Influence of Hospital Policy and Nurse Competency on Rates of Skin-to-Skin Contact in Neonates

To evaluate the relationship between the existence of a skin-to-skin contact (SSC) policy and rates of SSC implementation after cesarean and vaginal births at U.S. hospitals.

Cross-sectional secondary data analysis of the 2022 Centers for Disease Control and Prevention Maternity Practices in Infant Nutrition and Care survey.

Eligible participants were hospitals in the United States (or a U.S. territory) with active inpatient maternity units that provided labor and birth services in 2021. Among the 2,779 eligible hospitals, 1,994 (71.8%) responded, with the highest response rates in Nebraska (94%) and the lowest in Puerto Rico (40%).

Descriptive statistics, chi-square tests, and hierarchical logistic regression were used to assess the relationship between hospital SSC policies and SSC rates by birth mode. Mediation analysis was used to evaluate whether nurse competency influenced the relationship between policy and SSC rates. The primary outcome was at least an 80% SSC implementation rate after vaginal or cesarean birth. Confounders included the Baby-Friendly designation, facility type, and whether the hospital is a teaching hospital.

Hospitals without an SSC policy for both vaginal births (odds ratio [OR] = 0.35; 95% confidence interval [CI] [0.24, 0.51]) and cesarean births (OR = 0.46; 95% CI [0.32, 0.67]) had significantly lower odds of SSC rates exceeding 80%. A significant indirect effect of nurse competency was observed in the relationship between hospital SSC policy and SSC rates after cesarean (indirect effect = -1.27; Sobel z = -4.66; p < .001) and vaginal birth (indirect effect = -1.18; Sobel z = -4.13; p < .001).

Hospital policy and nurse training have positive effects on SSC rates. Formal policies and nurse competency can be used to decrease gaps and improve maternal-infant outcomes.