Date of Award

Spring 4-2-2020

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice




Mary Ellen E. Roberts, D.N.P.

Committee Member

Maureen Byrnes, D.N.P.

Committee Member

Edward Nekvapil, F.N.P.


Background: Literature has documented when a mother elects to breastfeed, she offers herself and her baby with many short and long-term wellness and health benefits. Therefore, maternal child healthcare providers should be prompted to scale up breastfeeding practices that promote lactation. Skin-to-skin contact (SSC) is underutilized, yet a cost-effective incentive to promote successful breastfeeding. Traditional postnatal assessments lead to the precipitous disconnect of the mother-baby dyad resulting in delayed SSC and breastfeeding initiation. In addition, practical barriers and delivery complications familiar to cesarean sections, postpones the start of breastfeeding in this birthing method which unfavorably impacts exclusivity. In such instances, paternal/newborn SSC in the absence of maternal/newborn SSC is a practical option that supports maternal breastfeeding initiation, proven to stimulate newborn pre-feeding behaviors. Project Aim: To promote early newborn maternal and/or paternal SSC through nursing education and clinical practice poster reminder to increase breastfeeding initiation and the at discharge exclusivity rate in uncomplicated cesarean deliveries. Methods: This is a quality improvement project of a quantitative methodology with a pre and post intervention design. Pre intervention chart review included 30 vaginal and 30 cesarean deliveries; 35 post intervention charts were reviewed to assess incidence of SSC, breastfeeding initiation and exclusivity at discharge. Intervention recipients were parents, newborns and staff nurses of the labor/delivery, postpartum and newborn nursery units in a community-based hospital. Primary project intervention reunited the newborn with its parents in post anesthesia care unit (PACU) for early SSC, nursing SSC education and a paternal newborn clinical practice poster reminder occurred before implementation of the primary project intervention. Results: In cesarean sections, PACU SSC significantly related to breastfeeding initiation and at discharge breastfeeding exclusivity. PACU paternal newborn SSC significantly relates with maternal breastfeeding initiation. Nursing education brings greater understanding and awareness on SSC to impact higher incidence of maternal and/or paternal PACU SSC, breastfeeding initiation and at discharge breastfeeding exclusivity. Nurse satisfaction survey indicates 58% nurses found education extremely helpful, 54.8% nurses found the clinical practice poster reminder extremely helpful. Conclusions: Through nursing education and clinical practice reminders of paternal SSC, newborns of uncomplicated cesarean deliveries that experienced maternal and/or paternal SSC, were likely to initiate early breastfeeding after delivery and breastfeed exclusively at discharge.