The experiences of women from three diverse population groups of immediate skin-to-skin contact with their newborn baby following birth

Personal Author: Finigan, Valerie 
Year: 2010.
Dissertation: Thesis (Doctor of Health and Social Care) -- University of Salford 

Abstract

Relevant contextual information

This study was carried out in a well-established UNICEF Baby Friendly accredited unit in a NHS trust in the north west of England. The culture within this trust was sensitive to the promotion, protection and support of breastfeeding, upholding skin-to-skin contact (SSC) as a fundamental component of breastfeeding success. The overall aim of the study was to explore women’s experiences of uninterrupted immediate SSC with their baby in the immediate period that followed birth.  The study explored the experiences of three diverse population groups of women (Bangladeshi, Pakistani and English) in order to find out whether or not SSC was both mother and baby-friendly and whether it supported the early establishment of breastfeeding.  The standard had been implemented in the author’s trust using an opt-out approach to care.

The evidence demonstrating the benefits of SSC is fairly robust, for example, increased uptake of breastfeeding (Righard and Alade 1990), improved thermo-regulation, increased oxygen saturation levels, reduced risks of hypoglycaemia, early colonisation against infection, and more stable heart and respiratory rates in the baby (Christensson et al 1992).  There is also evidence that demonstrates that women are more confident with their mothering abilities when they have intimate contact with their newborn babies (Nissen et al 1995). 

How doctoral work contributes to nursing scholarship

The study aim was to give a voice to women as there was no United Kingdom research that had been undertaken that asked women what their experiences of SSC were and whether it appealed to them or not.  Enabling women from different minority ethnic communities to share their experiences allowed me to put their voices at the centre of national policy and of their care. The women’s experiences would be used to refute or support current core recommendations from the National Institute of Clinical Excellence (NICE 2006) and the United Nations International Children’s European Fund’s practices to implement step 4 of the ‘Baby Friendly’ standards in all Trusts across the UK (UNICEF 2008).

Demonstrate innovation

The study was qualitative and underpinned by interpretive phenomenology. Phenomenology is clearly a method that allows women’s voices to become distinct and an approach that allows emotions to be shared (Lopez and Willis 2004). The very experience of SSC is situated in family tradition, community values and the socio-political context. Furthermore, phenomenology is concerned with life world, real human experience as it is lived, rather than as we contextualise, theorise or categorise it (Laverty 2001). The goal is to create meaning and achieve a sense of understanding (Laverty 2001, p2).  Data was collected by means of tape-recorded diaries, video recordings, photographs and semi-structured interviews. Reflection was an important element of the research method and a reflexive diary was kept throughout. 

Design

Twenty-two participants’ were engaged in the study: 11 English, 5 Pakistani, 5 Bangladeshi and I African. Purposive sampling was employed. Analysis was informed by Benner’s (1994) work including transcribing tapes verbatim, identifying recurring themes and taking findings back to participants to gain the ‘phenomenological nod’.

Common themes were established. SSC was reported as a positive experience during which women ‘get to know their baby’ and begin to ‘respond to its needs’ and ‘become a mother’.
“I know it sounds corny, but there was just this huge feeling of love.  I thought “I love you” (Participant 5)
The immediate ‘gaze’ that is demonstrated in the video data of this study and explored by women is of significance:
“I wondered if she was looking at me to get aquainted like. I wondered if she was looking at me and thinking the same thing. You know getting to know me” (participant 15)

Disgusting bodily secretions at birth have been held to be a barrier to SSC. Yet ‘birth dirt and bodily fluids’ were not abhorrent to this group of mothers, and both Pakistani and Bangladeshi women were able to contextualise this:
“He was all wet with blood on him.  He’s part of me just born, he was bound to have blood on him and it’s not a problem, not culturally an issue either” (Participant 20)

Furthermore, the women in this study pointed out that their post-birth pain was lessened when they had intimate SSC with their newborn babies:
“I had two stitches but I can’t remember them being put in.  I was too busy cuddling and bonding with her” (Participant 13)

The women felt that the period of SSC was too short and was often rushed because labour wards were busy; they wanted longer periods of time to get to know their babies:
“Don’t separate mum and baby until baby has fed.  Six weeks old and he won’t breastfeed, he keeps trying but he just can’t get the hang of it.  He really doesn’t know what to do” (Participant 20)

The findings also revealed that women felt that their partners were sidelined; they became spectators in care, except when they were encouraged to follow their wife and have SSC themselves after their baby had fed:
“Fathers feelings are often not taken into account.  They are expected to just get on with it.  After all they are not the one that is going through labour.  It’s hard on dads they need support as well, the birth of a baby is a life changing experience for everyone involved” (Participant 9)

The study findings support UNICEF and NICE recommendations to implement UNICEF standards into labour ward practices in maternity units.  Most women from within all three participant groups enjoyed SSC but felt that the 30 minutes required by UNICEF was far too short. The women suggested that SSC was a mother-baby-friendly experience in which relationships were forged and maternal confidence established. Furthermore, the study findings suggested current evidence that SSC assists in early mother-baby attachment and in establishing early breastfeeding is supported.

Explicit contribution to health care policy and or practice

The unique contribution that this study brought to the fore is the shared experience of English, Bangladeshi and Pakistani women. Capturing the women’s voices, where they reported experiences that went against received wisdom made a contribution to the evidence base.  Tessier et al (1998) drew an earlier conclusion that if SSC is interrupted then mothers may develop low self esteem and reduced self mastery.  In this study SSC gave women confidence in their own responses, they said that they felt empowered to nurture and nourish their infants by themselves.  The women felt that health services stereotype people and make decisions for them based on their own personal prejudices, beliefs and values. From a cultural perspective, the message was clear; SSC is both mother and baby friendly it is a welcomed part of care. 

The findings were shared with UNICEF and national policy was amended to encourage a minimum period of one hour SSC with the mother being the person who choose to discontinue SSC rather than it being the decision of the health care professional.  

Access the full e-thesis

Finigan, V (2010) The experiences of women from three diverse population groups of immediate skin-to-skin contact with their newborn baby following birth, Thesis (Doctor of Health and Social Care), University of Salford

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