Skin-to-skin contact and breastfeeding after caesarean section: A systematic review and meta-analysis of intervention studies

Abstract

Background

Breastfeeding has been widely studied as a factor that improves maternal and newborn health outcomes. Immediate or early skin-to-skin contact interventions have been proposed in health care services to increase breastfeeding or exclusive breastfeeding rates following caesarean births although the findings are inconclusive.

Objective

This systematic review and meta-analysis aimed to synthesize the available evidence on early or immediate skin-to-skin contact and breastfeeding in women and newborns following caesarean birth.

Methods

A systematic search was performed using in the MEDLINE, EMBASE, Cochrane Library and Web of Science databases from inception to June 2024. The effects of early or immediate skin-to-skin contact were reported as relative risks (RRs) with 95 % confidence intervals (CIs) provided by the original articles. Pooled estimates were calculated using the DerSimonan and Laird methods. The intervention groups received early or immediate skin-to-skin contact and the control group received standard care after caesarean birth. The risk of the bias of the randomized controlled trials was assessed using the Cochrane risk of bias tool for randomized controlled trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) assessment tool for nonrandomized studies. Publication bias was assessed with funnel plot asymmetry and Egger's test. Zotero reference manager and Stata 17 software were used.

Results

Eight randomized controlled trials and three quasiexperimental studies involving a total of 1.990 participants were included. The findings indicate that skin-to-skin contact decreased the time to first attachment by 51.73 min (95 % CI: − 68.54 to − 34.91; I²: 85.3), increased the breastfeeding rates in the first 2 h after birth (RR: 4.86; 95 % CI: 2.71 to 7.01; I²: 44.1) and the exclusive breastfeeding rate at discharge (RR: 1.69; 95 % CI 1.36 to 2.01; I²: 13.7), but not the exclusive breastfeeding rate at one month from birth or later (RR: 1.13; 95 % CI 0.73 to 1.54; I²: 0.0).

Conclusion

This study revealed that early or immediate skin-to-skin contact after caesarean birth improved breastfeeding rates and exclusive breastfeeding rates during the health care stay. Trials with longer follow-up times are needed to assess whether interventions based on early or immediate skin-to-skin contact maintain their effectiveness over time and to clarify whether early or immediate skin-to-skin contact is safe for preterm newborns or women with certain health conditions.