Skin-to-skin contact following caesarean section: a narrative review
Skin-to-skin contact (SSC) is commonly performed after normal vaginal delivery and there is an increased demand by mothers to perform SSC after caesarean section (CS). However, there are still many obstacles that inhibit the initiation of SSC after CS, especially the risk of neonatal hypothermia. Although the evidence suggests that SSC promotes neonatal normothermia, this evidence is based on studies after vaginal birth and not after CS. Current literature suggests that both mothers and newborns may become hypothermic during or after a CS in the absence of active preventative measures. Suboptimal neonatal and maternal temperatures could have adverse physiological effects in both newborns and mothers. This narrative review predominantly focuses on the available evidence for SSC after CS. It also synopsises the adverse effects of hypothermia in neonates and mothers, and explains the physiology of peripartum thermoregulation, the mechanisms of heat loss and their prevention.
Skin-to-skin contact (SSC), the deliberate placement of an infant on the bare chest of its mother, is commonly performed after normal vaginal delivery because of its numerous benefits (Moore et al, 2016). In contrast to the well-established evidence base after normal delivery, there is a paucity of high-quality clinical evidence for SSC after caesarean section (CS).
Despite the lack of evidence, the global prevalence of CS is elevated in developed countries, while the demand by mothers for SSC after CS has also increased as they strive to enhance their birth experience similar to a normal delivery (Phillips, 2013). The impetus to introduce SSC in mothers following CS is a consequence of a steadily increasing CS rate, especially in developed countries, with some areas of the USA and Ireland reporting a CS prevalence of 35% (Mangan et al, 2012). According to the NHS (2019), the CS rate in the UK for 2019 was 28%. The number of women performing SSC at birth following CS in UK and Ireland is not available. This number in USA facilities varies between 24–83% (Centers for Disease Control and Prevention, 2018), suggesting a cohort of women and infants are not receiving the potential benefits associated with performing SSC at birth during CS.
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