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. 2025 Nov 17;15(1):40123.
doi: 10.1038/s41598-025-23854-7.

Clinical audit of skin-to-skin contact and initiation of breastfeeding after birth

Roghayye Asadi  1 , Seyedeh Saeedeh Mousavi  2 , Seyedeh Batool Hasanpoor-Azghady  3 , Arash Bordbar  4 , Zari Dolatabadi  5
Affiliations

Clinical audit of skin-to-skin contact and initiation of breastfeeding after birth

Roghayye Asadi et al. Sci Rep. .

Abstract

Despite the well-established benefits of mother-infant skin-to-skin contact, the absence of immediate postnatal skin-to-skin contact and the separation of mothers and newborns appear to remain common practices in hospitals. This study was conducted to perform a clinical audit of skin-to-skin contact and the initiation of breastfeeding following birth. This cross-sectional study was conducted on 53 employed midwives and 265 postpartum mothers in two hospitals (Imam Sajjad and Shahid Akbarabadi) in Tehran Province. A census sampling method was applied. Data collection instruments included a demographic questionnaire and the national guideline checklist. Data were gathered through observation and interviews. For data analysis, descriptive statistics as well as the Chi-square and Fisher's exact tests were employed using SPSS (version 22). A significance level of less than 0.05 was considered in all analyses. The results showed that 69.8% of midwives had an acceptable level of awareness regarding the standards of the guideline for establishing immediate postnatal skin-to-skin contact and initiating breastfeeding within the first hour of birth. The educational performance of all midwives was deemed unsatisfactory. The practical performance of 84.9% of midwives, as observed, was reported as unacceptable, and midwives in Imam Sajjad Hospital demonstrated better practical performance compared to those in Shahid Akbarabadi Hospital (36.4% vs. 0%), which was statistically significant (P = 0.001). Furthermore, midwives' awareness was more acceptable in the age groups of 35-39 years (87.5%) and 40 years and above (100%), and this difference was statistically significant (P = 0.014).

Keywords: Breastfeeding; Clinical audit; Midwifery performance; Skin-to-skin contact.

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Conflict of interest statement

Declarations. Competing interests: The authors declare that they have no competing interests. Ethics approval and consent to participate: The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (Number: IR.IUMS.REC.1400.416) approved the study protocol. The purpose and procedures of the study were fully informed to the participants. Then informed written consent was obtained from them (midwives and mothers). In addition to the verbal explanation, the written informed consent signed by the mother specified that, with the mother’s written permission, skin-to-skin contact and breastfeeding of the infant would be observed by a midwife researcher during the first hour after birth. Given the study’s purpose, which required no intervention on the infant and solely involved observing skin-to-skin contact and breastfeeding, mothers considered their written consent sufficient and did not consider the need for consent from the father to be necessary. Participants were also assured of the confidentiality of their information. All methods were carried out in accordance with our study protocol, along with relevant guidelines and regulations associated with the Iran University of Medical Sciences and professional regulatory bodies such as the Nursing and Midwifery Council. Consent for publication: Not applicable.

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