Effects of Skin-to-Skin Care During Cesareans: A Quasiexperimental Feasibility/Pilot Study

Abstract

Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.

Systematic review confirmed the benefits of early skin‐to‐skin contact but highlighted lack of studies on very and extremely preterm infants

“…Pain perception following Caesarean section was lower and maternal satisfaction was higher in the early SSC group than the control group in another study by Sundin and Mazak. 36 Crenshaw et al 38 also demonstrated higher maternal satisfaction and lower salivary cortisol when they compared early and late SSC groups.…”

Measuring health professionals' beliefs about skin‐to‐skin care during a cesarean

“…Delaying or withholding immediate and uninterrupted SSC during a medically uncomplicated caesarean is usually not necessary (Crenshaw et al, 2019) and may be harmful (Cs asz ar-Nagy & B okkon, 2018;World Health Organization [WHO] & UNICEF, 2018).…”

“…Delaying or withholding immediate and uninterrupted SSC during a medically uncomplicated caesarean is usually not necessary (Crenshaw et al, 2019) and may be harmful (Császár‐Nagy & Bókkon, 2018; World Health Organization [WHO] & UNICEF, 2018). Given the global rate of caesarean birth (Boatin et al, 2018; Boerma et al, 2018; Visser et al, 2018), at least one‐third of women and their newborns may not have access to this evidence‐based practice that significantly improves breastfeeding outcomes and promotes optimal health for women and children (Császár‐Nagy & Bókkon, 2018; WHO & UNICEF, 2018).…”

“…Step 4 of the Baby‐friendly Hospital Initiative calls upon health professionals (HPs) to provide immediate and uninterrupted SSC and to help mothers begin breastfeeding as soon as possible after birth. SSC that begins immediately during a medically uncomplicated caesarean is feasible and safe, has no negative impact on maternal or newborn physiologic stability or temperature, reduces maternal stress, improves maternal satisfaction with the caesarean experience (Crenshaw et al, 2019) and significantly improves breastfeeding outcomes (Conroy & Cottrell, 2015). SSC during a caesarean also reduces newborn transfers to a neonatal intensive care unit for observation (Schneider et al, 2017), reducing maternal and newborn separation during this psychophysiologically sensitive time.…”

Immediate and Sustained Skin-to-Skin Contact for Healthy Late Preterm and Term Newborns After Birth: AWHONN Practice Brief Number 14

“…Implementing STS contact in the operating room promoted family centered care, improved the mother's satisfaction and confidence (Crenshaw et al, 2019), provided a more natural experience and sense of control (Bertrand & Adams, 2020;Frederick et al, 2016Frederick et al, , 2020, and facilitated bonding (Bertrand & Adams, 2020) and attachment (Hubbard & Gattman, 2017;Neczypor & Holley 2017). Contraindications may include maternal or neonatal instability or conditions not supportive of interaction (i.e., vomiting, use of general anesthesia; Frederick et al, 2020).…”