Colson S Does the mothers posture have a protective role to play during skin to skin contact?. Clinical Lactation. 2014; 5:(2)41-50

Conde-Agudelo A, Belizán JM, Diaz-Rossello J Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2011; 3

London: DH; 2009a

London: DH; 2009b

: HM Government; 2011

London: DH; 2012a

Department of Health. Helping people live healthier lives: the future for public health. 2012b. (accessed 1 December 2015)

Department of Health. 2013. (accessed 1 December 2015)

Ferber SG, Makhoul IR The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial. Pediatrics. 2004; 113:(4)858-65

Fleming PJ Unexpected collapse of apparently healthy newborn infants: the benefits and potential risks of skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed. 2012; 97:(1)F2-F3

Gregson S, Blacker J Kangaroo care in pre-term or low birth weight babies in a postnatal ward. British Journal of Midwifery. 2011; 19:(9)568-77

Health and Social Care Information Centre. NHS Maternity Statistics – England 2013–2014. 2015. (accessed 1 December 2015)

Hewitt V, Watts R, Robertson J, Haddow G Nursing and midwifery management of hypoglycaemia in healthy term neonates. Int J Evid Based Healthc. 2005; 3:(7)169-205

McAndrew F, Thompson J, Fellows L Infant Feeding Survey 2010.London: Health and Social Care Information Centre; 2012

Moore ER, Anderson GC, Bergman N, Dowswell T Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012; 5

National Institute for Health and Care Excellence. Caesarean section. 2011. (accessed 14 December 2015)

NHS England. Maternity and breastfeeding. 2015. (accessed 1 December 2015)

Overfield M, Ryan C, Spangler A, Tully RMorrisville, NC: ILCA Publicatons; 2005

Pejovic NJ, Herlenius E Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment. Acta Paediatr. 2013; 102:(7)680-8

Pérez-Ríos N, Ramos-Valencia G, Ortiz AP Cesarean delivery as a barrier for breastfeeding initiation: the Puerto Rican experience. J Hum Lact. 2008; 24:(3)293-302

Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012; 95:(5)1113-35

Renfrew MJ, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, Duffy S, Trueman P, Williams ALondon: UNICEF UK; 2012

Stevens J, Schmied V, Burns E, Dahlen H Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. Matern Child Nutr. 2014; 10:(4)456-73


Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, Trevisanuto D Elective cesarean delivery: does it have a negative effect on breastfeeding?. Birth. 2010; 37:(4)275-9

Zwedberg S, Blomquist J, Sigerstad E Midwives' experiences with mother-infant skin-to-skin contact after a caesarean section: ‘fighting an uphill battle’. Midwifery. 2015; 31:(1)215-20

Skin-to-skin contact after elective caesarean section: Investigating the effect on breastfeeding rates

02 January 2016
Volume 24 · Issue 1



To determine whether kangaroo care (skin-to-skin contact) between mother and baby in the operating theatre can affect breastfeeding outcomes following an elective caesarean section.


A randomised controlled trial recruited 366 women (182 in study group, 187 in control) having an elective caesarean section at term (≥37 completed weeks of pregnancy) who chose to breastfeed their baby at birth. Babies in the study group had immediate skin-to-skin contact in the operating theatre. The control group had standard care (skin-to-skin following the operation).


There was a 5% increase in breastfeeding rates at 48 hours (88% vs 83%) and 7% at 6 weeks (53% vs 46%); however, these differences were not statistically significant (P = 0.25 and 0.44). There was a significant correlation between the length of time for which skin-to-skin was performed and continuing to breastfeed at 48 hours (P = 0.04).


Skin-to-skin contact in the operating theatre following an elective caesarean section is a simple intervention associated with a trend towards an increase in breastfeeding rates at 48 hours and 6 weeks. There is a correlation between length of time for which skin-to-skin is performed during the first 24 hours and the continuation of breastfeeding at 48 hours (P = 0.04).

Numerous policy documents from the Department of Health (2009a; 2009b; 2011; 2012a; 2012b; 2013) recognise that breastfeeding is associated with overwhelming health benefits and large potential cost savings. It has been identified as a national priority and a key area of focus for the NHS and local partners. UNICEF UK published a report in 2012 stating that, if the number of babies in the UK receiving any breast milk at all rose by just 1%, this alone could potentially reduce 10 000 hospital admissions annually for babies owing to gastroenteritis and respiratory illness, and save approximately £40 million a year for the NHS (Renfrew et al, 2012). It also stated that this could potentially lead to a small increase in IQ which, across the entire population, could result in gains of more than £278 million in economic productivity annually.

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