What are women's experiences of immediate skin-to-skin contact at caesarean section birth? An integrative literature review

Background: Skin-to-skin is a well-established practice at vaginal births promoting the health of women and babies. Facilitation of skin-to-skin at caesarean section birth is growing despite environmental and historical challenges. This is led by the expectancy of women and of health professionals increasingly understanding its importance.

Objective: To synthesise original research that explores the experience of women having immediate and uninterrupted skin-to-skin contact at caesarean section when woman and baby are well.

Design: Integrative literature review.

Data sources: The databases of SCOPUS, PubMed, CINAHL plus, Wiley Online, Cochrane Library, Web of Science and MIDIRS were used to identify studies from 2010-2020. Hand searching of library journals, reference and citation lists were also used.

Methods: The framework of Whittemore and Knafl (2005) was used to guide the literature search, thematic analysis, and synthesis of original research. Initial screening against inclusion criteria was utilised for English-published papers of full-term, well, woman and baby dyads who experienced skin-to-skin at caesarean section birth. Papers were not limited by methodology. The validated Mixed Methods Appraisal Tool (MMAT) was used for critical quality appraisal (Bartlett et al., 2018).

Findings: In total, 750 results were returned in the initial search and a final 13 papers were included in this review including quantitative (6), qualitative (5) and mixed method (2) designs. Immediate and uninterrupted skin-to-skin at caesarean section birth, when mother and baby are well, is safe, appropriate and desired by women, improving birth experience and satisfaction. Three main themes were identified with sub-themes – Positive birth experience (satisfaction; breastfeeding goals); Sense of control (empowered; birth, not a procedure); Natural (wanting to hold their baby; becoming a mother).

Conclusions: The findings of this review show that skin-to-skin improves the experience for women, and particularly empowers women having a caesarean section giving them a sense of a more natural birth. Women see skin-to-skin as an opportunity to maintain control and not be separated from their baby. Many studies have focused on the benefits of skin-to-skin but less so on the wants and choices of women. Women want to see, hold and feed their babies but are unable to achieve this of their own volition during a surgical birth. Understanding how women value this close physical contact can seek to inform further research on the impact of separation. This can inform policy and practice development in maternity care services to ensure best outcomes for both women and infants.

Implications for practice: The practice of skin-to-skin and keeping mother and baby together is valued by women and justified by research as best-practice for health and well-being. The findings of this paper highlight the importance of maternity settings facilitating both skin-to-skin and non-separation for all women and their newborns, even more so at caesarean section births.

Crown Copyright © 2021 Published by Elsevier Ltd. All rights reserved.