Authors

1 Gloria Navalón Catalá, 1 Amparo Ballester Llopis, 2 Ada Belda Pérez

Position

1 Matrona. Hospital La Ribera (Alzira-Valencia). 2 Residente de Matrona Hospital La Ribera (Alzira). Unidad Docente de la Comunidad Valencia.

Contact email: glonaca88@gmail.com

Abstract

Introduction: the guidelines “Intrapartum Care: care of healthy women and their babies during childbirth”, by the Spanish Ministry of Health and Consume and the "Guidelines for an strategy for a normal childbirth" in the autonomous region Valencian Community, among other consensus papers conclude that skin to skin contact provides a benefit to star and maintain breastfeeding. This is recommended to be initiated immediately after childbirth (vaginal birth or C-section).
In January 2014, Hospital de la Ribera (Alzira, Valencia, Spain), started an immediate postpartum contact after C-section in the delivery suite, allowing skin to skin contact with the mother as soon as possible after leaving the operating room and starting breastfeeding in the first hour of life. Before 2014, after C-section women were in the surgical recovery room and could not be in contact with the newborn until being discharged to the maternity ward.
Purpose: to value the favorable impact on the initiation and maintenance of breastfeeding after discharge in women having an immediate postpartum contact in the delivery suite after C-section, compared to those having the contact in the surgical recovery room.
Methods: a retrospective observational cohort study including all pregnant (> 34 weeks) women wishing to initiate breastfeeding and having a C-section.
Data from computerized medical records were collected and classified into two groups: C-sections performed from January 2012 to June 2013 (immediate postpartum contact in the surgical recovery room) and C-sections performed from January 2014 to June 2015 (immediate postpartum contact in the delivery suite).
Results: the overall sample included 809 C-sections, 433 belonging to the first period and 376 from the second period. Prior to the protocol implementation, breastfeeding rate after discharge was 72%. After protocol implementation, 77% of women performed a skin con skin contact in the delivery room and 68% started breastfeeding in the first two hours.
At discharge, 85% of women maintained breastfeeding, with withdrawal rate being 10% and mixed feeding rate being 5%.

Discussion: statistical analysis showed a statistically significant associations of skin to skin contact in the first hours with the initiation of breastfeeding. On the other hand no statistically significant association was observed between skin to skin contact and breastfeeding after discharge. However, a substantially increased breastfeeding after discharge was observed. Finally, a decreased rate of breastfeeding discontinuation was observed after the protocol implementation.
Conclusions: following the current evidence-based recommendations regarding the importance of skin to skin contact in the first two hours of life in order to successfully initiate breastfeeding, a protocol for immediate contact after planned/urgent low-risk C-section was started in our hospital. Immediate contact after C-section in delivery suite and initiation of skin to skin contact in the first hours provided a benefit regarding initiation and maintenance of breastfeeding at hospital discharge.
Moreover, both women and their partners have reported satisfaction with the link developed through immediate contact after C-section, particularly in those women having had a previous C-section.

Keywords:

skin to skin contact; C-section; puerperium; breastfeeding

Versión en Español

Título:

La cesárea, nunca un impedimento

Bibliography