By Katie Kerwin McCrimmon
LAFAYETTE — When Amy Toner had to have a cesarean section for the birth of her first baby, she worried about the precious moments immediately after the birth.
“My biggest concern was, ‘Do I get to hold her right afterwards?’ ” Toner said. “I really looked forward to having that ‘skin-to-skin’ time and having the baby stay in the room.”
Toner’s instincts about the importance of the first minutes and hours with her newborn daughter were well founded and are buttressed by increasingly robust research.
Neonatal experts have long referred to the time right after birth as the “golden hour,’’ and researchers now are learning that keeping mother and baby together is all the more critical to fostering successful breastfeeding and cutting rates of infant hypothermia and low blood sugar. The newest strategy to do this is delaying newborn baths for at least eight hours. Keeping newborns warm on their mothers’ chests is a relatively simple practice in the hours after birth that can have profound health benefits for mothers and babies.
One of the newest areas of research centers on microbes, which boost immunities. Infants inherit their mother’s microbes at birth and begin to create their own systems. It’s not yet clear whether delaying a bath may strengthen the microbial system. But researchers believe the vernix, the cheesy layer that coats babies at birth, has various protective benefits.
In Colorado, one of the hospitals leading the way on delayed baths is Good Samaritan Medical Center in Lafayette. Already a “Baby Friendly Hospital” that follows guidelines set out by the World Health Organization and UNICEF, Good Samaritan started formally delaying newborn baths in January. Other hospitals in the SCL Health System are beginning to follow suit this summer.
“It makes our whole process more relaxed,” said Bekah Harvey, a charge nurse at Good Samaritan.
In the past, she said nurses would sometimes whisk newborns away, put them on a warmer, weigh them, give them medications, then do a bath within the first hour or two after birth.
“The mom couldn’t see the baby. Now the baby is just on the mom. They get skin-to-skin contact. Moms just get to enjoy their babies,” Harvey said.
Prioritizing warmth, bonding and breastfeeding soon after birth has been beneficial.
“Sometimes this is the best feeding they’re going to have for a while,” Harvey said.
Good Samaritan is also making efforts to keep mothers and babies as close as possible following C-sections.
Diane Heronema, a registered nurse and lactation specialist at Good Samaritan, led efforts to establish new protocols for the first few hours after birth to improve outcomes.
Along with the delayed bath, she and members of a task force worked to set up systems so babies born via C-sections could benefit from immediate skin-to-skin contact in the operating room.
They worked with obstetricians, anesthesiologists, and labor and delivery nurses to change the workflow. They made simple changes to allow newborns to be placed almost immediately on the mom’s chest. The medical staff can still monitor the baby, but now they aren’t interfering with bonding. For instance, nurses put the oxygen sensor on the baby’s toe instead of the finger.
“That leaves the mom more free to hold and embrace the baby. We’re doing skin to skin and always looking at the position of the baby’s airway. They’re in a safe position,” Heronema says.
In the past, women who had C-sections sometimes endured long separations from their babies and as a result, some had a difficult time getting going with breastfeeding.
There’s too little data to know exactly what impact the new protocols and delayed baths will have on mothers and newborns, but so far the anecdotal evidence at Good Samaritan is good.
“What I’m seeing and hearing is that very few (newborns) are declining,” Heronema says.
Research elsewhere in the U.S. and around the world supports the new changes.
“Studies have shown that women have better success at initiating breastfeeding and have longer duration,” Heronema said.
“Breastfeeding has health benefits for the baby and the mother. For babies, there’s a decrease in respiratory, GI infections and ear infections. And there’s a lower incidence of obesity. More and more studies are also showing benefits for the women. It helps with bone density later in life and prevention of osteoporosis. And we’re looking at breast cancer and uterine cancer.
“For social and economic reasons, it’s less expensive and for mothers who return to work, they don’t have as many days away from work because the infant isn’t ill,” Heronema said.
For Amy and Tyler Toner, even though the C-section was unexpected after their baby’s head got stuck during labor, they felt positive about the birth and their immediate connection with their daughter.
Kira Jeanette Toner arrived at 3:58 p.m. on May 27, weighing in at just over 9 pounds.
“It was so quick and we were out in recovery right away. It was wonderful. It was perfect,” Amy Toner said. “They did skin-to-skin and breastfeeding right away. There wasn’t a problem with that.”
Tyler Toner said he really appreciated the nurses and doctors keeping Kira with them.
“We’ve been waiting 10 months to meet her. You don’t want her to be taken away.”
The Toners live in Broomfield and chose Good Samaritan for their birth because it’s close.
They remembered hearing a bit about a delayed bath during their tour and didn’t give it much though.
“I put my trust in the hospital,” she said.
They noticed that Kira had a little gunk in her hair after the birth, but figured they’d get that cleaned up later.
Kira began latching on right away to feed. And her dad reports that she loves nestling on both his chest and his wife’s.
“She was a little fussy last night,” Tyler Toner said. “I popped my shirt off, put her on my chest and it calmed her right down.”
Becky Stoner is the clinical manager for the Mother Baby NICU at Good Samaritan.
It used to be common practice in the U.S. to separate mothers from their newborns.
“We had one patient who had a C-section with her first. She was separated and could hear the baby crying, but couldn’t do anything about it,” Stoner said.
For the next birth, “the baby was skin-to-skin with her and never left her. The difference is amazing. The baby is so relaxed. The first baby was fussy and crying and wasn’t nursing as well. This baby was breastfeeding wonderfully by the second day.
“In the old days, the babies almost always cried for the bath. They didn’t like being unwrapped,” Stoner said.
She said newborns who have had a chance to cuddle and eat are often calmer during the delayed bath and mothers are more tuned in too.
“That’s one of the benefits of delaying the bath,” said nurse Bekah Harvey. “The mom is more aware. We always did it in the room. She can actually help.”
Nurses will do a bath right away for any patient who tests positive for HIV or Hepatitis C. And any parents who want a bath sooner than eight hours can request it. But the nurses have found that nearly everyone is fine with the new system.
Delaying the bath seems to help with temperature regulation.
“If they’re getting cold, they’re using their energy to stay warm and they’re burning calories, then their blood sugar is going to go lower,” Harvey said.
That can trigger a domino effect. If a baby’s blood sugar declines, nurses in most hospitals will encourage parents to supplement with formula or sugar water, which can then make breastfeeding harder.
“Studies show that by maintaining that good skin-to-skin contact, babies can regulate their blood sugars better,” said Heronema, the lactation specialist. “Initiating breastfeeding sooner means the mother’s milk can come in sooner.”
While the nurses at Good Samaritan share the benefits of breastfeeding with all new mothers, they never force it on anyone.
Even so, skin-to-skin contact is beneficial for all babies and sometimes mothers who aren’t planning to breastfeed find the newborn leads the way.
“We’ve had the babies go skin-to-skin and the baby figures it out and they end up breastfeeding anyway,” Stoner said.
Good Samaritan opened in 2004 and earned the “Baby Friendly” designation in 2006.
Since then, they’ve kept looking for ways to mature.
“We’re always evolving. You’ve got the (Baby Friendly) guidelines and we’re always asking, ‘How can we improve upon these guidelines and make this the best experience for our families?’ ” Heronema said.