The Effect of Mother and Newborn Early Skin to Skin Contact on the Duration of Separation and Expulsion of the Placenta

Abstract

The present study was an experimental study, designed to identify the effect of mother and newborn early skin-to-skin contact on the placental delivery (separation and expulsion of the placenta)(study aim) and to prove or disprove the study hypothesis. In order to fulfill the aim and prove the study hypothesis, twenty eight (28) subjects were selected by purposive sampling technique according to the inclusion criteria and randomly divided into two groups, a control group and an experimental group, each group consisted of 14 subjects. The subjects were the parturient women who were admitted through the department of Obstetrics & Gynecology(ER) and had their childbirth in the labor and delivery room at King Fahd Hospital of the University; located in Al khobar region. Two instruments were used in this study to test the hypothesis (early skin-to-skin contact of mother and newborn will decrease the time of placental delivery) and to collect data from the parturient women. The first tool was the interview questionnaire sheet which consists of two parts as follows: first part was the socio- demographic and obstetrical data. These data were collected from the parturient women in both groups during the first stage of labor. The second part included an assessment items related to the second stage of labor such as time of delivery of the fetus and delivery outcomes. The second part also included. assessment items related to the third stage of labor such as time of placental delivery, uterine assessment, presence of episiotomy/ tear and initiation of breastfeeding. It was used for both groups, before, during and after delivery. Data related to the newborn such as APGAR scoring at 1 & 5 minutes, temperature of the newborn, presence of trauma/ bruises, caput. succedaneum or cephalohematoma, respiratory distress syndrome and any admission to neonatal intensive care unit (NICU) were assessed and data collected by the researcher during and after delivery. These items were included also in second part of the interview questionnaire sheet. The second tool was a Stop Watch'. It was used by the researcher to calculate the duration of the third stage of labor in both groups starting from complete expulsion of the fetus till the complete placental delivery (separation and expulsion of the placenta). Data collection commenced after permission to conduct the study. The parturient women who met the inclusion criteria were approached. The researcher had explained the purpose of the study and what would be expected from them during skin-to-skin contact, then the consents were obtained from all the parturient women. Their questions were answered by the researcher if there was any. The confidentiality was maintained throughout the study. The socio-demographic data of the subjects in both groups were collected. Then, the women & newborns in the control group received the routine hospital care provided by the staff nurses and the physicians, while women & newborns in the experimental group received early mother and newborn skin-to-skin contact by the researcher. After full expulsion of the placenta, the newborns were separated from their mothers and received the routine care again by staff nurses. The Main Findings of the Present Study were: Socio-Demographic Data: It was found that most of the study groups were housewives (78.6%) in the experimental group and (85.7%) in the control one. There were more parturient women in the experimental group who had a family income ranged between 6000-9000 SR (42.9%) compared to (7.1%) in the control group. However, there was no statistical significant difference between the two groups as P-1. Also, it was noted that most of both groups were Saudi, (71.6%) and (85.8%) in the experimental and control groups respectively. There was equal number of parturient women in both groups living in Al khobar. The two groups did not differ by age, education, occupation. The differences between the experimental and control groups were not statistically significant for all socio- demographic data. Obstetrical History: It was interesting to notice that, in the current study all deliveries (100%) in the experimental group occurred at evening time compare to four deliveries (28.6%) in the control group. The observed difference was statistically significant as P 0.001. It was also observed that less than one half of parturient women (42.9%) in the experimental group were gravida 3 and two-thirds of parturient women (64.4%) in the control group were gravida 2. The parity ranged between 0-6 in the experimental group and 0-5 in the control group. These differences were not statistically significant as P=0.2. Most parturient women in both groups had no history of miscarriage (71.4%) and (64.3%) in the experimental group and control group respectively. Also this study revealed that the majority of parturient women in both groups were more likely to plan their pregnancies (78.6%) of the experimental group and (71.4%) of the control group. In addition, most of the parturient women in both groups had no episiotomy (64.3%) and (57.1%) in the experimental and control group respectively. Also, It was noticed that (64.3%) of parturient women in the experimental group had first degree tear compared to one half (50.0%) in the control group. The observed differences were not statistically significant as P>0.05. Newborn Characteristics: In the current study, the newborns were warmer in the experimental group. The newborns temperature was ranged between (35.9-37.5 ï؟½ï؟½C) with SSC compared to (35.5-36 ï؟½ï؟½C) in the control group under warmer. This difference was statistically significant, which supports the fact that early skin-to-skin contact maintains the temperature of newborn in the neutral thermal range. Also, it was found that APGAR scoring of newborns at 5 minutes was constant value in all experimental group 10, while it was ranged between 9-10 in the control group. The findings of the current study revealed that there was no statistically significant difference in the number of the newborns who developed caput succedaneum in both groups. The studgs also show that none (0.0%) of the newborns in the experimental group had cephalohematoma compared to two newborns(14.3%) in the control group; P=0.5. And none (0.0%) of the newborns in the experimental group was admitted to NICU compared to one newborn (7.1%) in the control group; P= 1.0. All these differences were not statistically significant. In addition, all other newborns" characteristics were not statistically significant different between both groups. Duration of Placental Delivery: The results of this study demonstrated a statistically significant positive effect of early skin-to-skin contact on shortening the duration of placental delivery (separation and expulsion of placenta). The Significance between-group differences favoring SSC mothers were noted to have in summary shorter duration time of placental delivery. In the current study, half (50.0%) of women in the experimental group had shorter duration of the placental delivery (< 300 seconds) compared to none (0.0%) of women in the control group. On the other hand, less than half (42.9%) of women in the experimental group compared to (92.9 %) of women in the control group had normal duration (300-1200 seconds) of placental delivery (separation and expulsion of placenta). The median duration of placental delivery was (308.5 seconds) and (570 seconds) in the experimental and control groups respectively; P-0.042. In summary, the results of this study may enable the researcher to utilize the benefits of early skin-to-skin contact among the parturient women, and may have implications for nurse educators and nursing practice about planning learning experiences regarding skin-to- skin contact and bonding behaviors immediately after birth in the kingdom of Saudi Arabia. This will help in providing high quality of nursing care for parturient women in labor and delivery room. The results of current study highlight the need to build-in many opportunities for actual performance of mother & newborn skin-to-skin contact. It can be used as a routine practice in all maternity hospitals as it is the parturient woman's right and it should be an available choice for all parturient women. All nurse educators should be aware of the value of early SSC after birth. This is less expensive compared with the cost of keeping the newborns in the nursery and it can help reduce maternal complications such as postpartum hemorrhage. In addition, early skin-to-skin contact practice can benefit both mother and newborn in short and long-term period. The short-term benefits are improvement of maternal attachment behaviors, improvement of breastfeeding effectiveness and maintenance of newborn thermoregulation. Early skin-to-skin contact also improves cardio-respiratory stability in the newborn The long-term benefits are improvement of maternal attachment behaviors and longer duration of/ and exclusive breast feeding.