Running head: The GOLDEN HOUR

The Golden Hour

Molly Gleason
Methodist College
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Introduction

Imagine. You discover there is a tiny life growing in you. For nine months you nurture

your womb and imagine the moment you see your baby for the first time. You imagine his face,

his touch, and his smell. After the months of waiting, you get to meet your tiny life, your baby.

Your baby is placed on your bare chest, nothing between you, just like when he grew inside you.

This is a magical time. This is the golden hour.

The “golden hour” refers to the sixty minutes immediately following birth. During this

time, the baby transitions from life in utero to life in the outside world. The woman transitions

from a pregnant mother to a postpartum mother (McCulloch, 2016). Now imagine. You spent nine

months growing this life, and a number of hours laboring and birthing this life, and then right at

the moment you have been waiting for, the baby is taken to a radiant warmer, visitors swarm the

room, and the baby is placed in the arms of someone else. The proposed leadership change project

promotes uninterrupted skin to skin contact between mom and baby during this golden hour.

Research supports that this uninterrupted contact improves mother-baby bonding, breastfeeding

success, and the child’s growth and development for years to come (Sanford Health, 2012). Skin

to skin contact between mother and infant causes a reaction in the baby that activates

neuroprotective mechanisms and enables neurobehavioral self-regulation (Crenshaw, 2014). Other

benefits include improved temperature regulation, blood sugar regulation, promotion of delayed

cord clamping, an improvement in the infant’s immune system from the mother’s bacteria,

happier, calmer and less crying noted in the infant, and more stable heart, respiratory, and oxygen

rates (Women’s Memorial Hermann, 2017). This is what is natural, and this is what should be

recommended for mothers and babies.

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Current barriers to including this intervention in practice include a lack of education for

the staff and patients as well as the multitude of interventions and cares for mother and infant

that take place immediately following birth. It has been normal practice for the medical

procedures following the delivery to be the priority in these sixty minutes. Research now shows

that as long as mom and baby are medically stable, certain procedures can either wait for a later

time or be implemented while the infant is skin to skin with mother (Sanford, 2012). These

procedures include physical examination, weight and length, Vitamin K injections, Erythromycin

eye drops, and diapering and swaddling the baby (Sanford, 2012). APGAR scores can be taken

while the infant is with the mother, and priority assessments can be completed. The mother can

have her vital signs taken, vaginal repair, fundal massage, and pain medications administered

while the baby is with her, where he should be.

It is the duty of nurses to collaborate to implement change in the healthcare system.

Leadership is an integral component in the role of a nurse (Grossman & Valiga, 2013). The nurse

takes on a role of patient advocate, teacher, caregiver, and contributor to policy development

(Grossman & Valiga, 2013). As an advocate for participation in the golden hour, the nurse is

advocating for the baby to have the benefits, educating the mother on the benefits and how to

participate, caring for the mother and baby as they recover from delivery, and developing

policies related to the golden hour.

Description

The proposed leadership change project includes the implementation of a golden hour

hospital policy. This policy would outline uninterrupted skin to skin contact between mom and

baby for at least the first sixty minutes of life. Breastfeeding should be initiated within these

sixty minutes, and if unsuccessful, hand expression of colostrum should be performed. All

interventions for mom and baby should be performed as usual with the baby skin to skin on the
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mother’s chest. The infant assessment, weight, and bath can all be postponed until a later time

(as long as there is no medical indication). Visitors should be limited to the primary caregivers of

the child, and the infant should remain skin to skin with the mother during this time, not held by

other visitors (Sanford, 2012).

Exclusions to the initiative include pre-maturity, known infant anomalies, medical

emergencies, or cesarean sections. However, once the mom and/or baby are stable, the baby can

be skin to skin with the mother (Sanford, 2012). In the case of a cesarean section, the stable

infant can be placed skin to skin while the surgery is completed, and can stay with the mother

during recovery and beyond (Sanford, 2012).

This sensitive time requires respect, protection, and support from the healthcare provider

(Crenshaw, 2014). In order to initiate skin to skin during the golden hour, a warm blanket should

be placed over the baby, as well as a hat (McCulloch, 2016). A number of hormones can

influence maternal and newborn responses immediately after delivery. Oxytocin greatly

increases during skin-to-skin contact, which promotes attachment, decreases stress in the mother

and infant, and aids the newborn’s transition (Crenshaw, 2014). The mother should stay warm, as

this reduces the production of adrenaline. Adrenaline can interfere with the production oxytocin

and prolactin hormones, which are needed for breastfeeding and milk production (McCulloch,

2016). Anxiety, pain, and stimulation can all produce adrenaline as well. A quiet, calm, and

warm environment should be provided for the mother and baby during this time to reap the

benefits of the golden hour.

Purpose

The purpose of the leadership change project is to improve the bonding experience

between mom and baby, improve health outcomes for both, and to improve the success of
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breastfeeding. “Research has shown that what happens during the first sixty minutes of a baby’s

life can maximize the bonding experience between mother and child” (Sanford, 2012). Since

skin to skin contact during the golden hour improves breastfeeding, many benefits to both mom

and baby can occur. Benefits to the baby include lower rates of ear infections, asthma, diabetes,

childhood leukemia and Sudden Infant Death Syndrome (SIDS) (Sanford, 2012) Benefits to the

breastfeeding mothers include lower rates of breast cancer, ovarian cancer and diabetes (Sanford,

2012). These benefits to health of mother and infant are the purpose of the project.

Aims

The proposed outcomes of the leadership change project include:

I. Increased rates of infant patients who experience sixty minutes of uninterrupted

skin to skin contact with the mother

II. Increased in rates of successful breastfeeding within the institution

Increasing national breastfeeding rates is a goal of Healthy People 2020 (Hayman,

Crosley, Henry, Neff, & Otto, 2012). Research supports that breastfeeding should be initiated

within the first hour of life (Payne, 2012). This can be done during the golden hour. Alternatives

to the first outcome includes skin to skin contact with a primary caregiver if the mother is

unstable or unavailable and initiating skin to skin contact as soon as possible if the infant is

removed from the room for medical reasons.

Objectives

The strategies and interventions to achieve the leadership project outcomes include those

outlined by the American Academy of Pediatrics:

I. “Healthy newborns should be placed in skin to skin contact with the mother until the

first round of breastfeeding is established;

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II. The medical caregiver and the nurses can conduct the first physical assessment of the

baby while it is on the mother’s chest;

III. Conventional procedures such as weighing, measuring, bathing, injections or blood

test should wait until after the first feeding;

IV. Baby and mother should remain together throughout the recovery period” (Sanford,

2012).

These interventions would be outlined in the policy and procedure manual for the golden

hour initiative.

Thesis

The golden hour should be initiated immediately following delivery in the medically

stable mother and baby and maintained for a minimum of sixty minutes.

Review of Current Literature

Current literature states that having mother and baby together immediately after birth and

throughout hospitalization is best for the mother, the newborn, and for breastfeeding success

(Crenshaw, 2014). A physiologic need is present for the mother and newborn to be together after

birth. Having mothers and babies skin to skin after birth is a safe and healthy intervention that

should be routine practice (Crenshaw, 2014).

Not only are there positive physical effects to both mom and baby during skin to skin

contact during the golden hour, but some institutions have named this time the “sacred hour”

(Phillips, 2013). Birth is a sacred event, and this time after should be considered sacred as well.

Being skin to skin with the mother is the newborn infant's new natural habitat after leaving the

womb, their natural habitat for the last nine months (Phillips, 2013). This need should be

honored for both the mother and the infant’s emotional and physical health and well-being.
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Theoretical Framework

The following theoretical framework shows determinants of early initiation of

breastfeeding:

(Acharya & Khanal, 2015). These determinants would need to be addressed and plans

formulated to overcome these factors to ensure success rates in different populations. The article

discusses skin to skin contact during the first hour of birth increasing the likelihood of successful

breastfeeding (Acharya & Khanal, 2015). The article also shows the increase in health benefits

and the decrease in infant mortality when breastfed, proving the importance of the golden hour

for these children (Acharya & Khanal, 2015).

Methodology
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Education on the golden hour begins in the obstetric office during prenatal visits. It then

is reiterated during labor and delivery, and then immediately following delivery. Physicians,

nurse practitioners, nurses, childbirth educators, and other professionals have the responsibility

to support this intervention through education, advocacy, and implementation of evidence-based

interventions in their practice (Crenshaw, 2014). Research and findings should be published in

books, journals, and online for public access. Reading pamphlets and information on where to

find information should be provided regularly to the mother.

In order to achieve the goal of increased rates of infant patients who experience sixty

minutes of uninterrupted skin to skin contact with the mother and successful breastfeeding within

the institution, an evaluation will need to take place to determine the current rates. Successful

breastfeeding according to the policy should be defined. According to the American Academy of

Pediatrics, exclusive breastfeeding should occur for the first six months of life. This indicates

that no additional foods (except Vitamin D supplementation) or fluids be given to the infant

unless medically indicated (American Academy of Pediatrics, 2012). The policy will use this

recommendation to define success as a diet of exclusive breast milk for the infant until six

months of age. A search would be conducted to evaluate the percentage of institutions that have

a developed policy regarding the golden hour, skin to skin, and breastfeeding. These would be

compared to the new initiative.

Timeline and Strategy for Implementation

The timeline for implementation of the golden hour initiative will be one year. First, a

review will be conducted to find the current percentage of patients participating in the golden

hour in the department. Then, an educational program will be developed in order to educate the
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staff. Educators including the Unit Educator on Labor and Delivery for the nurses, Physicians,

Residents, and all staff will be at the forefront of implementing these sessions. This will take two

months to create the program and train the educators. Once the educational program has been

developed, the staff will be trained through a series of sessions, which will occur over six

months. Then for the next six months, the staff will implement the strategies learned in the

sessions to improve the rate of patients participating in the golden hour in all mothers and baby

patients within the department. At the end of the one-year mark, patient statistics will be

analyzed to evaluate the percentage of participants compared to the start of the program.

Stakeholders

Stakeholders for the proposed policy would include the hospital or institution adopting

the policy, along with its Board of Directors. The American Board of Obstetrics and

Gynecology’s objective and purpose is to maintain the highest professional standards in

Obstetrics, Gynecology, and Women’s Health (American Board of Obstetrics and Gynecology,

2017). The golden hour implementation would be held to this standard. This board would

become a stakeholder along with the American Board of Pediatrics and Women, Infants, and

Children (WIC).

The organization La Leche League is an organization of accredited volunteer mothers

with training who are able to provide assistance and support to mothers for breastfeeding.

Different efforts include group meetings, online help, and telephone communication (CDC,

2014). These efforts could be used for promotion and education on the golden hour. An

International Board Certified Lactation Consultant (IBCLC) specializes in the management of

lactation and breastfeeding (CDC, 2014). Lactation consultants should be available at the
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institution at all times to educate and assist in breastfeeding. La Leche League and IBCLC would

become stakeholders to achieve the outcome of successful breastfeeding.

Main Findings

In order to help achieve the goal of increased rates of infant patients who experience sixty

minutes of uninterrupted skin to skin contact and successful breastfeeding, the Baby-Friendly

Hospital Initiative (or “Baby Friendly”) could be implemented at the institution. Baby Friendly

was created to reduce the negative effects that lack of skin to skin, formula feeding, or other

medical interventions had on breastfeeding and mother-baby attachment (Crenshaw, 2014).

There are ten evidence-based steps in the initiative. Step four includes the use of health care

professionals to help mothers begin breastfeeding within this golden hour, and this step also

recommends that all healthy mothers and babies are placed skin-to-skin immediately after birth

(Crenshaw, 2014).

Recommendations

Recommendations for the policy would be based on evidence-based research. The

institution would be staffed with adequately trained Physicians, nurses, and lactation consultants

to achieve success with this new initiative. The policy would be developed and implemented,

then revisited yearly and as needed. Further down the road, the institution could seek Baby

Friendly status to help improve or maintain successful trends.

Evaluation Method
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Evaluation of the policy would include a survey for patients to determine whether they

were satisfied with their experience immediately after birth. The survey would include questions

regarding staff assistance, education, and their personal preferences and whether they were

honored. Chart audits would be conducted to look at the documentation of sixty minutes of skin

to skin contact as well as breastfeeding attempts within that time.

Summary and Conclusion

Research shows that uninterrupted skin to skin contact immediately following birth is

what is best for mother and infant. Does this mean when the sixty-minute timer goes off the baby

gets taken from the mother? Absolutely not. The current recommendation is that the baby spends

six hours a day skin to skin for the first six weeks of life (CDC, 2014). It is important for

healthcare providers to remember their role in childbirth. “What does the baby most need at the

moment of birth? Only mother” (Crenshaw, 2014). This initiative will help improve health

outcomes for mothers and infants. The medical benefits of the golden hour will last a lifetime, as

well as the memories.

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References

Acharya, P., & Khanal, V. (2015, October). The effect of mother’s educational status on early
initiation of breastfeeding: further analysis of three consecutive Nepal Demographic and
Health Surveys. BMC Public Health.
https://www.researchgate.net/figure/283356448_fig3_Figure-1-Conceptual-framework-
of-determinants-of-early-initiation-of-breastfeeding

American Academy of Pediatrics. (2012, February 27). Breastfeeding and the use of human
milk. Pediatrics, 129, e827–e841. Retrieved from
http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

American Board of Obstetrics and Gynecology. (2017). Objective & purposes. Retrieved from
https://www.abog.org/new/default.aspx

CDC. (2014). Breastfeeding report card. National Center for Chronic Disease Prevention and
Health Promotion. Retrieved from
https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf

Crenshaw, J. T. (2014). Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best
for Mother, Baby, and Breastfeeding. The Journal of Perinatal Education, 23(4), 211–
217. http://doi.org/10.1891/1058-1243.23.4.211

Grossman, S., & Valiga, T. M. (2013). The new leadership challenge: creating the future of
nursing. Philadelphia: F.A. Davis.

Hayman, R., Crosley, M., Henry, L., Neff, M., & Otto, D. (2012). Igniting the midnight shift
passion for breastfeeding support: a unique educational opportunity for the mother-baby
nurse. Journal of Obstetric, Gynecologic & Neonatal Nursing 41.doi:10.1111/j.1552-
6909.2012.01361_9.x

McCulloch, S. (2015, May 10). Seven huge benefits of an undisturbed first hour after birth.
BellyBelly. Retrieved from https://www.bellybelly.com.au/birth/7-benefits-undisturbed-
first-hour-after-birth/

Payne, C. (2012). Igniting change in implementation of nursing and medical practice to increase
exclusive breast milk feeding. Journal of Obstetric, Gynecologic & Neonatal Nursing,
41.doi: 10.1111/j.1552-6909.2012.01361_12.x

Phillips, R. (2013). Uninterrupted skin-to-skin contact immediately after birth. Newborn &
Infant Nursing Reviews. Retrieved from http://www.medscape.com/viewarticle/806325

Sanford Health. (2012, January). The golden hour: giving your newborn the best start. Retrieved
from http://www.sanfordhealth.org/stories/the-golden-hour-giving-your-newborn-the-
best-start
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Women’s Memorial Hermann. (2012). The golden hour. Retrieved from

http://womens.memorialhermann.org/labor-delivery/the-golden-hour/