skin-to-skin contact

 Skin-to-skin contact (SSC) plays a significant role in the initiation and continuation of breastfeeding and maintaining and improving the health of infants. The goal of this research was to study the start time and duration of SSC in the labor rooms or operating rooms of the hospitals in Khorasan Razavi province.

 This descriptive study has been done on 714 newborn babies in labor rooms and ORs of governmental hospitals in Khorasan Razavi province from 1399 to 1401 through convenience sampling method. A midwife who did not have any role in the delivery process kept a record of the time of the SSC and its duration after the delivery. In the next stage, probable reasons for not having SSC, the connection of the start time of SSC and its duration with the start time and duration of breastfeeding were studied.

Based on the results of the study, 65% of the cases had SSC after the delivery in labor rooms under study . The mean start time of the SSC was 5.06±12.30 minutes, and the mean duration of the SSC after the birth was 9.28±13.66 minutes. Non-cooperation of the mother (61.38%), the fear of non-sterile environment (8.62%) and hastening the delivery process by the professionals involved (3.79%) were the most common reasons for not having SSC.

  In 35% of cases, there was no SSC after birth. Starting the contact early after birth can increase the success rate of breastfeeding.

One crucial step in implementing the child-friendly protocol in hospitals is to monitor the current situation regarding skin-to-skin contact between mother and baby and initiating breastfeeding within the first hour of birth. The present study was conducted with the aim of investigating the level of skin-to-skin contact and breastfeeding within the initial hour postnatal and its associated factors

The present study was a cross-sectional study which was done in the winter of 2022 in Ayatollah Mousavi Hospital of Zanjan city. The sample size included 385 mothers who gave birth admitted to the Postpartum care unit of the Hospital, who were selected by simple random method. The data were collected by using the registering form of the demographic characteristics of the mother, the characteristics of the baby, the mother's pregnancy and delivery, and data related to the state of skin contact between the mother and the baby and the start of feeding in the first hour after the childbirth, through interviews with the mother, and with using SPSS software version 21 and descriptive statistics indicators, chi-square test and conditional logistic regression model were analyzed with a confidence level of 95%.

The study's findings revealed that approximately 53% of infants experienced skin-to-skin contact with their mothers. Within the initial hour post-delivery, 89% of infants were breastfed. According to the results of the logistic regression model, the variable of delivery method had a significant relationship with the state of mother-baby skin contact and the variable of residence with breastfeeding in the first hour after childbirth. So that in mothers living in the city, the chance of breastfeeding in the first hour after birth was 2.5 times higher (p=0.016) and the chance of skin-to-skin contact between mother and baby in cesarean section was 8% lower than natural delivery (p=0.001).

The results of the present study show that the skin contact between mother and baby was relatively good and breastfeeding was good. Considering the relationship between skin contact between mother and baby and delivery method, it is suggested to plan suitable interventions to increase skin contact coverage and breastfeeding in the first hour after childbirth, especially in cesarean deliveries.

The "golden hour" concept is a new evolving strategy for better prognosis of preterm and term infants, and all health care providers should be informed about the components and importance of the golden hour approach. The present study was performed with aim to investigate the percentage and sequence of primary care measures for newborns in the delivery or operating rooms in Khorasan Razavi hospitals.

This descriptive study was conducted in 2021-2022 on 1286 babies born in the maternity ward and operating room in Khorasan Razavi public hospitals. The percentage and sequence of taking care of newborns were investigated immediately after birth. Data were analyzed by SPSS software (version 26) and Statistical indices. P< 0.05 was considered statistically significant.

Drying and warming in 98%, making skin to skin contact of the baby with the mother's breast in 65%, positioning in 61%, emptying mouth secretions and stimulating the baby in 41%, putting on a hat in 61%, controlling the number Breathing in 48%, heart rate in 38% and temperature check in 25% were done among babies. The summary of the order of care measures performed for newborns was: tying the umbilical cord, starting skin-to-skin contact, drying, warming, stimulating, emptying mouth secretions, putting on a hat, determination of first minute Apgar, weight control, height control, head circumference control, determination of fifth minute Apgar, first respiratory rate control, first pulse rate control, first breastfeeding, body temperature control, foot impressions, vitamin K injection, diapering, and transfer to obstetrics department.

In maternity wards and operating room of Khorasan Razavi public hospitals, essential measures such as vital signs are evaluated in less than half of the babies, and the order of care is not appropriate. Therefore, the modification and training of the neonates' care worker needs a serious revision and it is necessary for the health care workers to review the care and order of their performance.

Making skin-to-skin contact between mother and baby immediately after birth and starting breastfeeding within the first hour of birth is the fourth step of the ten steps of the Baby-Friendly Hospital Initiative (BFHI). However, this step is still not properly done in Iran. This study was designed with the aim of analyzing the factors preventing skin-to-skin contact in the first hour of life in healthy term infants.

This research is a qualitative study with a content analysis approach.Data were collected by in-depth and semi-structural interviews using open-ended questions. Sampling was done in a purpose-based manner and continued until data saturation was reached. In total, we interviewed 27 experts, managers, and personnel of maternity service providers.

A total of 824 codes were extracted from the interviews, which were compared based on content affinity and then organized into 7 themes, 19 categories, and 75 subcategories. After qualitative data analysis, the themes were compared based on the four components of Walt and Gilson's policy triangle in four categories of creators, content, background, and process and included in them. We categorized instruction challenges as part of the content barriers within the topic, deficiencies of knowledge and awareness, skills, and the nature of the platform for conducting the contact process as part of the process barriers two topics, the challenge of supervision and monitoring at all levels of the system as well as the effective environmental components in the implementation of the contact program as part of the structural obstacles two topics, and finally the topic of the effective actors including the beneficiaries and their subordinates as part of obstacles related to the actors.

Maternity ward staff face serious obstacles to skin-to-skin contact in the first hour of birth, especially in receiving continuous and sufficient training, having the necessary motivation and support from managers, and establishing modern supervision and reward system for optimal skin-to-skin contact in the first hour of birth.

reast milk is the best food and the most valuable gift that any mother can give to her infant. After breastfeeding, 19 digestive hormones are released in the mother and neonate. Some of these hormones stimulate the growth of intestinal villi and cause more nutrients to be absorbed. Exclusive breastfeeding is the best nutrition for infants up to 6 months of age, in addition to providing physical and biological needs, it completes the psychological needs of infants and also mothers. This has been one of the most important recommendations of the World Health Organization and UNICEF in recent years. In recent years, malnutrition, respiratory infections and diarrhea have been the leading causes of child mortality. In this regard, there are reports that breastfeeding significantly reduces the incidence of these diseases. Exclusive breastfeeding in addition to the beneficial effects on the infant and mother, has obvious economic effects on family and society, due to lack of consumption of formula. Also, among the intervention programs that have been carried out in order to continue breastfeeding in developing countries, few studies have used an appropriate theoretical framework for breastfeeding continuity, therefore, in order to increase the effectiveness of educational programs, by understanding the mechanism responsible for change, it is necessary to design and evaluate interventions focusing on the mediating psychological variables. Success in breastfeeding requires several steps: Sufficient awareness - Comprehensive support for the mother - Acquiring the necessary skills.Education of benefits of breastfeeding should begin in the second half of pregnancy and continue immediately after delivery with the help and training of how to properly place the neonate on the motherchr('39')s breast and support the mother. In recent years, many studies have been conducted on the effect of skin-to-skin contact in premature neonates and significant results have been obtained. advantages of skin-to-skin contact between mother and infant include: Improving infantchr('39')s weight gain, improving infantchr('39')s sleep quality, reducing motherchr('39')s stress and anxiety, reducing infantchr('39')s crying rates, improving brain development, increasing maternal confidence in the ability of taking care of infant and reducing postpartum depression symptoms in mother. Considering the numerous benefits of skin-to-skin contact between mother and infant and the failure to find a study that examined the relationship between teaching this type of contact with exclusive breastfeeding in healthy non- hospitalized term neonate, this study aimed to investigate the effect of skin-to-skin contact education to mothers on rate of exclusive breastfeeding in the first two months of life.

This study is a randomized clinical trial. The study population included mothers with 3 to 5-day-old neonate and referred them for receiving usual care to Valfajr Clinic in West Tehran Health Center (University Center affiliated to Iran University of Medical Sciences) in the year 2019.Inclusion criteria: term infant born NVD or cesarean section whose mother wanted to participate in the study and collaborate, she was literate, and did not have any contraindication for breastfeeding. These mothers should breastfeed infants often until day 3 to 5. Data collection tools included demographic and midwifery information form and postpartum information form and breastfeeding nutrition evaluation and 12 Question of Quality of Life Questionnaire, the shortened form of Quality of Life Questionnaire is 36 questions that are widely used in various studies. Eligible mothers were taught in a session how to breastfeed properly, and it was recommended that they should exclusively be breastfed for two months. The source of the education was a "Maternal Guide for Breastfeeding" developed by UNICEF and the Ministry of Health. After a half-hour education session on how to properly breastfeed for all participating in the study, the intervention group was trained about the benefits and methods of doing skin-to-skin contact for at least 60 minutes a day and was recommended to do it after ending breastfeeding at 21-26°C. The procedure was that the mother should place her naked infant (only with a diaper cover) between her two bare breasts. The intervention group additionally was trained how to complete the forms, how to complete the daily skin-to-skin contact form was also added to the motherschr('39') training, so that mothers should have registered daily skin-to-skin contact time, daily sleep and a crying period during these two months. The control group included mothers who was not receive any training on the benefits of skin-to-skin contact, but were taught how to breastfeed properly, and was appointed to check their infantchr('39')s daily sleep and crying for two months and register at the checklist. At the end of the training session, both groups completed the demographic and midwifery information forms, the postpartum information form and the breastfeeding nutrition evaluation form, and a 12-question questionnaire on the quality of life. Mothers randomly entered the study to reach the required number of samples.Two months after the first visit, when the mother and infant were referred to receive usual care in both groups, weight, height, and head circumference were measured and recorded, Completed forms were collected and a questionnaire of 12 Questions on Quality of Life and 24-hours nutrition reminder form were filled out by the researcher with a question from the mother to evaluate the amount of exclusive breastfeeding.Data were analyzed by SPSS 18th edition software. Exclusive breastfeeding amount, height, head circumference, infant sleep and crying, and maternal quality of life scores at baseline and two months later were compared. The main variable, which was exclusive breastfeeding, was evaluated by questioning (self-declaration) and completing a checklist. The significance level for all tests on this study was 0.05 and 95% confidence interval was considered.

The study included 250 mothers and their infants. Demographic information was compared between the two groups. The results showed that there were no significant differences between the two groups in terms of motherchr('39')s age, education, employment, underlying disease, maternity and quality of life scores of the mother, education of the father, sex of the neonate, weight, height and head circumference of the neonate at the birth time.After the conducted training at the beginning of the study, exclusive breastfeeding in the intervention group was significantly higher than the control group (p=0.0001). Study on the variables of infant crying and sleeping showed that these variables had a significant change in skin-to-skin contact group so that the amount of crying decreased (p=0.018) and the amount of sleep increased (p=0.025). Furthermore, the mean score of maternal quality of life in the intervention group was significantly higher than the control group (p=0.013). The variables of weight, height and head circumference of the infant after two months were not significantly different between the two groups.

Education of skin-to-skin contact to mothers and doing it during the first two months of life by them has a significant effect on increasing exclusive breastfeeding, improving the quality of life of mothers scores, increasing sleep and reducing the infants crying rates in the first two months of life. The results of this clinical trial support health policies that recommend facilitating breastfeeding as soon as possible after birth, while recommending persistent skin-to-skin contact after birth and during the first two months of life. Skin-to-skin contact has protected infants against a wide range of negative outcomes. This safe and cost-effective intervention can prevent many of the complications associated with preterm delivery and can also bring benefits to term neonates

The kangaroo care method in newborn is a way of protecting the baby through skin to skin contact between newborn and their parents. This review study was done by using the keywords including kangaroo mothre care, neonatal, skin to skin contact and preterm. All related articles were published in Pubmed, Sience direct, Google scholar, SID, and Magiran were studied during 2000 to 2016. Finally, 36 articles were reviewed which were similar according to objectives, method of work, sample size, analysis method, and conclusion. Reviewing the selected articles showed that skin to skin contact among newborn and their parents regulated the body temperature of the neonate, increased the newborn's immune system, reduced infection and mortality rate, regulated heart and respiratory rate, increased the growth and weight gain in low birth weight neonates, reduced the stress and crying, increased prolong and stable periods of sleep, and also creates an emotional bond between the parents and the neonates. Kangaroo care method not only helps to care for the early stages of growth of premature neonate, but also increases the general health of the newborn and mother. This care can be used as an inexpensive and highly beneficial method for neonate's growth and health in human.

Skin to skin contact in the first hours after birth, the mother and the baby is ready to establish a harmonized model for bilateral interaction. Few studies have been undertaken Kangaroo contact for term infants and assessing mother behaviors after birth. The aim of this study was to compare of mother and newborns abdominal skin to skin and Kangaroo skin contact on mothers attachment behaviors.
This single-blind clinical trial was accomplished on 68 qualified pregnant women, in Torbat Heydariyeh in 1394.women were randomly divided into two groups Experimental(Kangaroo skin contact)and control(abdominal skin contact).The attachment behaviors were been recorded at the first hour of visit of mother and infant for 15 minutes. Every minute divided into two 30 second that researcher observed the behaviors of mother in the first 30 second and recorded behaviors in 30 second during 15 minutes. After encoding the data, were analyzed with SPSS software version 20, Mann-Whitney tests, t, chi-square and kruskalwallis.0/05>p was considered significant.
Among emotional, proximity and caring behaviors for one hour after delivery in both groups, only proximity behaviors were significantly different (p=0.049).Two groups had not significant difference in mothers attachment behaviors in the first hours (p=0.134) after delivery.
The effect of Kangaroo skin contact on maternal attachment behaviors was similar to abdominal skin contact and in the comparison of abdominal skin contact had positive effects on proximity behavior.

Breast Crawl is initiating breastfeeding and evidence based method. Followed by numerous studies on breast-feeding, and mother and child heath, BC was discussed for which a protocol was presented. There are few studies on BC method. For the first time in Iran, we performed this method in Alzahra hospital of Tabriz where we came across an interesting case. The report is about a term infant who was put on the mother's abdomen to find the mother’s breast. The infant was stuck to the mother’s skin due to abundant Vernix and could not move despite her attempts. This lengthens the expected time for BC method, but in the end, the infant managed to reach the mother’s breast and started sucking on her breast without any help. There are various causes that might prolong BC implementation time or even prevent you from doing it. This case mentions to a problem that never listed in breast crawl guideline and may be selected as a hindering factor for breast crawl in future.

Skin to skin continuous contact between mother and neonate، induced by the first breastfeeding، is the fourth of the ten steps for successful breastfeeding during one to two hour of birth that lead to express early breastfeeding behaviors. The present study aimed to evaluate the effect of two methods of crawl and routine breastfeeding on behavior of breastfeeding during two hours after delivery. In this randomized clinical trial (RCT)، 60 women with term and singleton pregnancy and without episiotomy in temperature of birth room (23-25 C) were enrolled in Imam Ali hospital، Zahedan، Iran، during 2009-2011. Participants were selected by purposive sampling and were randomly divided in two groups of crawl and routine breastfeeding. In crawl group، the neonate immediately after birth (before all of interventions) lied on mother''s skin between breasts and abdomen for 60 minutes to start breast crawl without helping. In routine group، the neonate only lied on mother''s skin between breasts and abdomen for 15 minutes. Then، in both groups the neonate was wrapped and closed to mother to be breastfed under the nurse supervision. During this time، 6 items of expository early movement and 4 items of successful breastfeeding behavior were evaluated using infant breastfeeding assessment tool (IBFAT) scale; mother''s satisfaction of skin contact with neonate was recorded according to numeric scale (0-5). 4 successful breastfeeding behavior items (P < 0. 001)، and four expository early movement items (P < 0. 001) were significantly better in crawl group. Skin sense satisfaction was significantly higher in crawl (4. 37 ± 0. 62) versus routine (1. 93 ± 0. 85) group. According to our findings، crawl method was more effective in promoting breastfeeding behavior during two hours after delivery. Regarding young mothers'' satisfaction، this method can be recommended to promote successful breastfeeding.

Infants are more sensitive than adults in pain staining due to disformation of descending control system. Since, non-pharmacological methods are recommended for infants’ pain control, this study aimed to determine combined effect of breastfeeding and maternal-infant skin to skin contact on pain of first injection in healthy term infants.

This clinical trial study was conducted on case and control groups in delivery room of Alavi Hospital for a period of 8 months in 1389.200 infants were randomly selected and divided in four groups; group1: Control, group2: breast-feeding, Group 3: skin to skin contact of mother and infant, and group4: breast-feeding and skin to skin contact of mother and infants. Researchers observed all the DAN scale factors and completed observation paper from the moment of injection until 45 seconds later. Data were analyzed by chi- sq square and t test using SPSS software.

Average pain severity was 5.34 for group 1, 3.70 for group 2, 4.16 for group 3, and 3.48 for group 4, based on DAN scale criteria. Statistically significant difference was observed between group 1(no intervention) and group 4 (breastfeeding with skin to skin contact) (p=0.04).

Since pain severity is decreased during breastfeeding and maternal- infants skin to skin contact, these two methods may be used to prevent mental and emotional consequences of intramuscular injection pain.

kangaroo mother care (kmc)was first suggested in 1978 by Dr.edgar ray in bogota, Colombia. It was developed initially as caring for low birth weight infants. few studies have reported the use of kmc with term infants and mothers behavior attachment. In a recent reviews, it was concluded that kmc after birth has a positive effect on long term breast feeding, infants deep sleep, and development of cognitive behavior. But there is a few research about effecting on mothers attachment behavior. We planned this study, that analyzed the effect kangaroo mother care immediately after birth on attachment behavior in primipara mothers With their term new born. This is a clinical random trial that was carried out in one of the training of Tehran hospitals. Samples were selected by non randomization method that was calculated as 90 primpara mothers. Women were assigned in allocated randomization in two groups, case and control by blocks A and B. Between Two groups there weren’t any difference by age, newborn weight, wanted pregnancy, education, time of labor. For the case group, the child was brought to mother immediately after the birth and let it be held for 15-20 minute in bare contact with skin of her/his mother. mother was offered touch her newborn and newborn sucked each breast for 5 minutes. But in control group, the hospitals routine procedure was done. After that, In home visit during 1 and 3 month, Researcher observed and registered mothers behaviors by using the mothers attachment behavior checklist during the first lactation session in continous periods for 15 minutes. The data were collected by spss soft ware and analyzed by descriptive (mean, SD, percent) and deductive (student-t,X2)statistics. Data showed that total mean attachment behaviour wsa significant(p=0.000). there were significant difference in affectionate behaviour in fondling(p=0.004),talking(p=0.001),smiling(p=0.001),cradle movement(p=0.001), Also total mean proximity behaviour after one month childbirth was significant between two groups(p=0.001),After 3 month of child birth the most affectionate behaviour was looking at infant(p=0.003), further more fondling(p=0.001),kissing(p=0.01), smiling(p=0.001), cradle movement(p=0.001) were significant. Proximity behaviour after 3 month showed the most behaviour is cuddling (p=0.03),carry in arms(p=0.04). also attachment behaviuor after 3 month was significant(p=0.001), The result showed that there is difference between affectionate (looking P<01) and talking(p<0.02) and proximity behaviors close contact with mother and total attachment behaviors of mothers in case and (P=0.006) control groups (P<0.05).However, regarding care taking behavior, this difference was not significant. Therefore, it could be said that, kangaroo method is effective method in mother attachment behavior in long time period and this is better that is done at early hours post partum period. Midwives who are the first care giver for mother and newborn, be sensitive and implement it longer after birth.