Implementing the practice of early skin-to-skin contact among infants ≥34 weeks gestation born by caesarean section: A quality improvement study

Abstract

Background

Separating mothers and newborns after caesarean delivery prevents early skin-to-skin contact (SSC), despite WHO recommendations to initiate SSC immediately at birth. Early SSC promotes breastfeeding success, enhances thermoregulation, reduces maternal postpartum complications, and fosters bonding. In our hospital, SSC was not practiced after caesarean deliveries, prompting this quality improvement (QI) initiative.

Methods

Conducted in the operating theatre of a tertiary care hospital over 4 months (January–April 2024), with a 3-month sustenance phase. Inborn infants ≥34 weeks gestation and ≥1.8 kg delivered via caesarean section, with good tone and breathing at birth, were eligible. Sequential Plan-Do-Study-Act (PDSA) cycles were implemented to introduce SSC within 5 minutes of birth, aiming for ≥90% compliance. Interventions included staff training, SSC protocol development, operating room reorganization, and maternal support during recovery.

Results

SSC compliance increased from 0% at baseline to 100% by cycle 4. Breastfeeding initiation improved from 48% to 95%, and exclusive breastfeeding at discharge increased from 77% to 97%. Deferred weighing and vitamin K administration rates increased from 10% to 100%.

Conclusion

Through systematic interventions, we achieved and sustained 100% SSC compliance for caesarean births. This study demonstrates that with a structured, multidisciplinary approach, SSC can be successfully integrated into caesarean delivery routines, potentially enhancing maternal-infant bonding and early breastfeeding initiation.