Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-to-Skin

Author

• Autumn SpencerFollow

Date of Completion

Summer 2026

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Lydia Forsythe, PhD, MA, MSN, RN, CNOR

Second Advisor

Corinne Cochran, DNP, RN, NNP

Abstract

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal outcomes by implementing a standardized skin-to-skin care process for cesarean deliveries to reduce initiation time to 20 minutes or less and increase exclusive breastfeeding rates to at least 70% within 12 weeks.

Review of the Evidence: Evidence supports immediate skin-to-skin contact for improving neonatal stability and breastfeeding outcomes. Quality improvement literature identifies standardized workflows, defined roles, interdisciplinary collaboration, and structured frameworks as key drivers of successful practice change. Findings informed workflow redesign, staff education, and Plan-Do-Study-Act (PDSA) cycles.

Project Design: A quality improvement initiative guided by the OhioHealth Change Management Model and Plan-Do-Study-Act methodology was implemented in an obstetric surgical setting. Baseline assessment, root cause analysis, fishbone diagramming, and SWOT analysis informed intervention development. Outcomes were monitored through an electronic health record-integrated Tableau dashboard.

Intervention: Interventions included workflow redesign, role clarification, staff education, change champions, biweekly rounding, communication scripting, refresher tip sheets, and performance monitoring. Support-person skin-to-skin contact was incorporated when maternal participation was limited. Outcomes were monitored through electronic health record data and manual chart review.

Significant Findings Outcomes: Average skin-to-skin initiation time decreased from 72 to 15.77 minutes, a 78.1% reduction. The lowest weekly average was 9.4 minutes, representing an 89.6% reduction from baseline. Operating-room skin-to-skin rates increased to 91.67%, and exclusive breastfeeding rates improved to 80%, exceeding the project goal.

Implications for Nursing: Nurses play a critical role in sustaining evidence-based skin-to-skin practices through care coordination, accountability, and advocacy. Defined responsibilities, real-time performance monitoring, and support from nurse leaders and executive healthcare leadership are essential for sustaining outcomes and promoting long-term practice change.

Recommended Citation

Spencer, Autumn, "Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-to-Skin" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 66.
https://fuse.franklin.edu/dnp-project/66

Rights

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