Skin to skin contact and breastfeeding rate

Formulation and theoretical positions. Consequence of the first two hours after birth skin-to-skin contact for full term babies on first suckling experience and suckling continuance: A randomized controlled test


It is undisputed that breastfeeding is the most important signifier of supplying nutrition for babies. Exclusive breastfeeding for at least the first six month of life, with continued suckling for up to two old ages or longer is extremely recommended by World Health Organization ( World Health Organization, 2000 ) . In add-on, The American Academy of Paediatrics ( 1997 ) stats “ Exclusive breastfeeding is ideal nutrition and sufficient to back up optimum growing and development for the first six months after birthaˆ¦It is recommended that suckling continue for at least 12 months, and thenceforth for every bit long as reciprocally desired ” . Harmonizing to The American Academy of Paediatrics ( 1997 ) described the benefits of suckling including improved general wellness, growing, and development of the breastfed baby ; decreased incidence and badness of diarrhea, lower respiratory infections, ear infections, bacterial meningitis, botulism, and urinary piece of land infections ; protection from sudden baby decease syndrome, childhood malignant neoplastic disease, insulin dependant diabetes mellitus, Crohn ‘s disease, ulcerative inflammatory bowel disease, allergic reactions, and other chronic digestive diseases ; and enhanced cognitive development.

To compare with other Europe states, suckling rates in the UK are low ( UNICEF, 1999 ) . In 2005, 45 % of all female parents in the United Kingdom were suckling entirely at one hebdomad, while 21 % were feeding entirely at six hebdomads. At six months the proportion of female parents who were suckling entirely was negligible ( & lt ; 1 % ) ( Infant Feeding Survey 2005, 2007 ) .

The Baby Friendly Initiative was introduced in the UK in 1992 by the WHO and UNICEF. The intent of the programme is to promote infirmaries to increase protection, publicity and support breastfeeding and implement the Ten Steps to Successful Breastfeeding ( UNICEF 1998 ) . Step four recommends skin-to-skin contact ( SSC ) in the early postpartum period, which should last until the first provender or for every bit long as the female parent wants ( UNICEF, 1998 ) .

The procedure of skin-to-skin contact was defined as “ the baby is naked in a prone place and skin-to-skin on the female parent ‘s au naturel venters or thorax during the first minute postbirth. Apgar tonss are assigned and suctioning is done if medically indicated. The baby must be gently dried and covered across the dorsum with a prewarmed cover. The initial physical appraisal is performed while the baby is with the female parent skin-to-skin. To forestall heat loss, the baby ‘s caput must be covered with a dry cap, which is replaced when it becomes moist. Ideally, all other intercessions are delayed until at least after the terminal of the first breastfeeding ” ( Moore & A ; Anderson, 2007 ) .

The optimum clip for newborn babes to develop pre-breastfeeding behavior, such as rooting and suction ( Gomez, et al. , 1998 ) , skin-to-skin contact and supply first breastfeeding is the first two hours postbirth when they are more watchful to the environment. In this phase, it may bespeak a “ sensitive period ” for set up effectual breastfeeding. Bornstein ( 1989 ) defines sensitive period as “ a developmental stage of constitutional competency for the development of specific behavior exchanges between the being and the environment whose effects presumptively endure for the being. ” After this sensitive period, the two hours postbirth, many newborn babes go into a drowsy phase which possibly hard to elicit for up to several hours ( Britton, 1998 ) .

Purpose of the research

Previous surveies found that babies were eight times more likely to suckle spontaneously if they spent more than 50 proceedingss in skin-to-skin contact with their female parents instantly after birth, and concluded that the dosage of skin-to-skin contact might be a critical constituent sing suckling success ( Gomez. et al. , 1998 ) . Despite legion paperss and randomized control tests have showed the positive impact of skin-to-skin contact on breastfeeding, mother-infant separation by physical appraisal and everyday attention during the first hours postbirth before holding the chance to get down skin-to-skin contact and breastfeeding is still common pattern in many healthcare scenes.

In visible radiation of the above, the purpose of the survey is to analyze the effects of skin-to-skin contact for full-term newborn babes during the first two hours postbirth on first suckling experience and sole breastfeeding rate in six months postbirth. Two hypotheses will be tested: ( 1 ) skin-to-skin contact during the first two hours postbirth has positive impact on first suckling experience ; ( 2 ) skin-to-skin contact during the first two hours postbirth increases the likeliness of suckling constitution ; ( 3 ) skin-to-skin contact during the first two hours postbirth additions both suckling constitution and continuance.

2. Methods to be used

The subject was “ skin-to-skin contact and breastfeeding rate ” and the methodological analysis selected was quantitative. This is because suckling rate is to be measured exactly so as to let comparings between the assorted groups. And for comparative representativeness and for generalizations made quantitative research a better pick.

The survey will be conducted by randomised controlled test comparing the effects of SSC with everyday attention on first suckling experience and breastfeeding continuance.

In the control group which having modus operandi attention, babes will rapidly dried and wrapped in a towel before being handed to their female parent or male parent. Mother-baby contact will be interrupted for physical appraisal, given a vitamin K injection, weighing, dressing and mensurating the babe, or for mending the female parent ‘s perineum lesion. After the everyday attention coating, the babe will be swaddled in prewarmed covers and return to the female parent. And the staff nurse will help with chest eating when both female parent and babe are ready. In the skin-to-skin attention group, the babies will be given to their female parents instantly after birth and will be placed nakedly in a prone place against the female parent ‘s tegument between the chests with a big pre-warmed cover. After the cord cut, the baby will be moved to radiant heater for the same everyday attention as the control group so back to their female parent once more for approximately 2 hours. And when both female parent and babe in skin-to-skin group are ready, the staff nurse besides will help with chest eating.

2.1 Sampling rules and processs

Standards for including/excluding survey participants

Eligible participants included pregnant adult female who are primiparas female parents, had no preexistent medical complications and no history of mental unwellness or illicit drug usage, 18 old ages or older, anticipating a vaginal bringing, intended to breast provender, her healthy foetus demand to greater than 37 hebdomads ‘ gestation. A adult female will be ineligible if their babes weighted less than 2200gm, & lt ; 37 hebdomads ‘ gestation, have a 5-minutes Apgar mark & lt ; 7 or hold medical complications at birth that against skin-to-skin contact or female parents who require either skin-to-skin contact or no skin-to-skin contact after bringing, or had a multiple gestation.

Sample size

In Shiau ‘s survey ( 1997 ) , skin-to-skin contact couples had better suckling position than control couples on twenty-four hours 28 ( 6.16 A± 2.06 vs. 4.0 A± 1.60, P= .004 ) . This computes to an consequence size of 1.17. And in Moore ‘s survey ( 2007 ) , the writer used the informations to calculate power in her survey for the samples were similar in their research. Moore ( 2007 ) indicated if the true consequence size is 1.17, the chance of observing important differences between the two groups is 81 % ( i.e. , 19 % of the clip important differences would non be detected ) . Therefore, 10 participants per group may be equal to observe statistically important between-group differences in suckling position and Moore besides used minimisation to command the influence of the variables, she explained that in little surveies, simple randomisation processs are

probably to ensue in groups that are imbalanced with regard to potentially confusing variables.

For the above ground, in this research, a sample of 10 participants per group will be appropriate but to avoid possible abrasion during the clip, 15 participants will be recruited.


The participants will be recruited through a infirmary in Manchester with the aid of clinical nurse and pregnancy advisers. Womans who fulfill the inclusion standards will be contacted by the clinical coordinator at 36-37 hebdomad ‘s gestation. The adult females will provided with unwritten account about the test, eligible participants will be recruited

and informed consent will be obtained. After birth, female parents and their newborn babes who still remained eligible will be randomized utilizing minimisation to either skin-to-skin group or control group.

2.2 Data aggregation methods

Minimization is an assignment scheme, similar in purpose to stratification that ensures first-class balance between intercession groups for specified predictive factors. The following participant is assigned to whichever group would minimise the instability between groups on specified predictive factors. Minimization is an acceptable option to random assignment ( CONSORT, 2007 ) . The minimisation plan will be applied to command the undermentioned variables: babe gender, birth weight, and gestational age, maternal age, instruction, matrimonial position, race, smoking history, suckling purpose and maternal employment ( no, parttime, or full-time employment ) .

When participants admit to the infirmary in active labor, the clinical co-ordinator will be contacted for information assemblage. And when all the information obtained, the computerized minimisation programme will delegate indiscriminately either to skin-to-skin group or control group. Demographic, labor and bringing history informations ( past and current gestations ) from the records will be collected by the clinical co-ordinator. Post-delivery information aggregation will be carried out through contact with the female parents before they left infirmary.

Post-delivery attention will be observed by the research helper every bit good as appraisal of first breastfeeding in the bringing room. The baby ‘s first breastfeeding will be score by the research helper by utilizing the IBFAT. The IBFAT measures 4 facet of suckling competency: ( 1 ) baby province of rousing or preparedness to feed ; ( 2 ) rooting physiological reaction ; ( 3 ) latch-on ; and ( 4 ) Suckling form. Each point has a mark of 0 to 3 for a maximal mark of 12, bespeaking “ competent ” breastfeeding. Success of the first breastfeeding ( mark of 10 to 12 ) will be measured by this tool. The IBS, which assesses the grade of suckling exclusivity ; The IBS is a single-item index consisting of three major degrees of breastfeeding: full, partial, and item. Eight degrees are ranked from 1 for sole to 8 for weaned. Full is divided into two subcategories: sole ( the baby consumes merely breast milk and no other liquid or solid nutrient [ score=1 ] ) , and about sole ( the baby is given H2O, juice, vitamins, and minerals infrequently in add-on to breast milk [ score= 2 ] ) . The partial class, which originally had two subcategories, was subdivided into four subcategories for greater truth: high-partial ( & gt ; 80 % of the baby ‘s diet is breast milk [ score= 3 ] ) ; medium-high ( 50 % – 80 % chest milk [ mark = 4 ] ) ; medium-low ( 20 % – & lt ; 50 % chest milk [ mark = 5 ] ) ; and low ( & lt ; 20 % chest milk [ mark = 6 ] ) . In nominal breastfeeding, the chest is used chiefly as a beginning of comfort for the baby, and breastfeeding is occasional and irregular, at & lt ; 15 proceedingss a twenty-four hours ( mark = 7 ) . The baby is considered weaned when no longer having any chest milk ( score = 8 ) .

Follow-up appraisal will be take topographic point when babies reached 1, 3, and 6 months corrected age. The research helper will reach to the female parent in progress so arrange the visit.

3. Datas analysis

There will be six phases in information analysis. Phase 1: informations readying. Checking, redacting and coding. Phase 2: informations entry. Entering the information in the computing machine. Phase 3: Graphic presentation. Showing the findings in the signifier of graphs or tabular arraies. Phase 4: information processing and analysis. Conducting statistical analysis. Phase 5: reading of the findings. Explaining the significance of informations separately. Phase 6: six- Conclusion. Proposing direct replies to the research inquiry ( Saratakos, 2005, p.364 ) .

A t-test is an interval/ration trial of significance which has the intent of determining whether or non the findings of a sample-based survey are important, that is besides valid for the mark population. It checks the grade if generalisability of the findings of the survey. the t-test serves the same intent as chi-square trials, except that it is suited for interval/ration variables ( Saratakos, 2005, p.388 )

Analysis in this research will follow the purpose to handle rule. SPSS computing machine package ( version 15 ) will be used for informations analysis. Differences between groups in demographic and other variables will be determined by utilizing descriptive statistics, t-tests for interval degree informations, and I‡2 analysis ( Fisher ‘s exact trial ) for nominal informations e.g. gender, 2.birth weight, 3.gestational age, 4.maternal age,, 6.marital position, 7.race, 8.smoking history, 9.breastfeeding purpose and 10.maternal employment ( no, parttime, or full-time employment ) .

4. Probable end products

If the consequence shows that skin-to-skin contact for full-term newborn babes during the first two hours postbirth has important consequence on first suckling experience and besides heighten the sole breastfeeding rate in six months postbirth.

The consequence will non merely supply support in the Ten Steps to Successful Breastfeeding rule, particularly in Step four recommends skin-to-skin contact in the early postpartum period, which should last until the first provender or for every bit long as the female parent wants but besides increase its credibleness in enhance breastfeeding constitution.

Early skin-to-skin contact can hold a positive impact on newborn babies wellness by set up first suckling good but besides increase the female parent ‘s satisfaction every bit good as the bonding and interaction between female parents and newborn babes.

The skin-to-skin used to exert as an intercession for premature babes, with the consequence, we can use to generalization. The intercession can non merely usage for premature babes but besides works in healthy, full term babes. When use the consequence into clinical pattern, the newborn baby modus operandi attention in bringing will alter significantly. First, in many health care puting, when bringing comes, the first precedence is to dry the babe and maintain the air passage unfastened and do a scope of physical appraisal and newborn modus operandi attention. Due the complicated undertakings, female parents and newborn babies normally have to divide more than one hr which miss the most cherished clip for adhering between female parents and newborn babies. To implement the intercession, the old pattern has to be changed. For clinical practicians might necessitate some clip header due to the assorted undertakings and responsibilities.

If the skin-to-skin contact intercession performs good in clinical pattern, possibly research workers can set more attempt in this country. For illustration, allow the male parent or important other pattern the skin-to-skin contact with newborn babies and analyze the consequence might be operate every bit good as female parents.

5. Scheduling of the survey

Calendar month











cubic decimeter








Identify informations beginnings, archives and specialist library collections.Identify possible instance studies.Review theory and methodological analysis, policy and clinical pattern.

Develop research inquiry

Complete research proposal

Develop research methodological analysis

Sampling and enlisting

Data Collection

Consequences, Data analysis and rating

Research undertaking completed

6. Detailed justification of costs



i??/ per twelvemonth



1. research helper

2. clinical coordinator

i??9/ per hr



20hours/per person/week

Approximately 20 hebdomads





MP3 recording equipment





-MP3 recorder-i??40

Administrative Expenses


Travel, communicating,

Attend conference, seminar, meeting






Fees and Service Charges





7. Ethical issues

There are some ethical issues we may run into when we do the research. First, start with informed consent, in a research, participants should be to the full informed as much information as possible that the participants can make up one’s mind whether they want to fall in or non. Therefore, before we set up the research, all the participants will have unwritten and written information about the nature and intent of the research survey and its possible deductions for them. After participants to the full understood, inform consent will be obtained before we start the research. And participants besides accept that they can halt or retreat the research at any clip they want. Second, the issue of the invasion of privateness, in the research undertaking, Confidentiality and anon. will be guaranteed. Any designation, paperss will be separate from the tape recording and written text. Data besides will be stored in a locked and unafraid container, merely the research worker can measure the key.

Last but non least, before any act, we have to obtain the blessing from Research Ethics Committee. By making so, everyone ‘s right is protected.

8. Contemplation on your survey

Early skin-to-skin contact may non consequence on first suckling experience and breastfeeding continuance, the grounds are vary. There are many factors influence suckling negatively. For illustration, for working female parent, possibly they experienced a really admiration first suckling while holding skin-to-skin contact with her babe when they in the infirmary with healthcare supplier ‘s support and suckling instruction. However, when the female parent and her newborn baby go place, a scope of unexpected things happened to them, without healthcare supplier ‘s aid, short pregnancy leave and nerve-racking work, all these grounds are impacting the determination of suckling constitution and continuance. Furthermore, if the intercession of skin-to-skin contact will implement in clinical pattern, it will alter the long established modus operandi and functions which is hard when face experience clinical practician whom do n’t wish to alter.

The undermentioned inquiries are from the Critical Appraisal Skill Programme ( CASP, 2003 ) . These 10 inquiries can assist us believe about these issues consistently.

1. Make the survey inquire a clearly-focused inquiry?

In this research, the population, intercession and result are clearly stated.

2.Was this a randomized controlled test ( RCT ) and was it suitably so?

In this research, I want to analyze the consequence of skin-to-skin contact for full-term newborn babes during the first two hours postbirth on first breastfeeding. To measure the effectivity of skin-to-skin contact, I have to take randomised controlled test to prove. In Glasziou ‘s paper ( 2001 ) , he stated that to analyze the effects of intercessions, it is necessary to compare a group of patients who have received the intercession ( analyze group ) with a comparable group who have non received the intercession ( command group ) . A randomised controlled test, which is a test in which topics are indiscriminately allocated to the survey or control groups, is normally the ideal design.

3. Were participants suitably allocated to intervention and command groups?

In the survey, I will utilize computerized minimisation to apportion participants, so I assume the participants will be allocated suitably.

4. Were participants, staff and survey forces ‘blind ‘ to participants ‘ survey group?

In this survey, participants, staff and survey forces, they wo n’t blind to participant ‘s survey group, which could do observer prejudice and perchance a failing in this survey.

5. Were all of the participants who entered the test accounted for at its decision?

In the survey, I assume all the participants who entered the test accounted for at its decision for avoiding abrasion prejudice.

6. Be the participants in all groups followed up and informations collected in the same manner?

In the survey, we have one research helper dose the post-delivery attention observation and appraisal of first breastfeeding in the bringing room. And the other clinical co-ordinator responsible for certification, so I presume the information will collected in the same manner.

7. Make the survey have adequate participants to minimise the drama of opportunity?

Harmonizing to old surveies ‘ consequence size, in this survey, we merely recruit 15 participants

8. How are the consequences presented and what is the chief consequence?

9.How precise are these consequences?

10. Were all of import results considered so the consequences can be applied?

for inquiry 8-10, it can non reply for the survey is non carry out yet.