Running Head: CESAREAN SKIN TO SKIN OUTCOMES
Cesarean Skin to Skin Outcomes Evidence Table
1
CESAREAN SKIN TO SKIN OUTCOMES
PICO Statement:
P = Population
I = Intervention
C = Comparison
O = Outcome
In newborn patients
is immediate skin-to-skin contact post C-section
as effective as usual care
in promoting infant stability and overall satisfaction?
2
Running Head: CESAREAN SKIN TO SKIN OUTCOMES
Study:
author,
Year
Study Design Study Question
Subjects
3
Interventions/ Control Outcome Measures
Groups
Significant Results
* include p values
CESAREAN SKIN TO SKIN OUTCOMES
Gouchon, S.,
Randomized
Gregori, D.,
control trial
Picotto, A.,
Patrucco, G.,
Level I
Nangeroni, M.,
& Giulio, P.D.
(2012)
Are there any
differences in newborn
and mother
temperatures after csection when skin-toskin contact (SSC) is
used when compared to
routine care?
4
N=34
mother/baby
pairs at the
Mother and
Child
Department of
Pinerolo
Hospital in
Italy.
-scheduled
elective Csections
-utilizing locoregional
anesthesia
-full term
infants (38-42
weeks) with
apgars greater
than 7 and
weight greater
than 2500kg.
Intervention group:
N=17 mother/baby
pairs utilizing skin-toskin
Control group: N=17
mother/baby pairs
utilizing routine care
Post-op temperature
Effectiveness of first
breast-feeding
Breastfeeding
exclusivity
Patient (mother and
father) satisfaction
No statistically
significant difference
in post-op
temperatures.
Intervention group
were fed earlier than
control group
Intervention group
was more exclusively
breastfed at discharge
(13 vs. 11)
Intervention group
more exclusively
breastfed at 3 months
(11 vs. 8)
Majority of
intervention women
were very satisfied
(12), felt skin to skin
improved bonding
(10)
CESAREAN SKIN TO SKIN OUTCOMES
Beiranvand,
S., Valizadeh,
F.,
Hosseinabadi,
R., & Pournia,
Y. (2014)
Randomized
control trial
Level I
Does skin-to-skin
contact after c-sections
have an effect on infant
temperature and
breastfeeding success
when compared to usual
care?
5
N=96 motherinfant pairs at
the Asali
Hospital in Iran
-singleton
pregnancy
-full term
(gestational age
38-42 weeks)
-scheduled
elective csection
-utilizing spinal
anesthesia
Intervention group:
N=48 mother/baby
pairs utilizing skin to
skin
Control group: N=48
mother/baby pairs
utilizing usual care
Post-op temperatures
Breastfeeding
successfulness
No statistically
significant differences
in newborn post-op
temperatures
(immediately post-op
p=0.86, 0.5 hours
p=0.31, 1 hour p=0.5)
Overall breastfeeding
assessment show no
statistical significance
between groups
(p=0.048) however
skin to skin group was
statistically significant
at readiness to
breastfeed (P=0.021),
effectiveness of
sucking (p=0.03) than
control group.
CESAREAN SKIN TO SKIN OUTCOMES
Stevens, J.,
Schmied, V.,
Burns, E., &
Dahlen, H.
(2014)
Review of
Literature
Level II-1
Review of literature in
order to provide
evidence for the use of
early skin to skin
contact during Cesarean
sections.
6
7 studies
focused on
immediate or
early skin to
skin post
Cesarean
delivery and
other various
inclusion
criteria
Not all RCT’s
N/A
Maternal pain
Maternal-newborn
stability
Newborn feeding
outcomes
Women’s statements
post delivery indicate
decreased pain levels;
however, pain scores
did not show a
statistical significance
No statistically
significant differences
between skin to skin
and control groups for
maternal and newborn
thermoregulation.
Newborns with early
skin to skin had
significantly lower
respiratory rates and
higher temperatures at
1hr post-op
Skin to skin newborns
latched on an average
of 21 minutes earlier
than control; artificial
formula
supplementation was
decreased by 41%
with early skin to
skin; no significant
difference found in
exclusivity of
breastfeeding
CESAREAN SKIN TO SKIN OUTCOMES
Frederick, A.
C., Busen, N.
H.,
Engebretson,
J. C., Hurst, N.
M., &
Schneider, K.
M. (2014)
Qualitative
study
“medical
ethnographic
design”
Level II-1
Mother’s perceptions of
immediate skin to skin
contact during the intra
and post operative
Cesarean section
periods.
7
N=11 pregnant N/A
women, full
term (3942weeks),
delivery via
Cesarean
section from
Texas Medical
Center
-no preexisting
medical needs
-utilizing spinal
anesthesia
-Newborn
APGARs
greater than 7
and 8
Themes:
Mothers’ perception
of experience
Practitioners
observations of
experiences
Themes:
-helped distract from
OR environment
-calming effect for
both mother and
infant
-early communication
between mothernewborn
-reported feelings of
strong bonding
between mothernewborn
-pro-feeding
behaviors observed,
not latch achieved
-surgical environment
hindered comfort/ease
of skin to skin contact
CESAREAN SKIN TO SKIN OUTCOMES
Erlandsson,
Randomized
K., Dsilna, A., control trial
Fagerberg, I.,
& Christenson, Level I
K. (2007)
Sundin, C. S.,
& Mazac, L.
B. (2015)
Qualitative
study
Level II-1
How does skin to skin
contact with a paternal
substitute post c section
effect pro-feeding
behavior and infant
crying compared to
usual care?
N=29 infantfather pairs
from surgical
and maternity
ward at
Karolinska
University
Hospital in
Stockholm,
Sweden
-full term
infants (37-41
weeks)
-utilizing spinal
anesthesia
-undergoing
elective
caesarean
section
Study maternal
N=46 repeat
satisfaction and pain
cesarean section
levels during caesarean patients
sections with immediate receiving skin
skin to skin use intrato skin contact
operatively
in the operating
room.
8
Intervention group:
N=15 utilizing skin to
skin a paternal
substitute
Control group: N=14
usual care
N/A
Infant pre-feeding
behaviors
Infant crying
Skin to skin infants
cried significantly less
than usual care infants
(p less than 0.001)
Sucking (p=less than
0.001) and rooting (p
less than 0.01)
behaviors and length
of wakefulness (p less
than 0.01) were less in
the intervention group
indicating greater
infant comfort.
Patient satisfaction
“maternal satisfaction
compared to previous was higher and
cesarean sections
perception of pain was
lower for women who
Patients perception to experienced STS [skin
pain compared to
to skin] in the OR
precious c section
when compared to
women where STS
was not performed”
CESAREAN SKIN TO SKIN OUTCOMES
Velandia, M., Randomized
Matthisen, A. control trial
S., UvansMoberg, K., & Level I
Nissen, E.
(2010)
Are effects of early skin
to skin contact
influenced by the parent
performing the skin to
skin contact?
Hung, K. J., & Quality
Does implementation of
Berg, O.
Improvement early skin to skin
(2011)
project
contact during cesarean
section increase
Level II-2
breastfeeding rates?
9
N=37 healthy
infants with
primipara’s and
their partners
-healthy
uncomplicated
pregnancy
Randomly assigned to
Parent newborn vocal
either skin to skin
interaction
contact with either
mother or father. Parent Infants behaviors
not conducting skin to
skin contact served as
control; all infants
received skin to skin
conact.
Healthy
N/A
mothers and
infants
delivered via
cesarean section
in a large
California
teaching
hospital over a
9 month period
LATCH scores
(Latch, Audible
swallowing, Type of
nipple, Comfort,
Hold)
Formula
supplementation
Parent performing
skin to skin contact
communicated with
infant more than
control (Overall
promotes vocalization
between infantparents)
Infants skin to skin
with father cried
significantly less
(p=0.002) and entered
a relaxed state quicker
(p=0.029) than those
with their mother
After implementation
of protocols for earlier
skin to skin contact
post-cesarean section
resulted in increased
average LATCH
scores and decreased
infant formula
supplementation
during hospital say
CESAREAN SKIN TO SKIN OUTCOMES
Nolan, A., &
Lawrence, C.
(2009)
Randomized
control trial
Level I
Moore, E. R.,
Anderson, G.
C., Bergman,
N., Dowswell,
T. (2012)
Does initiation of
protocols to reduce
maternal-infant
separation including
skin to skin contact
influence maternal and
infant outcomes
compared to usual
care/infant-mother
separation?
Review of
Review the effects early
Literature:
skin to skin contact
Meta-analysis post-delivery compared
to usual hospital care.
Level I
10
N=50 women
and newborns
-singleton
-full term
-repeat cesarean
delivery
Intervention group:
n=25 receiving protocol
treatment including
skin to skin contact
Review limited
to healthy
newborns either
full term or late
preterm (3437weeks)
-receiving skin
to skin contact
within 24hrs
after birth
-either vaginal
or cesarean
section delivery
34 randomized control
trials containing 2177
mother-infant dyads
Control Group: n= 25
usual care (infant
mother separation)
Intervention: receiving
skin to skin contact
Control group:
receiving standard
hospital care
Infant outcomes:
-respiratory rate,
temperature, stress,
breastfeeding rates
Maternal outcomes:
-pain, anxiety
-Intervention infants
had significantly
lower mean
respiratory rates
(p<0.05), significantly
higher temperatures
(p>0.05), significantly
higher salivary
cortisol levels
(p>0.05)
-greater intervention
dyads initiated
breastfeeding than
control group
-others reported less
pain and anxiety
however it was not
statistically significant
Study covered many Early skin to skin
areas but for the
contact is associated
purposes of this table with increased
this author focused
incidence and length
on breastfeeding
of breastfeeding, more
rates, infant
effective infant
thermoregulation,
thermoregulation,
maternal-infant
increased maternal
bonding, postsensitivity to infant
cesarean section
cues, decreased
delivery maternal
reports of postoutcomes
operative maternal
pain, and strong
desires to repeat skin
to skin care.
Running Head: CESAREAN SKIN TO SKIN OUTCOMES
11
References
Beiranvand, S., Valizadeh, F., Hosseinabadi, R., & Pournia, Y. (2014). The effects of skin-toskin contact on temperature and breastfeeding successfulness in full-term newborns after
cesarean delivery. International Journal of Pediatrics, 2014, 846486.
doi:10.1155/2014/846486
Erlandsson, K., Dsilna, A., Fagerberg, I., & Christenson, K. (2007). Skin-to-skin care with the
father after cesarean birth and its effect on newborn crying and prefeeding behavior.
Birth: Issues in Perinatal Care, 34(2), 105-114. doi:
10.1111/j.1523-536X.2007.00162.x
Frederick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M., & Schneider, K. M. (2014).
Exploring the skin-to-skin contact experience during cesarean section. Journal of the
American Association of Nurse Practitioners. doi: 10.1002/2327-6924.12229
Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., & Di Giulio, P. (2010). Skinto-skin contact after cesarean delivery: An experimental study. Nursing Research, 59(2),
78-84. doi:10.1097/NNR.0b013e3181d1a8bc
Hung, K. J., & Berg, O. (2011). Early skin-to-skin after cesarean to improve breastfeeding. The
American Journal of Maternal/Child Nursing, 36(5), 318-324. doi:
10.1097/NMC.0b013e3182266314
CESAREAN SKIN TO SKIN OUTCOMES
12
Moore, E. R., Anderson, G. C., Bergman, N., Dowswell, T. (2012). Early skin-to-skin contact for
mothers and their healthy newborn infants (review). Cochrane Database of Systematic
Reviews, 5. doi: 10.1002/14651858.CD003519.pub3
Nolan, A., & Lawrence, C. (2009). A pilot study of a nursing intervention protocol to minimize
maternal-infant separation after cesarean birth. Journal of Obstetric, Gynecologic, &
Neonatal Nursing, 38(4), 430-442. doi: 10.1111/j.1552-6909.2009.01039.x
Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin‐to‐skin
contact after a caesarean section: A review of the literature. Maternal & Child Nutrition,
10(4), 456-473. doi:10.1111/mcn.12128
Sundin, C. S., & Mazac, L. B. (2015). Implementing skin-to-skin care in the operating room after
cesarean birth. The American Journal of Maternal/Child Nursing, 40(2), 249-255. doi:
10.1097/NMC.0000000000000142
U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed.).
Baltimore: Williams and Wilkins.
Velandia, M., Matthisen, A. S., Uvans-Moberg, K., & Nissen, E. (2010). Onset of vocal
interaction between parents and newborns in skin-to-skin contact immediately after
elective cesarean section. Birth: Issues in Perinatal Care, 37(3), 192-201. doi:
10.1111/j.1523-536X.2010.00406.x
CESAREAN SKIN TO SKIN OUTCOMES
Appendix A: U.S. Preventive Services Task Force. Levels of Evidence
I: Evidence obtained from at least one properly designed randomized,
controlled trial or meta‐analysis of randomized, controlled trials.
II‐1: Evidence obtained from well‐designed controlled trials without
randomization.
II‐2: Evidence obtained from II well‐designed cohort or case–control analytic
studies, preferably from more than one center or research group.
II‐3: Evidence from multiple time series with or without the intervention.
III: Opinions of respected authorities, based on clinical experience, descriptive
studies or reports of expert committees
U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed.).
Baltimore: Williams and Wilkins.
13