Timing of skin-to-skin contact after cesarean section on exclusive breastfeeding: an open-label, randomized...

To compare the effect of skin-to-skin contact (SSC) initiation at three different time points on exclusive breastfeeding (EBF) rates at 6 weeks among healthy term infants delivered via cesarean section.

In this open-label randomized controlled trial, neonates were assigned to three groups: Group 1 (immediate SSC in the delivery room), Group 2 (SSC after transfer to the recovery room), and Group 3 (breastfeeding initiation followed by SSC in the recovery room). The primary outcome was the percentage of mothers exclusively breastfeeding (EBF) at 6 weeks. Secondary outcomes included duration of SSC, early initiation of breastfeeding (EIBF) rates, exclusive breastfeeding rates at 6 months, and challenges during implementation of SSC.

Baseline characteristics were similar across 750 enrolled infants (250 per group). In Group 1, 46 babies (18.4%) faced challenges in SSC initiation and were reallocated. No significant difference in 6-week EBF rates (RR 0.98, 95% CI: 0.77-1.25, p = 0.90). Group 3 was associated with the highest EIBF rates (RR 0.5, 95% CI 0.3-0.8, p = 0.013) and the longest duration of SSC.

Given the challenges of immediate intraoperative SSC after a C-section, our study found that initiating SSC in the recovery room is a practical and effective alternative, having a similar impact on breastfeeding rates. While the timing of SSC does not significantly impact EBF rates at 6 weeks or 6 months, it remains a critical factor for EIBF. Our findings show that immediate SSC significantly optimizes EIBF. Furthermore, the high EBF rates sustained across all cohorts suggest that robust institutional support is a primary driver of long-term breastfeeding success.