Influence of early skin-to-skin contact after cesarean section on maternal psychological status and exclusive breastfeeding rate: a prospective randomized controlled study

Objective To investigate the influence of early skin-to-skin contact (SSC) after cesarean section on maternal psychological status and the rate of exclusive breastfeeding. Methods This was a prospective randomized controlled study enrolling 221 singleton pregnant women who underwent elected caesarean section at term in Shenzhen Nanshan Maternity and Child Healthcare Hospital from August 1 to December 31, 2017. They were randomly divided into SSC group and control group. In the SSC group, naked infants were placed on the mothers' chests within 1 h after delivery for 1-2 h, while those in the control group received standard care. Clinical outcomes were compared between two groups, including the rate of exclusive breastfeeding and score of Breastfeeding Self-Efficacy Scale (BSES) and Edinburgh Postnatal Depression Scale (EPDS) at 72 h and 42 d after delivery, scores of Breastfeeding Assessment Tool (BAT) for the first breastfeeding, time to lactogenesis and successful rate of first breastfeeding. Two-independent sample t test, Chi-square test and binary logistic regression analysis were used as statistical methods. Results Eventually, 210 puerperae were analyzed with 105 in each group. Twenty in the SSC group and 17 in the control group were lost to follow-up 42 d after delivery. The successful rate of first breastfeeding [77.1% (81/105) vs 59.1% (62/105), χ2=7.913, P=0.005], BAT scores (9.5±1.7 vs 8.6±1.4, t=4.115, P<0.001), the rate of lactation initiation ≤24 h after birth [41.0% (43/105) vs 12.4% (13/105), χ2=23.205, P<0.001], and exclusive breastfeeding rates [36.2% (38/105) vs 22.9% (24/105), χ2=4.486, P=0.034; 76.5% (65/85) vs 60.2% (63/88), χ2=5.261, P =0.022] and BESE scores (117.5±12.0 vs 111.8±22.3, t=2.100, P=0.037; 124.3±11.6 vs 113.1±19.0, t=4.710, P<0.001) at 72 h and 42 d after delivery were all higher in the SSC group than those in the control group. However, no statistically significant difference in EPDS scores was observed between the two groups at either 72 h or 42 d after delivery (5.4±3.5 vs 5.9±4.0, t=0.937, P=0.350; 7.0±3.7 vs 8.1±4.0, t=0.905, P=0.058). Binary logistic regression analysis showed early SSC was a protective factor for successful exclusive breastfeeding 42 d after delivery (OR=2.359, 95%CI: 1.173-4.743, P=0.016). Conclusions Early SSC after caesarean should be recommended as a usual clinical practice because it can improve maternal confidence on breastfeeding, shorten the time to lactogenesis and increase the successful rate of first breastfeeding and exclusive breastfeeding rate during puerperium. Key words: Breast feeding; Postpartum period; Self efficacy; Self-assessment; Assertiveness; Randomized controlled trial