Early skin-to-skin contact after cesarean section: A randomized clinical pilot study

Martina Kollmann, Lisa Aldrian, Anna Scheuchenegger, Eva Mautner, Sereina A Herzog, Berndt Urlesberger, Reinhard B Raggam, Uwe Lang, Barbara Obermayer-Pietsch, Philipp Klaritsch, Martina Kollmann, Lisa Aldrian, Anna Scheuchenegger, Eva Mautner, Sereina A Herzog, Berndt Urlesberger, Reinhard B Raggam, Uwe Lang, Barbara Obermayer-Pietsch, Philipp Klaritsch

Abstract

Objective: Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response.

Study design: This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative ("early") SCC (n = 17) versus postoperative ("late") SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase.

Results: There was no evidence for differences in parameters reflecting neonatal transition or stress response between the 'Early SSC Group' and the 'Late SSC Group'. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group' (p = 0.004).

Conclusions: This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group', which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial.

Trial registration: ClinicalTrials.gov NCT01894880.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Timing of interventions and measurements…
Fig 1. Timing of interventions and measurements (M).
The first sample from the mother (M1) was taken 2 hours before the scheduled intervention. The second maternal sample (M2) and the first sample from the newborn (N1) were taken within the first 5 minutes after birth whereas the third maternal (M3) and the second neonatal sample (N2) were taken 25 minutes after birth.
Fig 2. Flow diagram.
Fig 2. Flow diagram.
Fig 3. Arterial oxygen saturation (SaO2) of…
Fig 3. Arterial oxygen saturation (SaO2) of newborns.
Fig 4. Heart rate (HR) of newborns.
Fig 4. Heart rate (HR) of newborns.
Fig 5. Change in rectal temperatures of…
Fig 5. Change in rectal temperatures of newborns.
Fig 6. Maternal salivary cortisol (sC) levels.
Fig 6. Maternal salivary cortisol (sC) levels.
Fig 7. Maternal salivary alpha-amylase (sAA) levels.
Fig 7. Maternal salivary alpha-amylase (sAA) levels.

References

    1. 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:CD003519. PubMed Central PMCID: PMCPMC3979156.
    1. Klaus MH, Jerauld R, Kreger NC, McAlpine W, Steffa M, Kennel JH. Maternal attachment. Importance of the first post-partum days. N Engl J Med. 1972;286(9):460–3. 10.1056/NEJM197203022860904
    1. Puig G. Early Skin-to-Skin contact for mothers and their healthy newborn infants: RHL commentary. Geneva: World Health Organization, 2007.
    1. 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. 10.1111/mcn.12128
    1. Organization PAH. Beyond survival: Integrated delivery care practices for long-term naternal and infant nutrition, health and development. 2nd Edition ed. Washington2013.
    1. Nolan A, Lawrence C. A pilot study of a nursing intervention protocol to minimize maternal-infant separation after Cesarean birth. J Obstet Gynecol Neonatal Nurs. 2009;38(4):430–42. 10.1111/j.1552-6909.2009.01039.x
    1. Velandia M, Uvnäs-Moberg K, Nissen E. Sex differences in newborn interaction with mother or father during skin-to-skin contact after Caesarean section. Acta Paediatr. 2012;101(4):360–7. 10.1111/j.1651-2227.2011.02523.x
    1. Velandia M, Matthisen AS, Uvnäs-Moberg K, Nissen E. Onset of vocal interaction between parents and newborns in skin-to-skin contact immediately after elective cesarean section. Birth. 2010;37(3):192–201. 10.1111/j.1523-536X.2010.00406.x
    1. Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio P. Skin-to-skin contact after cesarean delivery: an experimental study. Nurs Res. 2010;59(2):78–84. 10.1097/NNR.0b013e3181d1a8bc
    1. Horn EP, Bein B, Steinfath M, Ramaker K, Buchloh B, Höcker J. The incidence and prevention of hypothermia in newborn bonding after cesarean delivery: a randomized controlled trial. Anesth Analg. 2014;118(5):997–1002. 10.1213/ANE.0000000000000160
    1. Yuksel B, Ital I, Balaban O, Kocak E, Seven A, Kucur SK, et al. Immediate breastfeeding and skin-to-skin contact during cesarean section decreases maternal oxidative stress, a prospective randomized case-controlled study. J Matern Fetal Neonatal Med. 2016;29(16):2691–6. 10.3109/14767058.2015.1101447
    1. Beiranvand S, Valizadeh F, Hosseinabadi R, Pournia Y. The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery. Int J Pediatr. 2014;2014:846486 PubMed Central PMCID: PMCPMC4291124. 10.1155/2014/846486
    1. 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. 10.1111/j.1479-6988.2005.00025.x
    1. Mercer JS, Erickson-Owens DA, Graves B, Haley MM. Evidence-based practices for the fetal to newborn transition. J Midwifery Womens Health. 2007;52(3):262–72. 10.1016/j.jmwh.2007.01.005
    1. Walters MW, Boggs KM, Ludington-Hoe S, Price KM, Morrison B. Kangaroo care at birth for full term infants: a pilot study. MCN Am J Matern Child Nurs. 2007;32(6):375–81. 10.1097/01.NMC.0000298134.39785.6c
    1. Srivastava S, Gupta A, Bhatnagar A, Dutta S. Effect of very early skin to skin contact on success at breastfeeding and preventing early hypothermia in neonates. Indian J Public Health. 2014;58(1):22–6. 10.4103/0019-557X.128160
    1. Marín Gabriel MA, Llana Martín I, López Escobar A, Fernández Villalba E, Romero Blanco I, Touza Pol P. Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatr. 2010;99(11):1630–4. 10.1111/j.1651-2227.2009.01597.x
    1. Takai N, Yamaguchi M, Aragaki T, Eto K, Uchihashi K, Nishikawa Y. Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults. Arch Oral Biol. 2004;49(12):963–8. 10.1016/j.archoralbio.2004.06.007
    1. Nater UM, La Marca R, Florin L, Moses A, Langhans W, Koller MM, et al. Stress-induced changes in human salivary alpha-amylase activity—associations with adrenergic activity. Psychoneuroendocrinology. 2006;31(1):49–58. 10.1016/j.psyneuen.2005.05.010
    1. Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34(2):163–71. 10.1016/j.psyneuen.2008.10.026
    1. Lewis JG. Steroid analysis in saliva: an overview. Clin Biochem Rev. 2006;27(3):139–46. PubMed Central PMCID: PMCPMC1579286.
    1. Wagner J, Cik M, Marth E, Santner BI, Gallasch E, Lackner A, et al. Feasibility of testing three salivary stress biomarkers in relation to naturalistic traffic noise exposure. Int J Hyg Environ Health. 2010;213(2):153–5. 10.1016/j.ijheh.2009.08.004
    1. Nater UM, Rohleder N, Schlotz W, Ehlert U, Kirschbaum C. Determinants of the diurnal course of salivary alpha-amylase. Psychoneuroendocrinology. 2007;32(4):392–401. 10.1016/j.psyneuen.2007.02.007
    1. García-Blanco A, Vento M, Diago V, Cháfer-Pericás C. Reference ranges for cortisol and α-amylase in mother and newborn saliva samples at different perinatal and postnatal periods. J Chromatogr B Analyt Technol Biomed Life Sci. 2016;1022:249–55. 10.1016/j.jchromb.2016.04.035
    1. Tappauf C, Schest E, Reif P, Lang U, Tamussino K, Schoell W. Extraperitoneal versus transperitoneal cesarean section: a prospective randomized comparison of surgical morbidity. Am J Obstet Gynecol. 2013;209(4):338.e1–8.
    1. Reif P, Lakovschek I, Tappauf C, Haas J, Lang U, Schöll W. Validation of a point-of-care (POC) lactate testing device for fetal scalp blood sampling during labor: clinical considerations, practicalities and realities. Clin Chem Lab Med. 2014;52(6):825–33. 10.1515/cclm-2013-0732
    1. Reif P, Ulrich D, Lakovschek I, Tappauf C, Lang U, Schöll W. Practicability of fetal scalp blood sampling during labor using microtubes and a point-of-care (POC) lactate testing device: difficulty assessment, sampling time and failure rates. Clin Chem Lab Med. 2015.
    1. Hui CK, Huang CH, Lin CJ, Lau HP, Chan WH, Yeh HM. A randomised double-blind controlled study evaluating the hypothermic effect of 150 microg morphine during spinal anaesthesia for Caesarean section. Anaesthesia. 2006;61(1):29–31. 10.1111/j.1365-2044.2005.04466.x
    1. Saito T, Sessler DI, Fujita K, Ooi Y, Jeffrey R. Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Reg Anesth Pain Med. 1998;23(4):418–23.
    1. Urlesberger B, Kratky E, Rehak T, Pocivalnik M, Avian A, Czihak J, et al. Regional oxygen saturation of the brain during birth transition of term infants: comparison between elective cesarean and vaginal deliveries. J Pediatr. 2011;159(3):404–8. 10.1016/j.jpeds.2011.02.030
    1. Kamlin CO, O'Donnell CP, Davis PG, Morley CJ. Oxygen saturation in healthy infants immediately after birth. J Pediatr. 2006;148(5):585–9. 10.1016/j.jpeds.2005.12.050
    1. Rabi Y, Yee W, Chen SY, Singhal N. Oxygen saturation trends immediately after birth. J Pediatr. 2006;148(5):590–4. 10.1016/j.jpeds.2005.12.047
    1. Dawson JA, Kamlin CO, Vento M, Wong C, Cole TJ, Donath SM, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics. 2010;125(6):e1340–7. 10.1542/peds.2009-1510
    1. Dawson JA, Davis PG, O'Donnell CP, Kamlin CO, Morley CJ. Pulse oximetry for monitoring infants in the delivery room: a review. Arch Dis Child Fetal Neonatal Ed. 2007;92(1):F4–7. PubMed Central PMCID: PMCPMC2675297. 10.1136/adc.2006.102749
    1. Dawson JA, Kamlin CO, Wong C, te Pas AB, Vento M, Cole TJ, et al. Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed. 2010;95(3):F177–81. 10.1136/adc.2009.169102
    1. Einarsson S, Brandt Y, Lundeheim N, Madej A. Stress and its influence on reproduction in pigs: a review. Acta Vet Scand. 2008;50:48 PubMed Central PMCID: PMCPMC2630310. 10.1186/1751-0147-50-48
    1. Maruyama Y, Kawano A, Okamoto S, Ando T, Ishitobi Y, Tanaka Y, et al. Differences in salivary alpha-amylase and cortisol responsiveness following exposure to electrical stimulation versus the Trier Social Stress Tests. PLoS One. 2012;7(7):e39375 PubMed Central PMCID: PMCPMC3408464. 10.1371/journal.pone.0039375
    1. Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology. 1994;19(4):313–33.
    1. Bigert C, Bluhm G, Theorell T. Saliva cortisol—a new approach in noise research to study stress effects. Int J Hyg Environ Health. 2005;208(3):227–30. 10.1016/j.ijheh.2005.01.014
    1. Gunnar MR, Malone S, Vance G, Fisch RO. Coping with aversive stimulation in the neonatal period: quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev. 1985;56(4):824–34.
    1. Chatterton RT, Vogelsong KM, Lu YC, Hudgens GA. Hormonal responses to psychological stress in men preparing for skydiving. J Clin Endocrinol Metab. 1997;82(8):2503–9. 10.1210/jcem.82.8.4133
    1. Hung KJ, Berg O. Early skin-to-skin after cesarean to improve breastfeeding. MCN Am J Matern Child Nurs. 2011;36(5):318–24; quiz 25–6. 10.1097/NMC.0b013e3182266314
    1. Crenshaw JT, Cadwell K, Brimdyr K, Widström AM, Svensson K, Champion JD, et al. Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates. Breastfeed Med. 2012;7(2):69–78. 10.1089/bfm.2011.0040

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