Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates

Breastfeed Med. 2012 Apr;7(2):69-78. doi: 10.1089/bfm.2011.0040. Epub 2012 Feb 7.


Purposes: Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge.

Methods: For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010).

Results: In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change.

Conclusions: The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.

MeSH terms

  • Adult
  • Anthropology, Cultural
  • Breast Feeding* / ethnology
  • Breast Feeding* / methods
  • Breast Feeding* / psychology
  • Breast Feeding* / statistics & numerical data
  • Female
  • Hospitals
  • Humans
  • Infant
  • Infant Care / methods*
  • Infant Care / psychology
  • Mother-Child Relations
  • Mothers / psychology*
  • Object Attachment
  • Patient Satisfaction
  • Quality Improvement
  • Time Factors
  • Touch
  • United States
  • Video Recording*
  • Young Adult