title: Early skin-to-skin contact for healthy full-term infants after vaginal and caesarean delivery: a qualitative study on clinician perspectives.
abstract: OBJECTIVE
  This study aims to provide insight into key factors from a clinician's perspective that influence uninterrupted early skin-to-skin contact after vaginal and caesarean delivery of healthy full-term infants.
  
  
  BACKGROUND
  Early skin-to-skin contact of healthy full-term infants ideally begins immediately after birth and continues for the first hour or the first breastfeed as recommended by the Baby Friendly Hospital Initiative. However, adoption of early skin-to-skin contact is low in many settings and the barriers that hinder its universal use are not well understood.
  
  
  METHODS
  An exploratory qualitative research design using semi-structured interviews.
  
  
  METHODS
  Eleven clinicians were interviewed, including five registered nurses and one medical doctor from the obstetrics and gynaecology unit as well as four registered nurses and one medical doctor from the neonatal intensive care unit. Core topics that were discussed included perceptions on early skin-to-skin contact and facilitating factors and barriers to early skin-to-skin contact after vaginal and caesarean delivery. Interview sessions were recorded, transcribed and analysed using a thematic analysis approach. A coding framework was developed from which subthemes emerged. The overall themes were adopted from Lee et al.'s thematic framework to categorise factors into institutional, familial-level and implementation factors.
  
  
  RESULTS
  Critical institutional factors included inadequate staffing and education of clinicians on early skin-to-skin contact. On a familial level, parental education and motivation were identified as important factors. Barriers to implementation included the absence of a clinical algorithm and unclear definitions for eligible mothers and infants.
  
  
  CONCLUSIONS
  Various facilitating factors and barriers to early skin-to-skin contact of healthy full-term infants born via vaginal and caesarean delivery were identified.
  
  
  CONCLUSIONS
  Addressing these factors can help to provide a better understanding of clinician perspectives on early skin-to-skin contact and help guide its implementation as standard of care for healthy full-term infants.
authors.affiliation: Selective Utrecht Medical Master, Utrecht University, Utrecht, The Netherlands.
authors.forename: Inez
authors.initials: I
authors.lastname: Koopman
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Callaghan-Koru
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Oluwatope
authors.initials: O
authors.lastname: Alaofin
authors.affiliation: Labor and Delivery at Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.|The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Argani
authors.affiliation: Department of International Health, International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Farzin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015142:Baltimore; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D060127:Kangaroo-Mother Care Method; D008875:Middle Aged; D009034:Mother-Child Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011247:Pregnancy; D055815:Young Adult
keywords: attitudes; beliefs; clinician perspectives; early skin-to-skin contact; facilitating factors and barriers; healthy full-term infants