Team-Tested Practices

Going Skin-to-Skin Is Best for New Babies

Nurses Help Newborns Get Closer to Moms

Department: Labor and Delivery, Moanalua Medical Center, Honolulu

Value Compass: Quality

Problem: More newborns and mothers needed at least an hour of skin-to-skin contact immediately after birth as recommended by the Joint Commission

Metric: Length of time newly born infants spend in direct contact with mothers

Union co-lead: Kris Oishi, RN, HNA/OPEIU Local 50

Management co-lead: Maji, RN, perinatal manager

Small tests of change:

First, the team created a baseline measure by tabulating instances of skin-to-skin contact for each patient in a spreadsheet, using KP HealthConnect data. Then, members of the representative UBT did one-on-one education with fellow nurses and other staff members. Team members also talked to patients during their tours of the labor and delivery unit and during the hospital admission process about the benefits of skin-to-skin contact, says management co-lead Maji, who goes by a single name.

The team communicated in several different ways:

  • Informal conversations.
  • Bulletin board posters.
  • Handouts.

The team also used a “staff communication tree,” so each UBT member knew which colleagues he or she was responsible for sharing the benefits of breastfeeding and the Joint Commission's perinatal core measure set on exclusive breastmilk feeding during hospitalization.


The percentage of newborn babies spending at least 60 minutes with their mothers in skin-to-skin contact at the time of birth soared from 4 percent of babies born on the unit in February 2011 to 71 percent in September 2011.

“More babies are spending their first hour of life skin to skin on their moms,” says union co-lead Oishi.

Biggest challenges

The team’s biggest barrier was educating the other departments and staff members who work alongside the unit. “During deliveries, we may have a midwife, physician, resident, neonatologist, pediatrician, NICU nurse and respiratory therapist present,” Oishi says. “It was important to get our entire team on the same level of understanding before working out the logistics of delivering care.”

Side benefits

The project created leadership opportunities for experienced nurses, who could show others how to manage their care of mothers and babies following delivery while supporting uninterrupted skin-to-skin bonding. These nurses showed others how they can complete initial vital signs, conduct a head-to-toe assessment and even administer medications, all while babies are on their mothers.


Studies show a number of benefits for babies when they have skin-to-skin contact with their mother, without a blanket or any other barrier between them, immediately after birth. With increased skin-to-skin time, the baby bonds better, emotionally and physically. The baby's temperature, heart rate and respirations stabilize and blood sugar is maintained. In addition, it lays a foundation for successful breastfeeding and the numerous benefits it creates for moms and babies.

The team’s goal is for mothers and babies to have at least 60 minutes of this important time—allowing Moanalua to remain a “Baby-Friendly Hospital,” a title awarded by the World Health Organization and UNICEF in recognition of breastfeeding excellence and to increase breastfeeding rates worldwide. It also supports the team's effort to increase the number of babies who are breastfed exclusively during their hospital stay as measured by the Joint Commission's perinatal core measure set. To track these times, the team created its own charts to document how much time the babies spent with their mothers.

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