The association of early and continuous skin-to-skin contact and sustained exclusive breastfeeding at 3 months of age among healthy, term infants

Audrie Anne L. Lazaga. MD, Ma. Luisa DV. Manlapaz. MD

Background: Breastfeeding is a practice highly recommended by the World Health Organization (WHO) in improving maternal and child health. Immediate skin-to-skin contact (SSC) is part of the Essential Intrapartum Newborn Care (EINC) protocol to improve breastfeeding success. In particular, an uninterrupted SSC for 90 minutes is proposed to have a significant impact on breastfeeding success. However, this is challenging in actual practice for many particular reasons including maternal and infant status during delivery. Cultural factors may also play a part not only in the practice of SSC but also in the observance of exclusive breastfeeding. Presently, there is no local data on the association between uninterrupted SSC and exclusive breastfeeding success and duration. This study aims to investigate the association between the practice of uninterrupted SSC and successful exclusive breastfeeding during the third month of life.

Methods: This is a prospective cohort study conducted within a tertiary hospital in the Philippines. Mother-infant dyads born from October 2014 to September 2015 were recruited and outcomes were determined at the 3rd month of life. Participants were divided into two cohorts: (1) infants who were placed skin-to-skin with the mother but did not complete the 90 minutes, and (2) infants who were placed skin-to-skin with the mother for a full 90 minutes. Success of exclusive breastfeeding after 3 months of delivery was assessed through a structured questionnaire taken from WHO indicators for assessing infant and young child feeding practices part 2: measurement (2010) from the WHO Library Cataloguing-in-Publication Data. Statistical differences between the two groups were analyzed by Pearson Chi-square test and t-test using SPSS software version 19.

Results: A total of 71 participants were enrolled with 11 participants who were lost to follow-up and were excluded during the analysis. Twenty-nine participants had uninterrupted SSC contact while 31 had interrupted SSC. Initiation of breastfeeding within the first hour of life was statistically significant (p-value 0.002) between infants who had uninterrupted SSC with their mother (n=22, 66.7%) and infants with interrupted SSC (n=11, 33.3%). Follow-up at three months of age showed exclusive breastfeeding of 14 (48.3%) infants for the uninterrupted SSC group and 14 infants (45.2%) for the interrupted SSC group. Odds ratio of exclusive breastfeeding among uninterrupted SSC is 0.8824 (95% CI 0.3197 – 2.4355).

Conclusion: Initiation of breastfeeding within the first hour of life is higher in infants with uninterrupted SSC. The duration or completion of uninterrupted skin-to-skin contact for 90 minutes does not appear to be associated with exclusive breastfeeding at the 3rd month of life.