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March 2019
 How a Hospital Facilitates Skin-to-skin Contact
in the Operation Theatre 
following Cesarean Birth

Ms Sing Chu
Head of Department
Matilda International Hospital


The WHO Baby-Friendly Clinical Guidance1 published in 2018 updates Step 4 of the 10 Steps to Successful Breastfeeding as “facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth’’.

Skin-to-skin contact (SSC) is described
as the practice where 
an infant is dried,
unclothed, and placed directly on the  mother’s bare chest or abdomen after
, both of them covered in a
warm blanket and 
left for at least an
.1  This practice facilitates the newborn’s rooting reflex and helps to infix the behaviour of searching and suckling at the mother’s breast.1

Evidence shows the practice of SSC after birth benefits both the mother and infant. For the infant, it reduces the stress of being born, improves its cardiopulmonary dynamics during the early hours after delivery, results in more optimal blood glucose levels, promotes optimal thermoregulation, increases breastfeeding initiation and exclusive breastfeeding leading to earlier successful breastfeeding and reduces crying in the infant.2

For the mother, early SSC leads to earlier expulsion of the placenta, reduces postpartum bleeding, lowers her stress levels and enhances breastfeeding self‐efficacy. The contact of the baby with the mother also promotes parenting behaviours, bonding and attachment.2

Skin-to-skin contact after vaginal birth is being practiced in many birthing hospitals. However, SSC immediately following Cesarean birth in the operation theatre (OT) is not yet a common practiceStudies reveal that common barriers preventing SSC in the OT include the concerns of: not having immediate access to the mother if there is an emergency, not being able to assess the infant on the mother’s chest, having to maintain the sterility of the surgical field, having to safely position the infant while the mother is lying on the OT table and the possibility of the infant developing hypothermia because of the low temperature in the OT.3

In Hong Kong, immediately after Cesarean birth, the infant is usually separated from the mother for basic routine procedures such as measuring body weight, administration of vitamin K & Hepatitis B vaccine and providing incubator care. The duration of mother-infant separation depends on individual hospital’s policy. The WHO/UNICEF recommend starting SSC immediately after birth, regardless of the mode of birth.1 Implementing a practice change for SSC in the OT following Cesarean birth is a key component of supporting breastfeeding in the Maternity unit.


***Please click here to read more or download the whole article with the note of references.***

Key Message:
1. Involving key stakeholders in bringing about a new initiative creates ownership and builds the foundation for success.
2. Open communication among staff members and their readiness for change are crucial for success.
3. Providing expectant parents with antenatal education and opportunities for discussion on breastfeeding and other mother & baby friendly practices such as early skin-to-skin contact (irrespective of the mode of delivery) is essential.

Views expressed in this article are the author's and do not necessarily reflect the opinion or position of the BFHIHKA.   

Editor-in-Chief: Dr Shirley Leung

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