Background: The implementation of early essential newborn care (EENC) is important to maternal and neonatal health. However, few studies have conducted a complete procedure of EENC in cesarean section. This study aimed to systematically evaluate the effects of EENC during and after cesarean section.
Methods: A randomized controlled trial was conducted at a tertiary hospital in Wuhan, China. Full-term pregnant women who had no comorbidities and underwent elective cesarean section were recruited and received EENC intervention or routine health care. The Infant Breastfeeding Assessment Tool (IBFAT), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), a questionnaire of the breastfeeding behavior, the Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) were used to collect data. The correlation between EENC implementation and breastfeeding, maternal-infant attachment, postpartum depression, and other maternal and neonatal outcomes was analyzed.
Results: Mother-newborn pairs (N = 157) were enrolled in this study, 78 in the EENC group and 79 in the control group. A total of 155 (98.8%) were followed up at 14 days, 144 (91.7%) at 42 days, and 123 (78.3%) at 3 months. For the primary outcomes, generalized linear mixed model analysis showed that implementing EENC during cesarean section was beneficial for initiating breastfeeding (OR = 0.021), shortening the breastfeeding initiation time (β = - 45.321), improving the IBFAT scores (β = 2.740), and enhancing breastfeeding self-efficacy (β = 4.880). These effects were not influenced by time interaction. However, no difference was observed in the rate of exclusive breastfeeding between these two groups (P > 0.05). Implementing EENC during cesarean section significantly improved maternal-infant attachment (β = 9.668). Moreover, univariate analysis showed benefits of EENC in improving postpartum depression (P < 0.001) and decreasing maternal perinatal blood loss (P < 0.05).
Conclusions: According to our small sample study, there is a trend of improvement in breastfeeding related behavior and maternal infant attachment in women who received EENC during cesarean deliveries. The effects of EENC on exclusive breastfeeding should be further explored in the future.
Trial registration: Chinese Clinical Trial Register at www.chictr.org.cn , ChiCTR2300074760, retrospectively registration. Registration Date: August 15, 2023.
Keywords: Breastfeeding; Cesarean section; Early essential newborn care; Health outcomes; Randomized controlled trail.
EENC has been implemented in women who give birth vaginally and has been proven to have numerous benefits in aiding maternal postpartum recovery, increasing breastfeeding rates, and reducing admission rates to NICU. For a long time, China's cesarean section rate has remained high. While EENC has been well-promoted among women undergoing vaginal deliveries, its application in cesarean sections has been limited. Therefore, we conducted a randomized controlled trial, one group received EENC intervention and the other did not receive it. We collected data before and after the intervention to explore the safety and effectiveness of implementing EENC techniques in cesarean sections. The results indicate that the application of EENC in cesarean sections is safe and feasible. It can improve breastfeeding behaviors and mother-infant attachment. This intervention is recommended to be implemented on a larger scale.
© 2024. The Author(s).