The implementation of skin-to-skin contact in midwives using normalisation process theory: A multicenter cross-sectional study in China.

BACKGROUND: In China, the implementation of evidence-based skin-to-skin contact for ≥ 90 min after birth remains suboptimal. Although midwives play a pivotal role in facilitating skin-to-skin contact, the factors influencing their implementation of this practice have not been systematically examined. OBJECTIVE: To investigate the status of skin-to-skin contact implementation among midwives and identify key factors influencing its implementation, guided by Normalisation Process Theory. METHODS: A cross-sectional design with stratified sampling was used to recruit 342 midwives from 16 cities and districts in China between April and September 2025. Data were analysed using descriptive statistics, univariate analysis and binary logistic regression. RESULTS: Substantial gaps were observed in the implementation of skin-to-skin contact, with only 21.9% of midwives routinely completing skin-to-skin contact for ≥ 90 min. Binary logistic regression identified four independent predictors of skin-to-skin contact implementation: hospital nature (OR = 5.572, 95%CI = 1.994-15.574, P = 0.001), whether midwives had knowledge of skin-to-skin contact (OR = 2.751, 95%CI = 1.177-6.433, P = 0.020), coherence (OR = 1.277, 95%CI = 1.083-1.506, P = 0.001), collective action (OR = 1.198, 95%CI = 1.082-1.327, P = 0.001). CONCLUSION: The implementation rate of skin-to-skin contact among midwives remains suboptimal. To improve SSC implementation, future interventions should adopt a whole-system approach. This requires both strengthening midwives' conceptual understanding and commitment to SSC through targeted education, and enhancing collective action within teams through optimised resource allocation and streamlined clinical workflows.