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Babys Skind to Skin Contact Compared to Babys That Are Untouched

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The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor

  • Awaz Aziz Saeed1,
  • Shukir Saleem Hasanone &
  • Lida Moghaddam-Banaem2

International Breastfeeding Journal volume thirteen, Article number:32 (2018) Cite this commodity

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Abstruse

Background

Mother and newborn skin-to-skin contact (SSC) after birth brings nigh numerous protective effects; however, it is an intervention that is underutilized in Republic of iraq where a globally considerable charge per unit of maternal and child death has been reported. The present study was conducted in order to appraise the furnishings of SCC on initiation of breastfeeding, newborn temperature, and duration of the third phase of labor.

Methods

A quasi-experimental study was conducted on 108 healthy women and their neonates (56 in the intervention grouping who received SSC and 52 in the routine intendance group) at Hawler maternity teaching hospital of Erbil, Republic of iraq from February to May, 2017. Information were collected via structured interviews and the LATCH calibration to certificate breastfeeding sessions.

Results

The mean age of the mothers in the SSC and routine care groups were 26.29 ± half-dozen.thirteen (M ± SD) and 26.02 ± five.94 (M ± SD) respectively. Based on the LATCH scores, 48% of mothers who received SSC and 46% with routine intendance had successful breastfeeding. Newborns who received SSC initiated breastfeeding within ii.41 ± 1.38 (Grand ± SD) minutes after birth; however, newborns who received routine care started breastfeeding in five.48 ± v.7 (M ± SD) minutes. Duration of the third stage of labor in mothers who skillful SSC after birth was 6 ± 1.7 min, compared to 8.02 ± 3.half-dozen min for mothers who were provided with routine care (p <  0.001). Moreover, the prevalence of hypothermia in the newborns who received SSC and routine intendance was 2 and 42% respectively. Results remained unchanged after using regression modelling to adjust for potential factors and groundwork characteristics.

Conclusion

Skin-to-pare contact provides an appropriate and affordable yet high quality alternative to technology. It is easily implemented, fifty-fifty in minor hospitals of very depression-income countries, and has the potential to salve newborns' and mothers' lives. It is necessary to prioritize preparation of health providers to implement essential newborn intendance including SSC. Community engagement is also needed to ensure that all women and their families empathise the benefits of SSC and early initiation of breastfeeding.

Trial registration

ClinicalTrials.gov: NCT03548389.

Background

The rate of maternal and neonatal bloodshed is unacceptably high in Iraq. The maternal and neonatal mortality rates are as high every bit 84 cases per 100,000 alive births and 23 cases per 1000 live births, respectively [1]. These figures are significantly higher in Iraq than developed countries, for example neonatal bloodshed rates was reported to be 1.74 per 1000 birth in the Great britain in 2015 [ii]. Perinatal infections and fetal hypoxia are the nearly important causes of neonatal deaths in Republic of iraq, which tin be avoided through early initiation of sectional breastfeeding [1]. Yet, the prevalence of early on initiation of breastfeeding in Iraq is quite low at 38.i% [3].

Every bit recommended past the Baby Friendly Hospital Initiative (BFHI), newborn infants should exist placed in peel-to-pare contact with their mothers immediately later their nascence for at least one hour, and mothers should be helped to initiate breastfeeding within the first one-half-hour post-obit the nascence of their infants [4, v]. The term skin-to-skin contact (SSC) is defined as the placement of a naked infant, occasionally with a diaper or a cap on, on its mother's bare skin, and the exposed side/back of the babe covered by a blanket or a towel [vi]. The movement of the infant'southward hands over the mother breasts during SSC leads to increased secretion of oxytocin, which results in increased secretion of chest milk [7].

It is also known that SSC later nascence promotes newborn temperature regulation, metabolic adaptation, and maintenance of glucose blood levels. Infants accept a reduced chapters to generate heat, which leads to a rapid turn down in temperature. This is why maintenance of temperature is ane of the most important needs of infants at birth [8]. While the mother and her infant are in SSC, heat is transferred from the female parent to the babe, during which the mother's body temperature activates the infant'due south sensory nerves, which in plough results in the babe's relaxation, reduction in the tone of the sympathetic nerves, dilation of pare vessels, and increase in its temperature [7]. Hypothermia during the newborn period is widely regarded every bit a major contributory crusade of significant morbidity and, at its extreme, bloodshed in developing countries [9]. High prevalence of hypothermia has been reported in countries with the highest rate of neonatal mortality, where hypothermia is increasingly gaining attending and significance as a critical intervention for newborn survival [ten].

In addition providing the newborn with numerous benefits, SSC is associated with many benefits for mothers. Secretion of maternal oxytocin in mothers who receive SSC strengthens uterine contractions, which in turn helps the placenta to separate and the duration of the third stage of labor to subtract [11]. The third stage of labor, which involves separation and expulsion of the placenta and membranes, starts immediately later the commitment of the fetus [12]. In about obstetric settings, agile management of the third stage of labor is now a common practice to accelerate the 3rd phase, in which synthetic oxytocin that causes the uterus to strongly contract is administered. In a spontaneous, uncomplicated nascence, information technology is reasonable to plan a physiological or natural tertiary phase by utilizing the mother'south own oxytocin [13, xiv].

In that location is an urgent need to reorganize and restructure health services throughout Iraq, and motherhood and neonatal care is one of the disquisitional areas that needs substantial efforts in this regard [15]. As a cost-constructive, simple and advisable method, mother and newborn SSC later on birth should exist skillful in order to improve mail-delivery care and potentially salve the lives of mothers and newborns [16]. There are very few studies that focus on the furnishings of SSC on maternal and newborn health in Iraq. The present study was carried out in order to determine the effect of early maternal-newborn SSC later birth on the duration of the third stage of labor, early initiation of breastfeeding, and newborn temperature.

To attain the objectives of the study, the post-obit hypotheses were tested:

  1. (1)

    Mothers who practice early female parent and newborn SSC after giving nascency feel a shorter duration of the 3rd phase of labor compared with those who do non practise SSC.

  2. (2)

    Mothers who practise early on mother and newborn SSC afterward giving birth showroom before initiation of breastfeeding compared with those who do non practise SSC.

  3. (iii)

    Newborns with mother and newborn SSC showroom normal torso temperature 30 min later on nascence compare with those who do not receive this contact.

  4. (4)

    Mothers who do early mother and newborn SSC after giving birth exhibit more successful breastfeeding compared with those who do not perform this contact.

Methods

A quasi-experimental study was conducted on 108 mothers and their neonates in the maternity department of Hawler maternity teaching hospital in Erbil, Iraq from February to May, 2017. Hawler maternity educational activity hospital is one of the largest and busiest motherhood infirmary in Erbil. Erbil is a city that lies 80 km (fifty miles) east of Mosul, and is the capital of the Kurdistan Region of Iraq in which the dominant linguistic communication spoken by residents is Kurdish [17].

Of the 130 women who were eligible to participate in this written report, twenty-two women were unable to continue SSC for 1 h after birth, therefore they were excluded. Finally, we included results from 108 mothers in this study who were randomized into two groups: an intervention group consisting of 56 mothers; and the control group consisting of 52 mothers.

Mothers in both groups were homogeneous in terms of their age and gravidity. Laboring women and newborns who met the following weather condition were included in the study:

  • Normal pregnancy

  • Full-term (38 to 42 weeks of gestation)

  • Anticipated normal vaginal delivery and want to breastfeed the infant at birth

  • Lack of receiving any pharmacological pain relief

  • Willing to join the study

  • Newborns with an Apgar score >  vii

In this written report SSC meant holding the newborn baby undressed in a prone position against the female parent's bare breast between breasts while the back of the baby was covered with a blanket. This SSC commenced immediately afterwards giving nativity and connected for 1 h.

Study instruments

Four instruments were used to collect data. The commencement instrument was a questionnaire to gather the required demographic and obstetric data from the mothers, including age, gravidity, number of miscarriages, parity, and history of lactation, along with the demographic data of the infants, including weight and gender. The second musical instrument was a written form that was used to assess the elapsing of the third stage of labor, which was measured from time of delivery of the infant to the time of complete commitment of the placenta [18]. The 3rd instrument was a written grade to record axillary temperatures of the newborns. The fourth instrument was the LATCH breastfeeding assessment tool. LATCH is a sensitive, reliable and valid tool that evaluates breastfeeding techniques based on observations and descriptions of effective breastfeeding [19, xx]. The messages of the acronym LATCH designate five separate cess parameters: "L" for how well the infant latches onto the breast, "A" for the amount of audible swallowing, "T" for the female parent'south nipple types, "C" for the female parent'due south level of condolement, and "H" for the corporeality of support the female parent has be given to hold her infant to the breast. Each parameter is scored using a numerical score of 0, 1, or 2 [19]. The LATCH scale was designed to assess the success of breastfeeding in this study since it is a useful tool in female parent-babe pairs who might do good from boosted skilled back up to initiate breastfeeding in specific subgroups at risk of non-sectional breastfeeding at discharge [21].

The "L" cess was scored as "two" if proficient latching was identified (grasps breast, natural language down, lips flanged and rhythmic sucking); "1" if repeated attempts to hold the nipple in the mouth or to stimulate to suck were identified, and "0" if poor latching (as well sleepy or reluctant or no latching achieved) was seen. The "A" cess was scored as "2" if audible swallowing occurred (spontaneous and intermittent < 24 h onetime or spontaneous and frequent > 24 h sometime), "1" if a few swallows occurred with stimulation, and "0" if ineffective swallowing occurred. The "T" assessment was scored every bit "ii" if an everted nipple was nowadays (after stimulation), "1" if the nipple was flat, and '0' if the nipple was inverted. The 'C' assessment was scored as "2" if the breast was soft and tender, "1" if the chest was filled or reddened / featured minor blisters / bruised nipples, and "0" if the breast was engorged or if a cleft appeared. The 'H' assessment was scored as "ii" if good positioning was achieved (no assistance from the staff or mother able to position / agree infant), "1" if minimal help was required (i.e., drag the head of the bed or place pillows for support), and "0" if full assistance was required (staff held the infant at the mother's chest) [19]. The total score ranges from 0 to 10, with the higher score representing efficient breastfeeding techniques. A total score of more than seven is regarded as successful breastfeeding, and a score of less than 7 is considered as unsuccessful breastfeeding [19].

Method of data collection

The midwives who worked regularly in the birthing suite agreed that the researcher could nourish and record observations of consenting mothers while they were being provided with intendance. The midwives were requested to carry every bit if the researcher was non present and not to make changes to their normal practise. The researcher arrived at the delivery room, confirmed the consent of the laboring woman and her relatives, and gained her presence permission from the person managing the birth. The observation equipment included the observation record sheet on a clipboard, a stopwatch, a thermometer and a pen. When nascency was imminent, the researcher entered the room to observe. At the moment of birth, the researcher started the stopwatch to record the time following the birth. The researcher stayed with each adult female until the finish of the kickoff hr afterward birth.

In the routine intendance group, the baby was delivered by a midwife, wrapped in blankets, placed under a warmer, and and so stale. The Apgar score was adamant immediately afterward the umbilical string was cut. The infants were provided with this routine care past the midwife working in the delivery room. Afterwards the infants were weighed, dressed, and measured, they were handed to their mothers who were encouraged to begin breastfeeding. The routine care of placing a newborn under a warmer is performed in the least time possible (iv–five min) in Hawler motherhood teaching hospital due to the presence of only 2 warmers in the birthing suite for a five-bed room, which are virtually always occupied.

With the assistance of the researcher, infants in the intervention group were placed undressed in a prone position against their mothers' bare chest between breasts immediately afterwards nascency and before placental delivery or suturing of tears or episiotomy. The Apgar score was determined, the infant's olfactory organ and mouth were suctioned while on the mother's chest, the babe was stale, and both mother and baby were covered with a pre-warmed blanket. To preclude estrus loss, the baby's caput was covered with a dry out cap that was replaced when it became damp. Dressing and measuring of the infant were postponed to one 60 minutes after the delivery by a registered midwife.

By continuing backside or next to the bed and approaching closer to view the actions, the researcher monitored the infants while they were exhibiting feeding behaviors such as mouthing, licking, latching, and suckling. Breastfeeding initiation time subsequently nascency and elapsing of the first breastfeed were recorded, and then the LATCH calibration was used to assess the success of the first breastfeed in the two groups. Some of the mothers in the 2 groups asked the researcher for assistance to breastfeed their newborns; therefore, the degree of assist provided past researcher was scored along with other parameters of the LATCH scale (latch, audible swallowing, nipple type, comfort).

Active management of the third stage of labor was performed for all participants by a registered midwife. This composed of three steps: 1) administration of ten IU constructed oxytocin, immediately later on nascence of the babe; two) controlled cord traction (CCT) to deliver the placenta; and 3) massage of the uterine fundus later on the placenta is delivered [18]. The researcher did not interfere with the delivery of the placenta and just observed this process being performed by the midwife. Duration of the third stage of labor, which starts with the commitment of the fetus and end with the consummate commitment of the placenta was measured by the researcher [18].

In the 1991 World Health Arrangement (WHO) guidelines it was recommended that rectal temperature should be limited and axillary temperature should be used routinely for the newborn [22]. Therefore, in this study, axillary temperature of the newborns in both groups was checked xxx min after nascency. The measuring range of the thermometer was 32–42 °C with accuracy to the nearest tenth of a degree. The thermometer sensor was sterilized with seventy% alcohol before each apply. After the push button ability was activated, the digital thermometer was turned on and put with the sensor in the newborn'southward armpit, and kept there until the alarm sound was heard. The score on the screen showed the measured body temperature. Based on WHO'southward guidelines (1991), an axillary temperature of less than 36.0 °C in newborns is considered as hypothermia [23].

Statistical methods

Data were analyzed using SPSS statistical analysis software. Descriptive relationships betwixt demographic variables and type of care provided for mothers and newborns later birth were explored using means and standard deviations (SD) for continuous variables, whilst categorical variables were described using proportions. The relationship betwixt SSC and time to initiate breastfeeding, elapsing of third phase of labor, success of breastfeeding, newborn hypothermia, and temperature of the newborn 30 min later nascency were analysed using T tests and Chi square tests. Logistic regression modelling was used to examine the event of SSC and conventional care on outcomes of the report by adjusting for potential confounders similar mother'south historic period, teaching level, occupation, parity, and newborn gender. The level of statistical significance was set at p <  0.05 in this report. This report had 100% ability at a 95% level of confidence to detect 38 and 56% divergence in initiation of the breastfeeding and newborn temperature betwixt mother-newborn who experienced SSC and mother-newborns who underwent routine intendance. The equivalent power value to detect 17% differences in duration of third stage of labor was 81%.

Results

This written report was carried out on 108 mothers and their newborns. The results showed that mean age of the mothers in the SSC and routine care groups was 26.29± 6.13 (M± SD) and 26.02± 5.94 (M± SD) respectively. Higher numbers of the mothers in the routine intendance group had secondary and academic education compared with mothers in the intervention grouping. Most of the mothers in both groups were non-employed and multigravid. Approximately, the aforementioned proportion (50%) of the mothers in both groups were primipara. The results showed that the ii groups were not significantly unlike in terms of the mothers' demographic characteristics including maternal historic period, occupation, gravidity, number of miscarriages, parity and number of antenatal visits (Table one). This study revealed that 48% versus 46% of the newborns who experienced SSC or routine care accomplished successful breastfeeding, respectively (Table 2).

Tabular array one Maternal and newborn characteristics in SSC and routine care groups

Full size table

Table 2 Success of breastfeeding in mothers with peel-to-skin contact and routine care

Total size tabular array

There was an association between mother and newborn SSC and breastfeeding initiation time later on birth. Newborns who experienced SSC initiated breastfeeding 2.41 ± one.38 (Yard ± SD) minutes subsequently delivery, while newborns in the routine care grouping started breastfeeding 5.48 ± 5.70 (Thou ± SD) minutes following their birth (p <  0. 001).

As shown in Table iii, elapsing of the starting time breastfeed in mothers with SSC versus routine intendance was 23.07 ± 7.89 (M ± SD) and 23.79 ± 8.22 (M ± SD) respectively; however, this difference was not statistically significant. In mothers who skilful SCC, the duration of the third stage of labor was significantly shorter than that of the command group (6 ± 1.74 (M ± SD) versus 8.02 ± three.69 (M ± SD) minutes) (p <  0.001). The average axillary temperature of the newborns who experienced SSC was 37.33 ± 0.65 °C, while it was 36.18 ± 0.99 °C in newborns in the routine care group. It was found that 98% of the newborns in the SSC group had normal temperature and 2% of them had hypothermia. On the other paw, 42% the newborns in the routine care group had hypothermia.

Table 3 Comparison of breastfeeding behaviors, newborn temperature and 3rd stage of labor between groups

Full size tabular array

After using the regression model for aligning of potential factors and background characteristics such as age, education level, employment, parity and newborn gender, there was an clan between newborn temperature [Odds Ratio (OR) 0.01; 95% Conviction Interval (CI) 0.002, 0.12] newborn hypothermia (OR 180.3; 95% CI 3.84, 8480), time to initiate breastfeeding (OR 2.86; 95% CI 1.68, 4.85) and elapsing of third stage of labor (OR 2.14; 95% CI ane.27, 3.vi) with SSC (Table 4).

Table 4 Adapted relationship of breastfeeding behaviors, newborn temperature and third stage of labor with SSC

Full size table

Give-and-take

Fifty-two percent of the women in this written report received mother-newborn SSC immediately after birth, and 48% experienced convention care later on delivering their babe. In this study, mothers in the SSC group had completed lower levels of pedagogy compared to mothers in the routine intendance group; still, this deviation was not associated with the outcomes assessed in this written report when logistic regression analysis was applied. No relationship was observed betwixt other maternal characteristics with SSC and routine care.

According to the results of the present study, contact through the peel between the women and their newborns later on nascence led to greater initiation of breastfeeding. Information technology is non articulate why SSC improved breastfeeding behaviors of healthy total term infants, yet, similar findings have been reported in the literature [24]. The American College of Nurse-Midwives state that SSC helps infants smell and find the nipple so that breastfeeding will be initiated past them more rapidly and successfully [25]. This can be attributed to the loftier levels of catecholamine immediately afterwards birth, which makes olfactory bulbs in the baby'due south nose extremely sensitive to aroma cues [26]. The results of the studies carried out by Moore and Anderson in United states [27], Khadivzadeh and Karimi in Iran [28], and Mahmood et al. in Islamic republic of pakistan [29] showed that early contact improved breastfeeding initiation and prolonged the duration of breastfeeding in infants. Early initiation of breastfeeding stimulates breast milk production, produces antibody protection for the newborn and its practice determines the successful institution, longer duration of breastfeeding, and lower risk of neonatal mortality [xxx].

In their report, Essa et al., using the Infant Breastfeeding Cess Tool (IBFAT), found that the SSC and control groups were statistically unlike in terms of the success of the start breastfeed rate [31]. However, the LATCH scale used in this study to assess the success of breastfeeding plant no statistical difference between the 2 groups. This discrepancy could be due to a deviation in the tools used to assess the success of breastfeeding.

Neonatal hypothermia is an of import contributing factor to neonatal mortality and morbidity in both adult and developing countries; especially in developing countries [10]. The Maternal and Child Health Program past the WHO has issued guidelines for prevention of neonatal hypothermia every bit one of the elements of essential care in the newborn at birth and on the first day of life [32]. In the present study, 42% of the newborns who did not receive SSC care had hypothermia; however, merely 2% of the newborns who received SSC developed hypothermia later birth. In their study on 160 term neonates in Islamic republic of iran, Keshavarz and Haghighi investigated the furnishings of kangaroo contact on physiological variables later cesarean section. In and so doing, the neonates were randomly assigned into a SSC group and a routine care grouping. The newborns' temperatures in both groups were measured one-half an hour later the cessation of contact. The hateful temperature was significantly dissimilar in the SSC and routine care groups (36.eight °C and 36.6 °C respectively), and the mean temperature 1 hour afterward SSC was 36.nine °C, which was 0.3 °C college than the mean temperature in the control group (푃 = 0.001) [33]. The results of a meta-assay comprised of 23 studies indicated potent bear witness of increased trunk temperature as a event of SSC. It is interesting to note that the ambience temperature did not influence the outcome of body temperature, as even in colder environments the body temperature of newborns who received SCC increased or at least remained unchanged [34]. Transfer of rut from the mother to the newborn facilitated by direct skin contact has been demonstrated to be at to the lowest degree every bit effective every bit incubator care for warming [35].

Assessing the outcome of SSC on duration of the tertiary stage of labor in the present report showed that the mothers who had SSC with their babe after nativity had a shorter 3rd phase in comparing with those who received routine care (6 min vs 8.02 min). Similar findings have been reported in a study carried out in Baghdad, Iraq by Mejbel and Ali to examine the effectiveness of SSC on the duration of the third stage of labor [36]. In an Egyptian investigation of low take chances primiparous women who either received SSC or routine infirmary intendance, the mean duration of the third stage of labor in the SSC grouping was significantly shorter (2.eight ± 0.85 min) than the routine care group (11.22 ± 3.33 min) (p < .01) [31]. Common practices used in the management of 3rd stage of labor neither facilitate the production of a female parent's own oxytocin nor reduce catecholamine levels during the commencement minutes subsequently birth, both of which can be expected to physiologically amend the new mother's contractions and thus reduce her claret loss. The routine practice of separating female parent and infant deprives the mother of of import opportunities to increase her natural oxytocin levels [12].

The results of the present study demand to be considered in the light of its limitations. In this study, at that place were no data on exclusive breastfeeding, and duration of breastfeeding was not assessed. In hereafter studies, information technology would be beneficial to expect at exclusive breastfeeding later discharge through a longitudinal study. The researcher of the present study was faced with some challenges in facilitating SSC for the mothers in the intervention group. This may have been because mothers in this study had low cognition regarding SSC care, equally a consequence of poor provision of health education at antenatal care units in main health care center in Erbil: only 23.7% of visiting women receive education virtually baby care and breastfeeding [15]. Increased workload in the obstetric unit did non allow the researcher to continue SSC more than 1 hour later on birth, although well-nigh of the mothers were very pleased and enjoyed the feel of SSC and wished to prolong its duration.

Conclusion and recommendations

To reduce the current prevalence of high neonatal morbidity and mortality rate in Republic of iraq, there is a dire need for simple and cost-effective prevention and (complementary) intervention methods that are easily accessible to mothers and can be applied immediately after nascence. Mother and newborn SSC is a low-cost intervention that would be attainable, simple, and feasible for almost mothers in developing countries. In order to accomplish this goal, the old paradigms of labor and delivery care demand to be changed and immediate, uninterrupted SSC after birth should exist skillful. Unlimited opportunities for SSC and breastfeeding promote optimal maternal and child outcomes. It is critical to provide all midwives in delivery rooms with continuous educational and training programs on how to implement SSC for all mothers. These changes directly support the millennium goals of improved maternal and child health.

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Acknowledgements

The authors would like to thank the commitment room staff of Hawler motherhood teaching hospital of Erbil, Iraq for their cooperation.

Availability of data and materials

The datasets analysed during the current written report are bachelor from the corresponding author on reasonable request.

Author data

Affiliations

  1. Department of Nursing, College of Nursing, Hawler Medical Academy, Erbil, Republic of iraq

    Kolsoom Safari, Awaz Aziz Saeed & Shukir Saleem Hasan

  2. Department of Midwifery and Reproductive Wellness, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

    Lida Moghaddam-Banaem

Contributions

SAA and SK completed the data collection for this written report. SK and HSS participated in the design of the study and performed the statistical analysis. SK and SAA conceived the written report, participated in its design and coordination, and helped to typhoon the manuscript. MBL, HSS, and SK reviewed and revised the manuscript. All authors read and canonical the final manuscript.

Respective author

Correspondence to Kolsoom Safari.

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Ideals blessing and consent to participate

The participants gave informed consent for the data collection and ethical approving for the information collection was granted past ethical committee of the Nursing College of Hawler Medical University (Ref no. 20).

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Not applicable

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The authors declare that they accept no competing interests.

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Safari, K., Saeed, A.A., Hasan, S.S. et al. The effect of mother and newborn early on skin-to-peel contact on initiation of breastfeeding, newborn temperature and duration of tertiary stage of labor. Int Breastfeed J xiii, 32 (2018). https://doi.org/10.1186/s13006-018-0174-9

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  • DOI : https://doi.org/10.1186/s13006-018-0174-9

Keywords

  • Early skin-to-skin contact
  • Temperature
  • 3rd stage of labor
  • Initiation of breastfeeding

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Source: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-018-0174-9

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