Running head: EVIDENCE-BASED PRACTICE

Evidence-Based Practice in Maternity Care

Christina Post
NURS 211
February 21, 2014
Professor Williams

EVIDENCE-BASED PRACTICE

Evidence-Based Practice in Maternity Care

According to Cherry and Jacob, evidence-based practice is defined as the process of
systematically finding, appraising, and using research findings as the basis for clinical practice.
For a nurse to perform at the highest level, not only will he/she need to have the skills to be
capable of caring for their patient, but they will need to implement plans of care and
interventions that they know will be effective because they are based on evidence. There are
many ways that nurses can help to improve the care that their patients receive and some of these
changes and protocols started by nurses implementing changes and documenting their findings in
articles, etc. Evidence-based care is applied in all areas of the health care industry but the focus
of this paper are the practices that are demonstrated in maternity care.
Can New Dogs Learn New Tricks?
A qualitative study done by Marilyn Curl in the Family Birthing Center (FBC) of a
mainland community hospital explores the reasons for the lack of evidence-based care and the
challenges involved in creating change. Her observations were of nurses of different generations
and their approach to nursing in the labor and delivery ward of the hospital. The generations
were as follows: Baby Boomers (born between 1946 and 1964), Generation X (born between
1965 and 1980) and Generation Y (born since 1980). Some of the differences in care that she
noticed were that Generation Xers embraced the 12-hour shift and thought that it should be
mandatory despite evidence that patient safety is enhanced by shorter, more traditional shifts
(Curl & Lothian, 2013). Generation Xers also opted to stay near the nurses central monitor and
got excited when an emergency cesarean surgery was ordered rather than provide bedside care
and different hands-on laboring techniques.

EVIDENCE-BASED PRACTICE

Generation Y were described as being the most educated nurses and chose the field
because it called to them, not because they had no other options like some of the Baby
Boomers. They were willing to learn from the Baby Boomers- the nurses who unlike most of
their coworkers remained at the beside of laboring women, requested patients with birth plans
aimed at natural births, taught birth classes on their days off and requested to work 8-hour shifts
(Curl & Lothian, 2013). Marilyn Curl also mentioned that the Generation Y nurses were versed
in technology and up-to-date in knowledge and many other areas of nursing. They were a
combination of old and new. During Marilyn Curls stay at the FBC, a policy change headed by a
Baby Boomer provided strong evidence in support of prolonged, sustained skin-to-skin contact
between mothers and infants and was awaiting physician approval. Her study proved that nurses
knowledgeable in evidence-based care (as those practiced by the Baby Boomers) were passionate
about the care and outcomes of their patients.
Barriers to Skin-to-Skin Care During the Postpartum Stay
In a mixed-method study by Debi Ferrarello, MSN and Linda Hartfield, PhD, NNP-BC,
which included surveys and focus groups, postpartum nurses and new mothers helped to
determine the understanding of barriers to skin-to-skin care (SSC) during the postpartum stay.
According to the article, SSC is defined as a mother holding her diaper-clad infant in a ventral
position against her own bare skin with a blanket covering the dyad and is also an important
aspect in reducing the incidence of formula supplementation and enhancing the acquisition of the
maternal role (Ferrarello & Hatfield, 2014). The surveys and focus groups asked questions about
each persons attitudes, beliefs, and perceived barriers to SSC for mothers and nurses. The results
of the study showed that nurses believed that a few potential barriers to SSC included visitors in
the room, the mother being too groggy, the mothers modesty, and other people wanting to hold

EVIDENCE-BASED PRACTICE

the baby. The results of the surveys from mothers ranked barriers to SSC similarly and also
included pain from cesarean (Ferrarello & Hatfield, 2014). Each group agreed that the hospital
room had a revolving door and different people came into the room throughout the day for
different reasons- to clean, check on the patient, give them food, visit, etc. Suggested changes
and implications, according to the article, were to modify visiting policies and cluster care to
allow uninterrupted mother/baby time together, provide do not disturb hangers, use a garment
that facilitates SSC, and instituting afternoon nap time for mothers to decrease fatigue and
address safety concerns.
High 5 For Mom & Baby
Since 2012, hospitals in Kansas have been making a change in the way that maternity
care is provided in regards to the support of skin-to-skin care and breastfeeding. The High 5 for
Mom & Baby program is based on the report by Dr. Marianne Neifert, Getting It Right After
Delivery: Five Hospital Practices That Support Breastfeeding, and the five supportive hospital
practices that support women in their breastfeeding efforts (Whittit, 2014). The High 5
practices for Kansas hospitals are also founded on the most crucial of the 10 steps to successful
breastfeeding specified for the Baby Friendly Hospital program. The High 5 practices are:
1. Assure immediate and sustained skin-to-skin contact between mother and baby after
birth.
2. Give newborn infants no food or drink other than breast milk, unless medically
indicated.
3. Practice rooming in allow mothers and infants to remain together 24 hours a day.
4. Give no pacifiers or artificial nipples to breastfeeding infants.
5. Provide mothers options for breastfeeding support in the community (such as a
telephone number, walk-in clinic information, support groups, etc.) upon discharge.
(Whittit, 2014)

EVIDENCE-BASED PRACTICE

Skin-to-skin care promotes successful breastfeeding which leads to less infant infections, a
decrease in chances of developing asthma, less likely to be diagnosed with obesity and mothers
who breastfeed have a decreased risk of breast and ovarian cancers.
Conclusion
All of the evidence-based care mentioned in the above articles can be implemented in
maternity care to positively impact the relationship between the mother and her new baby. Each
practice demonstrates the importance of client-centered care in regards to laboring, delivering,
and caring for the new baby. The practice that conveys the best approach for evidence-based care
was the study done by Ferrarello & Hatfield, which obtained information from both sides of the
client-care issue- the nurse and the patient. The results from the survey and focus groups are
excellent solutions to problems that postpartum mothers face in the hours and days after birth.
These special times are supposed to be the most crucial in building the bond between mother and
child. The study proved that interruptions in this special time can be controlled and is avoidable.
The implementation of these evidence-based practices would greatly improve the quality of care
labor and delivery patients receive.

EVIDENCE-BASED PRACTICE

References
Cherry, B., & Jacob, S. R. (2014). Contemporary Nursing. St. Louis: Elsevier.
Curl, M., & Lothian, J. A. (2013). Evidence-Based Maternity Care: Can New Dogs Learn New
Tricks? The Journal of Perinatal Education, 22(4), 234-240. Retrieved from
http://dx.doi.org/10.1891/1058-1243.22.4.234
Ferrarello, D., & Hatfield, L. (2014). Barriers to Skin-to-Skin Care During Postpartum Stay. The
American Journal of Maternal Child Nursing, 39(1).
doi:DOI:10.1097/01.NMC.0000437464.31628.3d
Whittit, G. (2014, January). High 5 for Mom & Baby. Retrieved from High5Kansas:
http://www.high5kansas.org/role-of-hospitals-breastfeeding.html