Efficacy of skin-to-skin contact between mother and infant on maternal outcomes during the third stage of labour: A systematic review and meta-analysis.

Background: Postpartum haemorrhage is a preventable cause of maternal mortality that commonly occurs during the third stage of labour. Skin-to-skin contact is an intervention that can support the physiological processes of labour by increasing oxytocin levels, which can accelerate placental expulsion and enhance uterine contractions, thereby contributing to the prevention of postpartum haemorrhage.

Objective: This systematic review aims to evaluate the impact of skin-to-skin contact on key maternal variables during the third stage of labour, including the duration of this stage, placental integrity, the need for manual placental extraction, the administration of therapeutic uterotonics, and the position of the uterine fundus.

Methods: A systematic review with meta-analysis of randomised controlled trials and prospective quasi-experimental studies was conducted. Studies were searched in PubMed, Scopus, Cochrane, CINAHL, Google Scholar, and Web of Science. Statistical analysis was performed using STATA version 18. The results of the meta-analysis were reported using relative risk (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95 % confidence intervals (CI). A random-effects model was employed due to the anticipated heterogeneity among the included studies. Sensitivity analyses were performed to assess the robustness of the findings, and a subgroup analysis was conducted based on the type of birth, study design, and country economic level.

Results: Twenty-five trials were included. Skin-to-skin contact significantly reduced the duration of the third stage of labour (MD: -4.26; 95 %; CI: -5.70, -2.81), increased the likelihood of complete placental integrity (RR: 1.09; 95 % CI: 1.02, 1.16), and significantly reduced both the likelihood of a supraumbilical position of the uterine fundus (RR: 0.39; 95 % CI: 0.20, 0.76) and the need for uterotonic administration (RR: 0.24; 95 % CI: 0.12, 0.48).

Conclusions: Skin-to-skin contact is a simple practice that can favourably influence the physiological processes of labour and improve various maternal outcomes. These benefits include reducing the duration of the third stage of labour, ensuring complete birth of the placenta, decreasing the need for uterotonic administration, and increasing the likelihood of a proper uterine fundal position. Therefore, it is recommended to include this practice in labour care protocols.