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BMC Research Notes

, 12:136 | Cite as

Assessment of skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia

  • Asres BedasoEmail author
  • Emnet Kebede
  • Tariku Adamu
Open Access
Research note
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Abstract

Objective

The study aimed at assessing skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia.

Result

A total of 384 mothers-indexed newborns admitted in postnatal wards were interviewed. The prevalence of mothers’ SSC practice to their newborns with in the first 1 h during the postpartum stay was 28.1%. Mothers education (AOR = 18.23 [95% CI 5.26, 63.52]), and number of ANC visits (AOR = 8.55 [95% CI 1.05, 69.54]) were independently associated with SSC practice of mothers to their infants.

Keywords

Skin-to-skin contact Determinants Mothers Postpartum stay Ethiopia 

Abbreviations

ANC

ante natal care

BEmONC

basic emergency obstetric and newborn care

C/S

cesarean section

CI

confidence interval

EBF

exclusive breast feeding

EDHS

Ethiopian Demographic Heath Survey

EMA

Ethiopian Midwife Association

EPHA

Ethiopian Public Health Association

FMoH

Federal Ministry of Heath

GA

gestational age

HC

health center

Kg

kilo gram

MNCH

maternal, newborn and child health

SPHMMC

St. Paul’s Hospital Medical Millennium College

SPSS

statistical package for social science

SSC

skin to skin contact

SVD

spontaneous vaginal delivery

UNICEF

United Nations Children’s Fund

Introduction

Early skin-to-skin contact (SSC) is defined as placing the naked baby, covered across the back with a warm blanket, prone on the mother’s bare chest [1]. Skin-to-skin contact between mother and baby after birth reduces crying, improves mother-baby interaction, keeps the baby warmer, and helps women breastfeed successfully. Long-lasting SSC throughout the postpartum period is important to decrease the frequency of formula supplementation for breast feeding and it will improve acquisition of the maternal role [1, 2].

Regardless of the importance of early mother–newborn SSC immediately after birth, it has not been universally implemented as routine care for healthy term neonates, and separation of mothers and infants is common in many health facilities. [3].

According to UNICEF 2.9 million babies die each year within 28 days and the first 24 h after birth are the most risky period both for the child and the mother. In Ethiopia, an approximate 84,400 new born die within the first month of birth, according to the Lancet Series of Every New-born [4].

Some low and middle-income countries are making significant improvement by providing training for midwifery and nurses professionals to address the poorest families with good quality care at birth, particularly for small or ill new-born. Ethiopia is dedicated in minimizing the under-five mortality rate to 68 deaths per 1000 live births by 2015 [5]. Nevertheless, as in other developing countries, the reduction is mainly a result of fewer deaths in children 1 to 59 months old, while neonatal (first 28 days of life) mortality has shown more modest reaching 37 deaths per 1000 live births in 2011 according to EDHS [6].

There has been many research surrounding early SSC hours after birth, but far less in assessing the practice after the first hours and throughout the hospital stay during postpartum period. The effect of early SSC shortly after birth is so influential that it appears to surely contribute for exclusive breast feeding and the quality of mother–baby interactions [7].

Therefore, identification of perceived barriers held by mothers is vital in order to conduct interventions to facilitate early SSC. It is possible that increasing SSC in the postpartum period may reduce the frequency of formula supplementation during their hospital admission, a practice that is strongly linked with decreased breast feeding duration [8, 9, 10].

For mothers, SSC reduced postpartum bleeding, decreased the time it took to expel the placenta, increased oxytocin levels, and decreased cortisol levels, resulting in happier childbirth experiences, improved bonding with newborns, and increased confidence in their ability to care for the newborn [11, 12, 13]. Also, it is found that a dose-dependent correlation between the duration of SSC with full-term newborns initiated within the first 3 h of child-birth and the establishment of exclusive breastfeeding [14].

The importance of SSC continues beyond the first hour. The longer and more often mothers and babies are on SSC in the hours and days after the birth, the greater the benefit to get [15]. A recent study reported that Skin to skin contact in the postpartum period may also minimize the occurrence of postpartum depression, a condition that adversely affects mother/baby bonding, [16]. Also, SSC immediately after birth, which lasts for at least an hour has positive effects like maintaining body temperature normal, maintains heart rate, respiratory rate and blood pressure normal, and more likely to breastfeed exclusively and breastfeed longer [17].

Therefore the study aimed to assess SSC during the Postpartum Stay and its determinant factors among mothers at public health institutions in Ethiopia.

Main text

Methods

Study design, area and period

Institutional based cross-sectional study design was employed among mothers who gave live births at public health institutions in four selected towns, Ethiopia. This study was carried out in Addis Ababa (Central Ethiopia), Bahir Dar (Amhara National Regional State), Shashemene (Oromia Regional State) and Pawi (Benshangule Gumuz National Regional State). This study comprised Addis Ababa at St. Paul’s Hospital Medical Millennium College (SPHMMC). There are two referral hospitals and 38 health centers which provide maternal, newborn and child health (MNCH) and delivery services to their catchment areas in all the selected study areas. The study was conducted from January 2016 to May 2017, in the four selected cities public health institutions of post-natal units.

Source and study population

Source population for this study was all mothers who gave a live birth at public health institutions. Study population were all mothers who gave live births and admitted at post-natal wards for at least for the first 6 h in the selected public health facilities during the study period and fulfill the inclusion criterion.

Inclusion and exclusion criteria

Mothers who gave singleton live births vaginally and admitted for at least the first 6 h post-natal period during data collection period were included in the study. Mothers who developed serious postpartum complications/unconscious were excluded from the study.

Sample size determination and sampling procedure

Single Population proportion formula was used to calculate the sample size considering the following assumptions: 95% confidence level, margin of error (0.05), 50% prevalence of early SSC since there is no previous research conducted on early SSC practice in Ethiopia. Considering 10% non response rate the final estimated sample size was 384. Simple random sampling technique was employed to select public health institutions in the four selected study areas. A mother who gave live births and admitted in post-natal units during the first 6 h was taken proportionally from each selected health facilities post-natal wards.

Four of the health facilities were selected using simple random sampling technique. Study subjects were obtained proportionally to the client flow from each post-natal unit and all mothers who gave live births in the selected public health facilities during the data collection period was interviewed consecutively with convenience to respond until the predetermined sample size was obtained (Additional file 1).

Instruments

A structured interview questionnaire was adopted from different literatures and used to explore the objective of the study, which was prepared in English and translated into Amharic (local language).

Data collection technique

Data collection was conducted by trained data collectors from January 2016 to May 2017 in each selected public health facilities during working hours. After getting written consent from each mother, interview was conducted by trained Midwives in each post-natal units of the study site. Pre-test was done on 5% of the study participants. Additional modifications and adjustments of the questionnaire were made based on the results of the pre-test.

Study variables

Dependent variable

SSC practice status of mothers during postpartum stay.

Independent variables

Socio-demographic characteristics of mothers: age, marital status, educational status, residence. Newborn characteristics: sex, weight and prematurity. Obstetric related characteristics: type of pregnancy, ANC follow-up, parity, type of delivery, birth attendant profession and type of health institution.

Data analysis

The data was entered using Epi-Info version 3.5.1, and exported to SPSS version 20 for analysis. SSC practice status was assessed by using self-report method and actual observation during data collection time. The association between variables to the outcome variable was measured by OR with 95% confidence interval. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals. Statistical significance was declared at P < 0.05 and variables which showed statistical significant association (P < 0.2) during the bi-variate logistic regression was included in the final model.

Result

Mothers’ and newborn’s socio-demographic characteristics

A total of 384 mothers of newborn were interviewed with 100% response rate. The mean age mothers’ is 26.47 years (SD ± 5.04) and 139 (36.2%) mothers were between the ages of 25–29 years and 72.9% of study participants were from urban areas (Table 1).
Table 1

Mothers’ with their indexed babies’ characteristics of SSC practice status during postpartum stay at public health institutions in four selected cities post-natal units, Ethiopia, 2016/17

Variables

Frequency

Percent

SSC status (N = 384)

Yes (n = 108)

No (n = 276)

n

%

n

%

Age

 16–20

25

6.5

6

24.0

19

76.0

 21–24

105

27.3

37

35.2

68

64.8

 25–29

139

36.2

40

22.8

99

71.2

 30–34

79

20.6

18

22.8

61

77.2

 > 35

36

9.4

7

19.4

29

80.6

Residence

 Urban

280

72.9

100

35.7

180

64.3

 Rural

104

27.1

8

7.7

96

92.3

Religion

 Orthodox

249

64.8

76

30.5

173

69.5

 Muslim

73

19.0

19

26.0

54

74.0

 Protestant

49

12.8

11

22.4

38

77.6

 Catholic

13

3.4

2

15.4

11

84.6

Ethnicity

 Amhara

228

59.4

74

32.5

154

67.5

 Tigray

40

10.4

8

20.0

32

80.0

 Oromo

116

30.2

26

22.4

90

77.6

Marital status

 Single

32

8.3

5

15.6

27

84.4

 Married

333

86.7

100

30.0

233

70.0

 Divorced

19

4.9

3

15.8

16

84.2

Educational status

 Unable to read and write

73

19.0

4

5.5

69

94.5

 Primary (1–8)

119

31.0

25

21.0

84

79.0

 Secondary (9–12)

113

29.4

45

39.8

68

60.2

 Tertiary (Diploma and above)

79

20.6

34

43.0

45

57.0

Occupation

 Housewife

261

68.0

73

28.0

188

72.0

 Employed

90

23.4

32

35.6

58

64.4

 Unemployed

33

8.6

3

9.1

30

90.9

Newborns weight (in grams)

 ≥ 4000

10

2.6

4

40.0

6

60.0

 2500–3999

346

90.1

90

26.0

256

74.0

 1500–2499

27

7.0

13

48.1

14

51.9

 1000–1499

1

0.3

1

100.0

0

0.0

Sex

 Male

203

52.9

54

26.6

149

73.4

 Female

181

47.1

54

29.8

127

70.2

Obstetrics Characteristics of Mothers

From the total study participants 315 (82%) of the pregnancy was unwanted and 348 (90.6%) have ANC follow up at health facility (Table 2).
Table 2

Obstetric characteristics of mothers indexed infants on SSC practice status during postpartum stay at public health institutions in four selected cities post-natal units, Ethiopia, 2016/17

Variables

Frequency

Percent

SSC status (N = 384)

Yes (n = 108)

No (n = 276)

n

%

n

%

Type of current pregnancy

 Wanted/planned

315

82.0

99

31.4

216

68.6

 Unwanted/unplanned

69

18.0

9

13.0

60

87.0

ANC follow up

 Yes

348

90.6

107

30.7

241

69.3

 No

36

9.4

1

2.8

35

97.2

Number of ANC visits

 One

17

4.4

1

5.9

16

94.1

 Two

32

8.3

7

21.9

25

78.1

 Three

67

17.4

15

22.4

52

77.6

 Four

232

60.4

84

36.2

148

63.8

GA (gestational age)

 < 37 weeks

9

2.3

7

77.8

2

22.2

 37–42 weeks

375

97.7

101

26.9

274

73.1

Parity

 Primi para

139

36.2

47

33.8

92

66.2

 Multi para

245

63.8

61

24.9

184

75.1

Current birth attendant

 Midwife

274

71.4

88

32.1

186

67.9

 Nurse

30

7.8

6

20.0

24

80.0

 Doctor

25

6.5

6

24.0

19

76.0

 Health officer

55

14.3

8

14.5

47

85.5

Mode of delivery

 Normal SVD

292

76.0

103

35.3

189

64.7

 Assisted delivery

66

17.2

5

7.6

61

92.4

 Abdominally (C/S)

26

6.8

0

0.0

26

100.0

Time after delivery

 < 6 h

295

76.8

77

26.1

218

73.9

 6–12 h

50

13.0

16

32.0

34

68.0

 > 12 h

39

10.2

15

38.5

24

61.5

Prevalence of mothers SSC practice

All (384) mothers were observed to look whether their infants attached with their body (skin), and about 154 (40.1%) of newborns were kept skin-to-skin with their mothers. Mothers were asked to indicate whether they provide SSC to their newborns during their postpartum stay for at least 1 h, and only 108 (28.1%) of mothers have practiced (Additional file 2).

Benefits of SSC

Among mothers who were asked about the advantages of SSC; 214 (55.7%) of mothers have responded as they know the purpose of SSC, and 170 (44.3%) of mothers didn’t know. Among mothers who know SSC importance 88 (22.9%) of them replied that SSC helps both to prevent hypothermia and facilitates EBF; 73 (19%) knew as it prevents hypothermia; only 53 (13.8%) of mothers said that SSC increases ‘Mother-Infant’ bonding.

Mothers’ reasons for not practicing SSC to their newborns

Mothers who didn’t practice SSC to their indexed infants also responded to a question about their reasons not to practice SSC to their newborns. About 126 (32.8%) of them replied that it was due to embarrassment (Additional file 3).

Factors associated with mothers SSC practice to their newborns

Binary logistic regression model showed that educational status, Occupation, Type of current pregnancy and numbers of ANC visits of mothers were associated with SSC practice of mothers to their newborns. Also, Mothers whose current pregnancy is unplanned, mothers who had attended ANC visits, gestational age of current pregnancy of mothers, mothers’ current birth attendant by health officer were significantly associated with SSC practice to their newborns (Table 3).
Table 3

Bivariate and multivariable logistic regression analysis of mothers SSC practice and its determinant factors during postpartum stay at public health institutions in four selected towns’ post natal units, Ethiopia, 2016/17

Variables

SSC status (N = 384)

COR (95% CI)

P-value

AOR (95% CI)

P-value

Yes (n = 81)

No (n = 150)

n

%

n

%

Educational status

 Unable to read and write

4

5.5

69

94.5

13.03 (4.33, 39.23)

0.000

18.23 (5.26, 63.52)

0.000*

 Primary (1–8)

25

21.0

84

79.0

2.84 (1.52, 5.32)

 

3.72 (1.62, 8.52)

 

 Secondary (9–12)

45

39.8

68

60.2

1.14 (0.64, 2.05)

 

1.59 (0.75, 3.39)

 Tertiary (Diploma and above)

34

43.0

45

57.0

1.00

 

1.00

Occupation

 Housewife

73

28.0

18

72.0

1.00

 

1.00

 

 Employed

32

35.6

858

64.4

0.70 (0.42, 1.17)

 

0.43 (0.11, 1.66)

 

 Unemployed four

3

9.1

30

90.9

3.88 (1.15, 13.12)

0.029

67 (0.16, 2.83)

0.582

Type of current pregnancy

 Wanted/planned

99

31.4

216

68.6

1.00

 

1.00

 

 Unwanted/unplanned

9

13.0

60

87.0

3.06 (1.46, 6.40)

0.003

0.59 (0.24, 1.45)

0.251

Number of ANC visits

 One

1

5.9

16

94.1

1.00

 

1.00

 

 Two

7

21.9

25

78.1

19.87 (2.67, 147.62)

 

9.97 (1.21, 81.91)

 

 Three

15

22.4

52

77.6

9.09 (1.18, 69.69)

0.003

8.55 (1.05, 69.54)

0.032*

 Four

84

36.2

148

63.8

2.03 (0.84, 4.88)

 

1.31 (0.49, 3.50)

 

GA (gestational age)

 < 37 weeks

7

77.8

2

22.2

1.00

 

1.00

 

 37–42 weeks

101

26.9

274

73.1

9.49 (1.94, 46.47)

0.005

0.07 (0.01, 0.53)

0.010*

Current birth attendant

 Midwife

88

32.1

186

67.9

1.00

 

1.00

 

 Nurse

6

20.0

24

80.0

1.89 (0.75, 4.79)

 

0.20 (0.07, 0.53)

 

 Doctor

6

24.0

19

76.0

1.49 (0.58, 3.88)

 

0.22 (0.06, 0.89)

 

 Health officer

8

14.5

47

85.5

2.78 (1.26, 6.13)

0.011

0.28 (0.07, 1.09)

0.212*

COR crude odds ratio, AOR adjusted odds ratio, CI confidence interval

* Significant association with P-value < 0.05

As it was clearly shown on the multivariable logistic regression analysis, after controlling for the effects of confounding variables, only two variables were significantly associated with mothers SSC practice to their newborns; educational status (AOR = 18.23 [95% CI 5.26, 63.52]), and number of ANC visits (AOR = 8.55 [95% CI (1.05, 69.54)] were significantly associated with SSC practice of mothers to their newborns (Table 3).

Discussion

It is well documented that continuous uninterrupted SSC, which lasts for at least an hour has been shown to improve the success of EBF, maintains body temperature normal, maintains heart rate, respiratory rate and blood pressure normal [10, 17].

The prevalence of SSC Practice amongst mothers–infants indexed during the postpartum stay in this study was 28.1%. This finding was low as compared to studies in high-income countries in which SSC practice rate ranges from 60 to 70%. The prevalence of SSC in this study was lower as compared to developed countries. The variation might be due to mothers’ poor educational status (50%), 44.3% of mothers didn’t know SSC practice merits, and mothers were also lack knowledge and skills (31%) on how to provide SSC in the present study.

In this study, from mothers who didn’t practice SSC to their indexed infants about 32.8% of them put their reasons for not providing SSC to their newborns due to discomfort and lack of SSC knowledge and skills (31%).

This result was in line with the study conducted in Canada and northern Midwest United States, which showed about 20–30% of mothers interrupted breast feeding to their newborns due to discomfort during the postpartum stay [16, 18]. The reason for this might be around 25% of mothers in this study experienced instrumental delivery during their delivery which might prevent to provide SSC to their newborns because of the pain they develop.

SSC practice of mothers to their newborns is associated with their educational status. Illiterate mothers were 18 times more to practice SSC to their infants relative to their counterparts with mothers attended tertiary education (AOR = 18.23 [95% CI 5.26, 63.52]). These results could be explained that since majority of mothers in this study were housewives (68%) and they pass all their time with their newborns and feed their breast milk while employed mothers were mostly unable to do this.

Numbers of ANC visits was significantly associated with mothers SSC practice to their newborns during the postpartum stay. Mothers who had attended ANC visits three times were 8 times more likely to provide SSC to their newborns as compared to those who had attended only their first visit (AOR = 8.55 [95% CI 1.05, 69.54]). This could be explained that when mothers attended more ANC visits, their awareness will increase (more than half (55.7%) of mothers have good knowledge on the purpose of SSC) and adherence to care for them and the newborn become more effective, this results low compliance, and finally leads mothers to provide SSC to their newborns.

Conclusion

This study revealed that the proportion of mothers’ SSC practice for at least 1 h to their indexed newborns’ during the postpartum stay was better (28.1%) as compared to other settings.

Limitations

The cross sectional nature of the present study prevents any causal inferences.

Notes

Authors’ contributions

AB, EK, TA participated in the conception, design of the study, reviewing proposal and data analysis. AB and EK participated in reviewing proposal and writing the research report. AB prepared the manuscript for publication. All authors read and approved the final manuscript.

Acknowledgements

First and foremost, we would like to acknowledge the Ethio-Canada MNCH Project of Federal Ministry of Health (FMoH) Ethiopia which gave us an opportunity to engage and undertake this project. We are also grateful to our host institutions and staffs; where data collection undergone, for their facilitation during data collection period, and providing us the necessary information and cooperative support. Finally, our deepest gratitude also goes to the data collectors, supervisor and respondents without whom this project would not have been realized.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

All relevant data are included in this article and its supporting document.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from the Ethical Committee of St Paul’s Hospital Millennium Medical College (SPHMMC). Officials from each selected region/town health offices were communicated through formal letters which was obtained from SPHMMC. An official letter also secured to all the selected health facilities. Before interviewing, written consent was obtained from each study participant mothers. They were informed about the purpose and objective of the study. They were also informed that, they have the right to discontinue or refuse to participate in the study. Confidentiality of information and privacy was also maintained.

Funding

No funding was received for this research work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary material

13104_2019_4176_MOESM1_ESM.docx (13 kb)
Additional file 1. Schematic representation of the sampling procedure for the study on assessment of SSC during the postpartum stay and its determinants among mothers at public health institutions in four selected cities post-natal units, Ethiopia, 2016/17.
13104_2019_4176_MOESM2_ESM.docx (25 kb)
Additional file 2. Proportion of mothers SSC practice status to their indexed newborns during postpartum stay at public health institutions in four selected towns’ post-natal units, Ethiopia, 2016/17.
13104_2019_4176_MOESM3_ESM.docx (21 kb)
Additional file 3. Mothers reasons for not providing SSC to their indexed newborns during postpartum stay at public health institutions in four selected towns’ post-natal units, Ethiopia, 2016/17.

References

  1. 1.
    Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012;5:CD003519.  https://doi.org/10.1002/14651858.cd003519.pub3.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Dalbye R, Calais E, Berg M. Mothers’ experiences of skin-to-skin care of healthy full-term newborns: a phenomenology study. Sex Reprod Healthc. 2011;2(3):107–11.  https://doi.org/10.1016/j.srhc.2011.03.003.CrossRefPubMedGoogle Scholar
  3. 3.
    Service package of care for healthy neonate in hospital: Bureau of Neonatal Health, Office of Family and School Population Health, Ministry of Health and Medical Education. Persian: Winter; 2011.Google Scholar
  4. 4.
  5. 5.
    Karim AM, Admassu K, Schellenberg J, Alemu H, Getachew N, et al. Effect of Ethiopia’s health extension program on maternal and newborn health care practices in 101 rural districts: a dose-response study. PLoS ONE. 2013;8(6):e65160.  https://doi.org/10.1371/journal.pone.0065160.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    CSA and ICF International. Ethiopia demographic and health survey 2011. Addis Ababa: Central Statistical Agency and ICF International; 2012.Google Scholar
  7. 7.
    Bystrova K, Ivanova V, Edhborg M, Matthiesen AS, Ransjö-Arvidson AB, Mukhamedrakhimov R, Widström AM. Early contact versus separation: effects on mother–infant interaction one year later. Birth. 2009;36(2):97–109.  https://doi.org/10.1111/j.1523-536X.2009.00307.CrossRefPubMedGoogle Scholar
  8. 8.
    DiGirolamo, Grummer-Stawn, & Fein, 2008; Murray, Ricketts, & Dellaport, 2007; Parry, Ip, Chau, Wu, & Tarrant, 2013; Semenic, Loiselle, & Gottlieb, 2008.Google Scholar
  9. 9.
    Beyond survival: integrated delivery care practices for long-term maternal and infant nutrition, health and development. 2nd ed. Washington, DC: PAHO; 2013. https://www.who.int/nutrition/.../infantfeeding/BeyondSurvival_2nd_edition_en.pdf?u.
  10. 10.
    Ferrarello D, Hatfield L. Barriers to skin-to-skin care during the postpartum stay. Am J Matern Child Nurs. 2014;39(1):57–60.  https://doi.org/10.1097/01.NMC.0000437464.31628.3d.CrossRefGoogle Scholar
  11. 11.
    Galligan M. Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN Am J Matern Child Nurs. 2006;31:298–304.CrossRefGoogle Scholar
  12. 12.
    McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birth-weight infants. Cochrane Database Syst Rev. 2010;17:CD004210.Google Scholar
  13. 13.
    Ludington-Hoe SM, Morgan K, Abouefettoh A. A clinical guideline for implementation of kangaroo care with premature infants of 30 weeks’ postmenstrual age. Adv Neonatal Care. 2008;8(3 Suppl):S3–23.CrossRefGoogle Scholar
  14. 14.
    Bramson L, Lee JW, Moore E, et al. Effect of early skin-to-skin mother–infant contact during the first 3 hours following birth on exclusive breastfeeding during the maternity hospital stay. JHumLact. 2010;26:130–7 (Epub 2010 Jan 28).Google Scholar
  15. 15.
    Moore ER, Anderson GC. Randomized controlled trial of very early mother–infant skin-to-skin contact and breastfeeding status. J Midwifery Women’s Health. 2007;52(2):116–25.CrossRefGoogle Scholar
  16. 16.
    Bigelow A, Power M, MacLellan-Peters J, Alex M, McDonald C. Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal physiological stress. J Obstet Gynecol Neonatal Nurs. 2012;41(3):369–82.  https://doi.org/10.1111/j.1552-6909.2012.01350.CrossRefPubMedGoogle Scholar
  17. 17.
    Svensson KE, Velandia MI, Matthiesen AS, Welles-Nyström BL, Widström AM. Effects of mother–infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial. Int Breastfeed J. 2013;8(1):1.  https://doi.org/10.1186/1746-4358-8-1.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. J Obstet Gynecol Neonatal Nurs. 2006;35(6):709–16.  https://doi.org/10.1111/j.1552-6909.2006.00095.CrossRefPubMedGoogle Scholar

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© The Author(s) 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  1. 1.School of Nursing, College of Medicine and Health SciencesHawassa UniversityHawassaEthiopia
  2. 2.Department of Midwifery, College of Medicine and Health SciencesHawassa UniversityHawassaEthiopia
  3. 3.Department of Midwifery, College of Medicine and Health ScienceAssosa UniversityAssosaEthiopia

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