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Newborn Temperature Stability During Skin-to-skin in the OR

June 2018

The Baby-friendly Hospital Initiative (BFHI) encourages "skin-to-skin contact between mother and baby soon after birth” (WHO, 2016). This includes any healthy delivery, vaginal or surgical. Although many birthing centers and hospitals find instituting this for a vaginal birth, offering safe skin-to-skin (SSTS) in the operating suite offers many complications to the policy. Not only do the nurses need to be educated to provide SSTS care, but the physician/surgeon, anesthesiologist/nurse anesthetist, special care nursery nurses, and others need to cooperate together to have this be successful for everyone.


Billner-Garcia, Skilker, and Goyal (2018) performed a retrospective study in their northern California hospital. Completing an electronic medical record data study of 91 mother/baby dyads, they set out to address one of the complaints and concerns of the healthcare providers: thermoregulation of the infant in the cold OR. A procedure was developed, which is included in the publication, with prewarming of the mother's breast, infant taken to the warmer for the initial 1-and-5 minute Apgar scoring, placement of a prewarmed hat and diaper on the infant, and placing the stable infant in SSTS care. All nursing assessments then took place during the skin-to-skin care with frequent axillary temperatures of the infant. This is an excellent model to use if your facility is not yet offering safe skin-to-skin care following a surgical delivery.

There are definite limitations in this study, including lack of charting of temperatures, early disruption of SSTS care ("until surgical skin closure of cesarean section begins”, p. 160), and not putting the infant into direct SSTS care immediately following delivery. However, the procedure guidelines are a great starting point for OR deliveries. The findings demonstrate a greater than 50% infant temperature with either no change or increased. Good luck in increasing your safe skin-to-skin numbers and working toward the BFHI designation for your facility. The research is there for all delivery methods to back your efforts!


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA

Professional Development Educator



WHO. (2016). BFHI. Downloaded June 16th from http://www.who.int/nutrition/bfhi/infographics/en/

Billner-Garcia, R., Spilker, A., and Goyal, D. (2018). Skin to skin contact: Newborn temperature stability in the operating room. MCN; 43(3): 158-163.


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