Effect of Combined Skin-to-Skin Contact and Kangaroo Care on Breastfeeding and Bonding in Cesarean-Born Newborns

Официальное название

The Effect of Consecutive Skin-to-Skin Contact Applied by the Mother and Father on Breastfeeding Parameters and Bonding in Babies Born by Cesarean Section

Обзор

This randomized controlled study aims to evaluate the effect of consecutive skin-to-skin contact applied by the mother and father on breastfeeding parameters and parent-infant bonding in babies born by cesarean section. The study includes two groups: an intervention group receiving consecutive skin-to-skin contact by the father followed by the mother, and a control group receiving routine postnatal care. Breastfeeding success and parental bonding will be assessed using validated measurement tools during the early postnatal period and follow-up.

Подробное описание

The global increase in cesarean section rates has become a significant public health concern. In Türkiye, the cesarean section rate reached 57.4% in 2023, one of the highest among OECD countries. Babies born by cesarean section are often deprived of early skin-to-skin contact in the immediate postnatal period due to maternal physical limitations, which may negatively affect breastfeeding outcomes and parent-infant bonding.

Skin-to-skin contact and kangaroo care are evidence-based practices known to support neonatal physiological stability, breastfeeding success, pain management, and parent-infant bonding. However, operational and clinical barriers following cesarean delivery often limit the early implementation of maternal skin-to-skin contact. While the effects of skin-to-skin contact have been extensively studied in the context of mother-infant dyads, evidence regarding father-infant skin-to-skin contact remains limited, particularly in term infants.

Delayed maternal contact following cesarean delivery may result in missed opportunities for early bonding and breastfeeding initiation. In this context, involving fathers in early skin-to-skin contact may provide an effective strategy to compensate for delayed maternal contact. Active paternal participation in newborn care has been shown to support infant development, enhance paternal role adaptation, and strengthen family bonding.

This randomized controlled study will be conducted in the delivery and postpartum units of a private mother- and baby-friendly hospital in Istanbul, Türkiye. The study population will consist of mothers and term newborns born by cesarean section who meet the inclusion criteria. Sample size will be determined using G\*Power software.

Participants will be randomly assigned to one of two groups. In the intervention group, newborns will receive uninterrupted skin-to-skin contact with the father for 30 minutes immediately after birth. Painful procedures, including hepatitis B vaccination and vitamin K administration, will be performed during father-infant skin-to-skin contact. Following maternal recovery and confirmation of clinical suitability, consecutive skin-to-skin contact will be initiated between the mother and the newborn. The first breastfeeding attempt will occur during maternal skin-to-skin contact.

The control group will receive routine postnatal care according to the hospital's standard protocol.

Breastfeeding success will be assessed using the Bristol Breastfeeding Assessment Tool prior to discharge, on postpartum day 2, and at one month postpartum. Maternal and paternal bonding will be evaluated using the Maternal Postnatal Attachment Scale (MPAS) and the Paternal Postnatal Attachment Scale (PPAS) at the same time points. Breastfeeding parameters and parental bonding outcomes will be statistically compared between the two groups.

Вмешательства

• Поведенческое Intervention
  Consecutive skin-to-skin contact is applied to newborns born by cesarean section, first by the father for 30 minutes immediately after birth, followed by skin-to-skin contact with the mother as soon as maternal clinical condition allows. Routine newborn care is provided alongside the intervention.

Первичные конечные точки

• Maternal Postnatal Attachment Scale (MPAS) [Срок оценки: 3 months]

Вторичные конечные точки (1)

• Paternal Postnatal Attachment Scale (PPAS) [Срок оценки: 3 months]

Критерии участия

Критерии включения

• Mothers who delivered by cesarean section
• Mothers and fathers willing to participate and provide written informed consent
• Newborns who are stable after birth
• No health conditions in mothers or fathers that would prevent participation in skin-to-skin contact

Критерии исключения

• Serious maternal or neonatal illness
• Newborns requiring NICU admission
• Mothers or fathers unwilling to participate
• Any maternal or paternal condition preventing the implementation of skin-to-skin contact

Additional note:

-Eligibility is based on biological sex (female for mothers, male for fathers, newborns of any sex), not on gender identity.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Поддерживающая терапия

Центры проведения

Turkey (Türkiye) · 1 центр

• Zeytinburnu Avrasya Hospitol — Istanbul

Публикации

• Martinez-Hortelano JA, Saz-Lara A, Gonzalez JLG, Cristobal-Aguado S, Iglesias-Rus L, Martinez-Vizcaino V, Garrido-Miguel M. Skin-to-skin contact and breastfeeding after caesarean section: A systematic review and meta-analysis of intervention studies. Int J Nurs Stud. 2025 Jun;166:105038. doi: 10.1016/j.ijnurstu.2025.105038. Epub 2025 Mar 5. PMID 40086104
• Abiha U, Banerjee DS, Mandal S. Demystifying non-invasive approaches for screening jaundice in low resource settings: a review. Front Pediatr. 2023 Nov 20;11:1292678. doi: 10.3389/fped.2023.1292678. eCollection 2023. PMID 38054187
• Moore ER, Brimdyr K, Blair A, Jonas W, Lillieskold S, Svensson K, Ahmed AH, Bastarache LR, Crenshaw JT, Giugliani ERJ, Grady JE, Zakarija-Grkovic I, Haider R, Hill RR, Kagawa MN, Mbalinda SN, Stevens J, Takahashi Y, Cadwell K. Immediate or early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2025 Oct 22;10(10):CD003519. doi: 10.1002/14651858.CD00351 PMID 41120189
• Huang Y, Chen L, Wang X, Zhao C, Guo Z, Li J, Yang F, Cai W. Maternal knowledge, attitudes and practices related to neonatal jaundice and associated factors in Shenzhen, China: a facility-based cross-sectional study. BMJ Open. 2022 Aug 24;12(8):e057981. doi: 10.1136/bmjopen-2021-057981. PMID 36002214
• Zarei Salehabadei M, Amini L, Haghani S, Sadeghi Avval Shahr H. Postpartum depression and paternal-infant attachment in Iranian fathers. J Reprod Infant Psychol. 2025 Mar 27:1-14. doi: 10.1080/02646838.2025.2485120. Online ahead of print. PMID 40150891
• Karaman SC, Unal E, Demir H. Investigation of the effect of fathers' postnatal feelings of security on father-infant attachment. J Pediatr Nurs. 2025 Nov-Dec;85:586-592. doi: 10.1016/j.pedn.2025.09.022. Epub 2025 Sep 27. PMID 41016224

Идентификаторы

NCT: NCT07410754 · MD-PM-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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