Quality Improvement Results
We collected data on all healthy infants born by cesarean.
We focused on the timing of STS initiation, Latch, Audible
swallowing, Type of nipple, Comfort, Hold (LATCH)
scores, and the use of formula supplementation. All of these
data were already routinely recorded by the nurses in the
infant charts, which was essential to the feasibility of our
assessment plan. Although there are various breastfeeding
assessment tools in the literature, we used the LATCH tool
because it was already being used in the birth center and is
considered to be a reliable and effective tool to assess breastfeeding
(Adams & Hewell, 1997). The duration of STS in
the OR ranged from a few minutes to over 30 minutes, but
was regarded as equal for data collection purposes.
It is important to note that the following data results
are not meant to show associations between STS and
breastfeeding, but rather to track the progress of this quality
improvement project. During the first 3 months after
implementation, the rate of STS within 90 minutes from
healthy cesarean birth increased from 20% to 68%, and
the rate of infants who did not get any STS contact within 4
hours decreased from 40% to 9% (Figure 2). Nine months
later, 60% of healthy infants born by cesarean were STS
in the OR, and 70% were STS within 90 minutes of birth.