Exploring Skin-to-Skin Contact Practices After Vaginal Birth in Saudi Arabia: A Mixed Method Study

Abstract

Background: The World Health Organization (WHO) recommends the practice of immediate continuous and uninterrupted Skin-to-Skin Contact (SSC) after birth for its physiological, psychological and social benefits. However, separation of mothers and infants seems to be common practice in many hospitals. In Saudi Arabia, rates of SSC have not been reported. The aim of this thesis was to explore the policies, practices, and health care providers’ and mothers’ perceptions of SSC after vaginal birth for healthy term newborn infants in two major hospitals in Jeddah, Saudi Arabia. Methods: A mixed methods design was employed, comprising four studies based on a range of data sources. Study Ⅰ, a systematic review of the prevalence of SSC worldwide; Study Ⅱ, an evaluation of the current practices of SSC by observing 22 mother-infant dyads after birth; Study Ⅲ, face-to-face interviews with Health Care Providers (HCPs) (obstetricians, midwives and nurses ), investigating barriers and enablers of SSC with 20 obstetricians, midwives and nurses; and Study Ⅳ, a survey exploring the perceptions about SSC with 254 mothers. Findings: The practice of SSC (Study Ⅰ) varied among the 35 studies representing 28 countries, with no evidence from Saudi Arabia. The observational study (Ⅱ) found only two mother-infant dyads (9%) had direct SSC, while the majority had the baby placed on their chest/abdomen with a sheet/gown between them (72%). Likewise, the survey data (Ⅳ) found 15% had direct SSC and a further 54% had a sheet/gown under the baby. Barriers faced by HCPs to SSC (Ⅲ) included lack of skills and motivation to implement SSC, time constraints, and a medicalised birth environment. Analysis of the mothers’ survey (Ⅳ) and HCPs’ interviews (Ⅲ) demonstrated that while mothers held favorable perceptions towards SSC, clinicians were out of step with mothers’ desire. Conclusion: The insights gained from this study will enhance the implementation of immediate, continuous and uninterrupted SSC after birth in Saudi Arabia.