title: Early skin-to-skin contact after cesarean section: A randomized clinical pilot study.
abstract: OBJECTIVE
  Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response.
  
  
  METHODS
  This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative ("early") SCC (n = 17) versus postoperative ("late") SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase.
  
  
  RESULTS
  There was no evidence for differences in parameters reflecting neonatal transition or stress response between the 'Early SSC Group' and the 'Late SSC Group'. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group' (p = 0.004).
  
  
  CONCLUSIONS
  This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group', which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01894880.
authors.affiliation: Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Kollmann
authors.affiliation: Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Lisa
authors.initials: L
authors.lastname: Aldrian
authors.affiliation: Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Scheuchenegger
authors.affiliation: Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Mautner
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, Graz, Austria.
authors.forename: Sereina A
authors.initials: SA
authors.lastname: Herzog
authors.affiliation: Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Berndt
authors.initials: B
authors.lastname: Urlesberger
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.|Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.affiliation: Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Uwe
authors.initials: U
authors.lastname: Lang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Obermayer-Pietsch
authors.affiliation: Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Klaritsch
mesh_terms: D000328:Adult; D001034:Apgar Score; D001317:Austria; D001831:Body Temperature; D002585:Cesarean Section / Q000379:methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007231:Infant, Newborn; D060127:Kangaroo-Mother Care Method / Q000379:methods; D009034:Mother-Child Relations; D058748:Pain Perception; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry; D055291:Salivary alpha-Amylases / Q000032:analysis; D013312:Stress, Physiological
chemical_list: D055291:Salivary alpha-Amylases; D006854:Hydrocortisone