Prevalence and predictors of mother–infant skin-to-skin contact at birth: findings from a U.S. tertiary medical center

Abstract

Background Immediate skin-to-skin contact has well-established benefits for both mother and baby. However, its implementation varies widely, with limited data on predictors. Objective This study aimed to investigate prevalence, duration, and maternal and newborn predictors of immediate skin-to-skin contact following vaginal deliveries. Study design We conducted a retrospective cohort study of vaginal deliveries from May to October 2019 at Albany Medical Center. We abstracted patient demographic and clinical predictor variables from medical records. The primary outcome was prevalence of skin-to-skin contact during the first hour of life, including any and that meeting the World Health Organization standard of care (defined as initiation within 5 minutes lasting for 60 minutes without separation). The secondary outcome was skin-to-skin contact duration in minutes during the first hour of life. Data were analyzed using multivariate logistic and linear regression models as appropriate. Results Among 635 mother–infant dyads, the prevalence of any skin-to-skin contact was 74% and the prevalence of skin-to-skin contact meeting the World Health Organization standard of care was 43%. Maternal higher education increased odds of any skin-to-skin contact [adjusted odds ratio, 2.34; 95% confidence interval, 1.07, 5.13], while maternal delivery complications were associated with decreased odds [adjusted odds ratio, 0.39; 95% confidence interval, 0.17, 0.91]. Infants with 1-minute Apgar scores of 0–3 were four times less likely to receive any skin-to-skin contact compared with infants with scores of 7–10 [adjusted odds ratio, 0.26; 95% confidence interval, 0.09, 0.75]. Other neonatal factors that decreased odds of skin-to-skin contact were multiple gestation [adjusted odds ratio, 0.06; 95% confidence interval, 0.02, 0.19], preterm delivery [adjusted odds ratio, 0.39; 95% confidence interval, 0.19, 0.78], and neonatal intensive care unit admission [adjusted odds ratio, 0.13; 95% confidence interval, 0.06, 0.29]. All significant neonatal predictors also significantly decreased skin-to-skin contact duration in minutes. Conclusion The practice of immediate skin-to-skin contact after vaginal delivery did not meet the recommended standard. Neonatal complications and lower maternal educational level further reduced prevalence and duration, indicating the need for targeted educational interventions for patients and providers. Condensation The prevalence and duration of immediate skin-to-skin contact after vaginal delivery are lower than recommended. Staff and patient education could mitigate some barriers. Highlights Skin-to-skin contact occurs less often and with shorter duration than recommended Newborn health is a stronger predictor of skin-to-skin contact than maternal health Higher maternal education increases prevalence of skin-to-skin contact