SSC in the operating room, and request her to bring along a nappy and baby hat. Intraoperatively, as soon as the neonate has been examined and noted to be well, and we have donned the nappy and hat, Baby is taken to the mother and SSC begins on the operation table. Prior consultation with the anaesthetist and the surgeon about my intention to initiate perioperative SSC usually gains the cooperation, and even the assistance, of the team. It gives me great satisfaction to see how many neonates in SSC with their mothers initiate breastfeeding in the operating room itself. The star of the show has to be the neonate who so naturally roots towards the nipple, showing readiness to feed. This is the cause of much giggling and amazement among the team, and only strengthens our efforts to advocate for early SSC in the operating room. Celebrating skin-to-skin It makes me so happy that now, more midwives in our hospital are advocates of SSC at caesarean-section births, and there have been no reported adverse events. I am convinced that if we provide the opportunity, these smart little beings naturally do what is best for them! Why not join me and do this in your hospital? 4 eSensitive Midwifery Magazine Issue 43