Delay the Baths

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Delay the Baths

• Anne Marie Henri, RN, BSN
• Nurse Manager
• Mother Baby Units
• Boston Medical Center

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Boston Medical Center

• Urban setting (Boston)
• Academic teaching hospital
• Strong 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

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Delay the Bath Initiative

• Background 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
  (gt97.6 ax) achieved
• We 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

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Challenges

• MDs on board with delaying the bath
• Staff nurses were not enthused for the following
  reasons
• Gooky
• Smelly
• Parents will hate it
• Infections
• Its not the way we do things

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How we did it

• Lots of discussion and coaxing
• Finally, we picked a GO date
• On May 10, 2010, the Delay the Bath Initiative
  would begin
• Baths would be delayed until infant 12 hours of
  life
• Except if history of maternal HIV, hepatitis B
  or C positive
• Then after the the bath, infant placed
  skin-to-skin on mothers chest

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Signs were posted in unit areas
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Informationposted in maternity rooms in three
languages
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We added a bassinette card
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Our first baby! This mom had C-Sec and insisted
on getting out of bed to give the first bath.
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Skin-to-skin after the bath
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Skin-to-skin can be with Dad too!
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Lessons Learned

• Change 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 dont bathe babies at all