Immediate skin-to-skin contact (SSC) has well-established benefits for both mother and baby, yet its implementation varies widely, with limited data on predictors. This study aims to quantify the prevalence and duration of immediate SSC for vaginal deliveries and to determine how maternal and newborn health affect SSC occurrence and duration. We conducted a retrospective cohort study of vaginal deliveries over six months at an academic medical center. Demographic and clinical predictor variables were abstracted from medical records. We determined associations with SSC occurrence and duration using multivariate logistic and linear regression, respectively. The prevalence of any SSC was 74%, with steady reduction as duration increased. The mean duration of SSC was 30.5 minutes. The presence of maternal delivery complications decreased SSC occurrence (aOR 0.41, 95%CI: 0.18-0.94), but maternal comorbidities did not. Maternal higher education increased odds of any SSC (aOR 2.06, 95%CI: 1.20-3.53). Compared to infants with 1-minute Apgar scores of 8-10, those with scores of 0-3 were about 4 times less likely to receive any SSC (aOR 0.24, 95%CI: 0.09-0.68). Other neonatal factors that decreased odds of any SSC were multiple gestation (aOR 0.06, 95%CI: 0.02-0.18), prematurity (aOR 0.39, 95%CI: 0.20-0.78), NICU admission (aOR 0.13, 95%CI: 0.06-0.28), and exclusive formula-feeding at discharge (aOR 0.49, 95%CI: 0.24-0.99). Low Apgar score, multiple gestation, prematurity, NICU admission, and feeding method at discharge also significantly decreased SSC duration. Maternal comorbidities, delivery complications, and higher education were not associated with SSC duration. The practice of immediate SSC after vaginal delivery occurs less often and with shorter duration than recommended. This practice is further decreased in the setting of maternal and neonatal complications, despite documented benefits extending to those scenarios. Interventions to increase SSC should include education on benefits and safety for patients and providers to improve maternal and neonatal care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)