Aim This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full‐term infant placed skin‐to‐skin with the mother during the first hour after birth following a noninstrumental vaginal birth. Method This state‐of‐the‐art article forms a link within the knowledge‐to‐action cycle, integrating clinical observations and practice with evidence‐based findings to guide clinicians in their work to implement safe uninterrupted skin‐to‐skin contact the first hours after birth. Results Strong scientific research exists about the importance of skin‐to‐skin in the first hour after birth. This unique time for both mother and infant, individually and in relation to each other, provides vital advantages to short‐ and long‐term health, regulation and bonding. However, worldwide, clinical practice lags. A deeper understanding of the implications for clinical practice, through review of the scientific research, has been integrated with enhanced understanding of the infant's instinctive behaviour and maternal responses while in skin‐to‐skin contact. Conclusion The first hour after birth is a sensitive period for both the infant and the mother. Through an enhanced understanding of the newborn infant's instinctive behaviour, practical, evidence‐informed suggestions strive to overcome barriers and facilitate enablers of knowledge translation. This time must be protected by evidence‐based routines of staff.

The purpose of this study was to evaluate the impact of the individual services offered via a workplace lactation program of one large public-sector employer on the duration of any breastfeeding and exclusive breastfeeding. Exclusive breastfeeding was defined as exclusive feeding of human milk for the milk feeding. A cross-sectional mailed survey approach was used. The sample (n = 128) consisted of women who had used at least one component of the lactation program in the past 3 years and who were still employed at the same organization when data were collected. Descriptive statistics included frequency distributions and contingency table analysis. Chi-square analysis was used for comparison of groups, and both analysis of variance (ANOVA) and univariate analysis of variance from a general linear model were used for comparison of means. The survey respondents were primarily older, white, married, well-educated, high-income women. More of the women who received each lactation program service were exclusively breastfeeding at 6 months of infant age in all categories of services, with significant differences in the categories of telephone support and return to work consultation. After adjusting for race and work status, logistic regression analysis showed the number of services received was positively related to exclusive breastfeeding at 6 months and participation in a return to work consultation was positively related to any breastfeeding at 6 months. The study demonstrated that the workplace lactation program had a positive impact on duration of breastfeeding for the women who participated. Participation in the telephone support and return to work consultation services, and the total number of services used were related to longer duration of exclusive and/or any breastfeeding.

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Background: Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin-to-skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes. Method: Prospective comparative design. Sixty-three low-risk mothers self-selected to labor with intrapartum analgesia/anesthesia or not. Video recordings of infants during the first hour after birth while being held skin-to-skin with their mother were coded and analyzed to ascertain whether or not they achieved Stage 8 (suckling) of Widstr€ om's 9 Stages of newborn behavior during the first hour after birth. Results: A strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth. Conclusions: Results suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skinto-skin with its mother during the first hour after birth. (BIRTH 42:4 December 2015)

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.

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Increasing breastfeeding duration and exclusivity is an acknowledged public health priority. Breastfeeding problems, especially with the healthy term neonate latching-on or feeding with a suboptimal latch, are common reasons for early breastfeeding termination when they result in inadequate breastfeeding, poor milk transfer, and sore nipples. This article describes clinical strategies for systematic latch-on and suckling assessment with the goal of improving the skills of clinicians who provide care for breastfeeding women.

Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications.