Determinants of uninterrupted skin-to-skin contact and early breastfeeding after term vaginal birth: a secondary analysis of a randomized clinical trial.

BACKGROUND: Early skin-to-skin contact and breastfeeding within the first hour after birth are recommended components of evidence-based intrapartum and immediate postpartum care and central elements of humanized childbirth models. These approaches emphasize uninterrupted mother-newborn contact, physiologic processes, and minimization of nonessential interventions immediately after birth. Despite these recommendations, early contact and breastfeeding are frequently interrupted in routine maternity care. Such interruptions may occur when newborn behavioral reflexes and maternal neuroendocrine pathways are most primed to support breastfeeding, potentially undermining practices intended to protect the early postpartum transition. OBJECTIVE: To identify provider-related and peripartum factors associated with longer uninterrupted skin-to-skin contact and breastfeeding within the first hour of life among low-risk term vaginal births. STUDY DESIGN: This is a secondary analysis of data from an open-label, parallel-group, 1:1 randomized clinical trial conducted at a tertiary maternity hospital [location withheld for double-anonymized peer review] between April and November 2019. The original trial compared physiological umbilical cord clamping after cessation of pulsation with delayed clamping at 1 to 3 minutes after birth. For the present analysis, candidate determinants included allocated clamping strategy, model of intrapartum care (midwifeled vs physician-led), and time of birth (night vs day). Outcomes were uninterrupted skin-to-skin contact duration and breastfeeding within the first hour of life. Determinants of skin-to-skin duration were evaluated using quantile regression, and determinants of breastfeeding were assessed using modified Poisson regression with robust variance estimation. RESULTS: Among 560 mother-infant dyads (physiological clamping 278, delayed 282), skin-to-skin contact occurred in 553 (98.8%). Median uninterrupted duration was 10.7 minutes (95% confidence interval, 10.0-12.2), and 67 dyads (12.0%) achieved ≥60 uninterrupted minutes. Breastfeeding data were available for 536 dyads (95.7%); 319 (59.5%) breastfed within the first hour. Physiological clamping and midwife-led care were independently associated with longer median skin-to-skin duration (adjusted median differences 8.65 and 4.86 minutes, respectively). In adjusted models, breastfeeding within the first hour was more likely with physiological clamping (adjusted risk ratio 1.41) and longer skin-to-skin duration (adjusted risk ratio 1.09 per 10 minutes) and less likely after night birth (adjusted risk ratio 0.81). CONCLUSION: In this low-risk trial cohort, skin-to-skin contact was nearly universal but typically brief. Physiological clamping and midwife-led care were associated with longer uninterrupted contact, and longer contact was strongly associated with breastfeeding within the first hour. Strategies that protect uninterrupted mother-newborn contact-particularly during night shifts-may improve early breastfeeding.