Immediate skin-to-skin contact and postpartum hemorrhagic morbidity

Abstract

Objective: To examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC).

Methods: This study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust error variance to determine the strength of the association.

Results: Of 8623 deliveries during the study period, 3520 (40.8%) deliveries were included; of which 2428 (55.5%) had immediate SSC and 1028 (31.0%) did not. Immediate SSC reduced the overall rate of composite morbidity (adjusted relative risk 0.78, 95% confidence interval 0.65-0.92), and rate of blood loss 1000 mL or greater, use of additional uterotonics, and use of mechanical tamponade. Blood loss and third stage of labor duration were significantly less for immediate SSC. Transfusion rate and hematocrit change after delivery, did not differ.

Conclusion: Immediate SSC among term vaginal deliveries was associated with a significant reduction in PPH. Emphasis on early contact for maternal benefit may increase uptake of SSC and provide an accessible intervention for PPH in high- and low-resource settings.

Keywords: atony; kangaroo care; postpartum hemorrhage; skin‐to‐skin contact; uterotonic.

FIGURE 1

Exclusion criteria of study population.