Association of duration of skin-to-skin contact after cesarean section in China: a superiority, multi-centric randomized controlled trial

In China, rates of early initiation and exclusive breastfeeding are low. The high cesarean section rates further contribute to low breastfeeding outcomes. Skin-to-skin contact (SSC), a key component of Early Essential Newborn Care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to an RCT.To determine the association of duration of SSC after cesarean section on breastfeeding outcomes and maternal and neonatal health outcomes in China.A multi-centric RCT was conducted at four hospitals in China. 720 participants ≥37 gestational weeks with singleton pregnancy receiving elective cesarean section, using epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at the ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2) and 3 (G3) received 30, 60 and 90 minutes of SSC immediately after cesarean section, respectively.Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2 and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71% and 72%, compared to 22% in control group (p<0.001). The exclusive breastfeeding rate at discharge were 69%, 62% and 71%, compared to 57% in control group (p=0.003). EENC practices were associated with reduction in postpartum blood loss and NICU or neonatal ward admission (p< 0.001, p=0.022) .Our findings highlight that prolonged SSC after cesarean section was associated with higher initiation and exclusive breastfeeding at discharge. It also found associations with reduced postpartum blood loss and NICU or neonatal ward admission.