Am J Obstet Gynecol MFM. 2021 Aug 25:100472. doi: 10.1016/j.ajogmf.2021.100472. Online ahead of print.
ABSTRACT
BACKGROUND: Women who undergo cesarean delivery report that they are less satisfied with their child birthing experience and have later skin-to-skin contact. As cesarean deliveries account for nearly one-fifth of all births globally, improving the child birthing experience is imperative. One delivery technique that may improve the child birthing experience, termed the family-centered cesarean, allows the mother to view the birth of her baby and to have the baby immediately placed on her chest following delivery.
OBJECTIVE(S): Our primary outcome was to compare satisfaction with birthing experiences between women who underwent either a family-centered or traditional cesarean delivery. Our secondary outcomes compared timing of skin-to-skin contact, and maternal and neonatal outcomes between the two methods of cesarean delivery.
STUDY DESIGN: Pregnant women aged ≥ 18 years who had been admitted to Labor and Delivery with a planned cesarean delivery at one of two delivery units were prospectively enrolled. Women were randomized 1:1, but not blinded, to either the family-centered cesarean (Method 1; N=68) or traditional cesarean (Method 2; N=61). Time to skin-to-skin interactions and newborn vitals were recorded by a nurse at time of delivery. A self-administered questionnaire was provided to participants in the hospital on postpartum to obtain satisfaction with the birthing experience using a modified Likert scale, ranging from 1 (lowest) to 5 (highest). Baseline characteristics and all other variables of interest were abstracted from the electronic medical record. Baseline characteristics, maternal satisfaction, and maternal/neonatal outcomes between methods of delivery were compared using t tests and Pearson’s chi-squared (or Fisher’s exact), as appropriate.
RESULTS: Between June 2016-July 2018, women who were randomized to either Method 1 or Method 2 did not significantly differ by baseline characteristics. This study was unable to detect a difference in satisfaction (4.6 Method 1 vs. 4.4 Method 2; p=0.27). However, mean time to skin-to-skin contact was significantly different. Patients in Method 1 established skin-to-skin contact on average 11.2 minutes earlier than those in Method 2 (5.1 vs 16.3; p<0.01). No other differences in maternal and neonatal outcomes were identified.
CONCLUSION(S): While our study did not find statistical differences in maternal/newborn outcomes, including maternal satisfaction, the family-centered cesarean was significantly associated with earlier skin-to-skin contact. Given known benefits of earlier skin-to-skin contact without associated harm, women should be allowed to choose either method of cesarean delivery based on their personal preference.
PMID:34454161 | DOI:10.1016/j.ajogmf.2021.100472
