Delay the BathsAnne Marie Henri, RN, BSNNurse ManagerMother Baby Units Boston Medical Center

Boston Medical CenterUrban setting (Boston)Academic teaching hospitalStrong affiliations with neighborhood health centersBirths per year: About 2,500Maternity unit on two floors 17 (4th floor) and 15 (3rd floor) private roomsNICU: Level 3, 12 bedsStep Down Unit: Level 2, 6 beds

Delay the Bath InitiativeBackground: After birth, a babys blood glucose level reaches its lowest point at about 2 hours of life Our practice for years has been to bathe babies at 2 hours of life or when a stable temperature (>97.6 ax) achievedWe would sponge bathe the babies body, wash the hair under the facet, and then place the baby on the warmerWith new private rooms came the opportunity to bathe babies in their rooms without taking them to the nurseryAlso the opportunity to review the best time to bathe

ChallengesMDs on board with delaying the bathStaff nurses were not enthused for the following reasons:GookySmellyParents will hate itInfectionsIts not the way we do things

How we did itLots of discussion and coaxingFinally, we picked a GO dateOn May 10, 2010, the Delay the Bath Initiative would begin Baths would be delayed until infant 12 hours of lifeExcept if history of maternal HIV+, hepatitis B or C positiveThen after the the bath, infant placed skin-to-skin on mothers chest

Signs were posted in unit areas

Informationposted in maternity rooms in three languages

We added a bassinette card

Our first baby! This mom had C-Sec and insisted on getting out of bed to give the first bath.

Skin-to-skin after the bath

Skin-to-skin can be with Dad too!

Lessons LearnedChange is hard. Discuss, review evidence-based practice, discuss again and then at some point you just gotta GOParents love it. No complaints. Great opportunity to teach about baths. Great opportunity to reinforce importance of and teach about skin-to-skin, bonding and breastfeedingHypoglycemia has almost vanished (?TTN?)Study underwayAt UCSD they dont bathe babies at all