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Skin-to-Skin Contact After Cesarean Delivery

An Experimental Study

Gouchon, Silvia; Gregori, Dario; Picotto, Amabile; Patrucco, Giovanna; Nangeroni, Marco; Di Giulio, Paola

doi: 10.1097/NNR.0b013e3181d1a8bc

Background: The effectiveness of skin-to-skin contact (SSC) after vaginal delivery has been shown. After cesarean births, SSC is not done for practical and medical safety reasons because it is believed that infants may suffer mild hypothermia.

Objective: The aim of this study was to compare mothers' and newborns' temperatures after cesarean delivery when SSC was practiced (naked baby except for a small diaper, covered with a blanket, prone on the mother's chest) with those when routine care was practiced (dressed, in the bassinet or in the mother's bed) in the 2 hours beginning when the mother returned from the operating room.

Methods: An experimental, noninferiority adaptive trial was designed with four levels of analysis: 34 pairs of mothers and newborns, after elective cesarean delivery, were randomized to SSC (n = 17) or routine care (n = 17). Temporal artery temperature was taken with an infrared ray thermometer at half-hour intervals.

Results: Compared with newborns who received routine care, SSC cesarean-delivered newborns were not at risk for hypothermia. The mean temperatures of both groups were almost identical: after 30 min, 36.1°C for both groups (±0.4°C for SSCs and ±0.5°C for the controls), and after 120 min, 36.2°C ± 0.3°C for SSCs versus 36.4°C ± 0.7°C for the controls (no significant differences). Time from delivery to the mothers' return to their room was 51 ± 10 min. The SSC newborns attached to the breast earlier (nine SSC newborns and four controls after 30 min) were breast-fed (exclusively or prevalently) at discharge (13 SSCs and 11 controls) and at 3 months (11 SSCs and 8 controls), and the SSC mothers expressed high levels of satisfaction with the intervention.

Discussion: Cesarean-delivered newborns who experienced SSC within 1 hour of delivery are not at risk for hypothermia.

Silvia Gouchon, MSc, RN, is Nursing Coordinator, Research and Education Unit, Ospedali Riuniti, Pinerolo, Italy.

Dario Gregori, PhD, is Statistician and Associate Professor, Department of Public Health and Microbiology, Turin University, Turin, Italy.

Amabile Picotto, RN, is Nursing Coordinator, Mother and Child Department; Giovanna Patrucco, MD, is Pediatrician and Former Head of the Neonatology Unit; and Marco Nangeroni, MD, is Pediatrician, Head of the Neonatology Unit, Ospedali Riuniti, Pinerolo, Italy.

Paola Di Giulio, MSc, RN, is Associate Professor, Department of Public Health and Microbiology, Turin University, Turin, Italy.

Accepted for publication November 19, 2009.

This study was made possible thanks to the support of the coordinator, the director, and a consultant of neonatology; the health care workers (pediatric nurses, nurses' aids, midwives); and the nursing students and mothers who agreed to participate.

Corresponding author: Paola Di Giulio, MSc, RN, Department of Public Health and Microbiology, Turin University, Turin, Italy 10100 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.