Environmental Context
This quality improvement project used early STS contact
in the operating room (OR) and during recovery to
increase the rate of early STS among healthy infants
born by cesarean. It took place at a large, urban, acute
care teaching hospital in California. The hospital’s
birth center consists of a combined labor, birthing, and
postpartum unit, with a separate level III nursery. The
birth center has 1,300 births per year and a 20% cesarean
birth rate, resulting in about 22 cesarean births per
month. The birth center serves culturally diverse women
and infants: 58% Hispanic, 13% African American,
12% Asian or Pacifi c Islander, and 6% White. Half of
the women are single (neither married nor partnered),
and the majority (88%) live at or below 150% of the
federal poverty level. Breastfeeding support at the
birth center is a high priority, as evidenced by its BabyFriendly
hospital accreditation. As a Baby-Friendly
hospital it follows the Ten Steps for Successful Breastfeeding,
developed by the World Health Organization
(WHO) and the United Nation’s Children Fund (UNICEF).
However, infants born by cesarean had notably
lower exclusive breastfeeding rates compared to infants
who were born vaginally.