Early skin-to-skin contact after cesarean section: A randomized clinical pilot study.

Martina Kollmann,Eva Mautner,Anna Scheuchenegger,Lisa Aldrian,Reinhard B Raggam,Sereina A Herzog,Uwe Lang,Philipp Klaritsch,Berndt Urlesberger,Barbara Obermayer-Pietsch,Jacqueline Ho

doi:10.1371/journal.pone.0168783

Abstract

ObjectiveEarly bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response.Study designThis prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase.ResultsThere was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004).ConclusionsThis study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial.Trial registrationClinicalTrials.gov NCT01894880

Highlights

Bonding describes the process by which individuals become emotionally attached to one another
This study did not reveal significant risks for the newborn in terms of neonatal transition when early skin-to-skin contact (SSC) is applied in the operating room
Skin-to-skin contact after cesarean section levels did not differ either, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system

Summary

Introduction

Bonding describes the process by which individuals become emotionally attached to one another. There is evidence that SSC is beneficial for neonatal thermoregulation after vaginal delivery, there is few data regarding neonatal thermoregulation after cesarean section [10, 12,13,14,15,16,17]. Two randomized controlled trials (RCTs) investigated the effect of SSC on infants’ temperatures and found controversial results [10, 12]. One of the latter studies found that the mean neonatal core temperature decreases without active warming from beginning of the surgical procedure until the end of the bonding period. The second study found that neonates were not prone to hypothermia [12]

Methods

Results

Conclusion