Delay the Baths

Anne Marie Henri, RN, BSN

Nurse Manager

Mother Baby Units

Boston Medical Center

Boston Medical CenterUrban setting (Boston)

Academic teaching hospitalStrong affiliations with neighborhood health centers

Births per year: About 2,500

Maternity unit on two floors 17 (4th floor) and 15 (3rd floor) private rooms

NICU: Level 3, 12 beds

Step Down Unit: Level 2, 6 beds

Delay the Bath InitiativeBackground: After birth, a baby’s blood glucose

level reaches it’s 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 warmer

With new private rooms came the opportunity to bathe babies in their rooms without taking them to the nursery

Also the opportunity to review the best time to bathe

ChallengesMDs on board with delaying the bath

Staff nurses were not enthused for the following reasons:“Gooky”“Smelly”“Parents will hate it”“Infections”“It’s not the way we do things”

How we did itLots of discussion and coaxing

Finally, 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

positive

Then after the the bath, infant placed skin-to-skin on mother’s chest

Signs were posted

in unit areas

Information

posted 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 GO

Parents love it. No complaints. Great opportunity to teach about baths. Great opportunity to reinforce importance of and teach about skin-to-skin, bonding and breastfeeding

Hypoglycemia has almost vanished (?TTN?)Study underway

At UCSD they don’t bathe babies at all