Bridging the gap for skin-to-skin

It’s dangerous to think it’s up to mothers alone to successfully breastfeed. Support for breastfeeding moms in the home, in the community, and at the national level matters.  

Regina Hirt, RN, IBCLC and her team at Froedtert & the Medical College of Wisconsin Community Memorial Hospital in Menomonee Falls, Wis. are making sure breastfeeding dyads are protected and supported beyond their initial postpartum period in the hospital setting.

Last winter Hirt and her colleagues launched an initiative, Bridging the Gap for Skin-to-Skin, which educates and trains hospital staff and EMS providers in the community how to implement skin to skin contact between mother and baby. Skin to skin contact has seemingly endless benefits including increased breastfeeding success.

Hirt and her team started with hospital grand rounds in February 2016. When a mother comes to the hospital, even for a non-obstetrical related procedure, skin to skin with her baby is now offered as a standard of care.

Hirt and Johnston present their poster at the 2017 International Breastfeeding Conference.

Two months later, Hirt, EMS Liaison Julie Brady, Nurse Educator Pamela Johnston RNC, BSN, and the Medical OB Director collaborated to develop new training for EMS providers in the community. This piece was of particular importance because newborns admitted after precipitous births were arriving hypothermic and with delayed breastfeeding initiation. Training these providers how to implement skin to skin contact was the answer. The practice regulates babies’ body temperature better than any device on the market and allows baby direct access to its food source.

Skin-to-skin in the OR

Obstetrical emergency training was given too including how to safely assist with a precipitous birth in the field or in the ED, assist with initial skin to skin contact, safely assist with shoulder dystocia, and be able to identify cord prolapse and manage care until delivery.

The team extended the training to outlying EMS systems: a freestanding Emergency Department and local fire departments in Waukesha and Washington Counties.

“There was a lot of education that was needed,” Hirt says.

For instance, emergency responders were surprised to learn that the umbilical cord should be cut after baby is placed skin to skin on its mother.

One fire department claimed that transporting baby placed skin to skin on mother was against their policy; that baby must be placed in a separate restraint. Transporting baby and mother belted to the same restraint is indeed safer, Hirt explains. Training included showing personnel how to properly belt mother and baby to the restraint while implementing skin to skin contact. Hirt shared the case of the newborn baby who was severely burned by a foil blanket while transported separately from her mother after an unexpected birth as an example of how dangerous it can be to separate mother and baby.

Despite minor pushback from this department, Hirt and her team applaud 100 percent positive feedback from 150 staff and EMS personnel.

EMS personnel surveyed reported that is was “awesome education, new information was presented, and the hands on practice was great.”

In an effort to ensure changes are continuously and safely implemented and so new staff receive proper training, quarterly hospital-wide education is performed. Emergency department orientation occurs monthly, and Hirt’s team offers yearly education and site visits to the local fire departments, all of which have welcomed the opportunity.

Eventually, Hirt says they’d like to extend this training to Froedtert & the Medical College of Wisconsin in Milwaukee and the Milwaukee Fire Department.

“It’s a big undertaking,” Hirt states.

Compared to the smaller communities this program has been working in, the sheer size of a bigger city could present interesting challenges. Moreover, Milwaukee staffs their providers whereas some communities in Waukesha and Washington Counties typically also employ volunteers.

Father and his baby skin-to-skin

In the meantime, Hirt and her team look forward to their Birth Center Skills and Education Fair this Fall where there will be a continued emphasis on skin to skin as well as practical information about supporting pumping mothers and helping lactating mothers access sound information about pharmaceuticals.
Hirt is currently piloting equipment to launch virtual lactation and breastfeeding support. Virtual breastfeeding support could benefit mothers who have other children and can’t easily leave the home, or mothers who have undergone a c-section and cannot drive for instance. The virtual support will be offered free of charge to patients. Hirt hopes to eventually offer 24 hour lactation services.

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