Continous parental care models after elective caesarean section : effects on infants’ wellbeing, onset of breastfeeding, and on gender equal parenting

Sammanfattning: Background: Birth by caesarean section is still seen by some as a reason for separation of mother and newborn with the child being placed in a cot or in an incubator separated from the mother. This was the situation in Chile in 2009 to 2012 when this research programme was begun. The overall aim of this research programme was to compare different Continuous Parental Caregiving Models of newborn infants after Elective Caesarean Birth. The specific aim were to determine the effect on the newborn's physiological adaptation, wellbeing, onset of breastfeeding and parents’ experiences and perception of the care provided. Methods: Immediately after caesarean section birth, 95 infants were randomised and assigned to one of three groups with 32 infants in a cot with the father besides, 34 clothed infants in the father’s arms, and 29 in skin-to-skin contact with the father from 45 minutes to 120 minutes after birth. After a second allocation at the end on the time with the father, before the reunion with the mother from 130 to 205 minutes after birth, 56 infants were randomised to be clothed and placed in the mother’s arms and 39 to be placed in skin-to-skin contact with the mother. The neonatal state of wakefulness, rooting and sucking was assessed using the Neonatal Behavioral Assessment Scale, physiological parameters and the time to first breastfeed were recorded. The 95 mothers’ and fathers’ experience and perceptions were captured with open questions to be completed by each subject. The quantitative data were analysed with descriptive statistics, and the qualitative data were analysed using systematic text condensation as described by Malterud. Results: The results from the RCT studies (Studies I - II) were that, regardless of the model of care, all infants were found to display normal physiological patterns while being cared for by the fathers during maternal-infant separation with some advantages being observed for the skin-to-skin cared for group (Study I). Reunited with the mother after being cared for by the father, the infants were in a wakeful state, breastfeeding was initiated, and the infants showed stable physiological patterns. A continuous model of parental care after caesarean section was considered by the mothers to be a beneficial family practice for the baby and the whole family, during mother-child separation (Study IV), confirmed by the experience of the fathers caring for the child during maternal-infant separation. The emerging parenting process is described in study III, and both the mothers and the fathers confirmed that a continuous model of parental care after caesarean section enhances equal parenting. Conclusion: Newborn infants can be cared for safely and appropriately by their parents after elective caesarean section, and if maternal-infant separation occurs, skin-to-skin contact with the father enhances the child's wellbeing, facilitates the onset of breastfeeding and has a positive effect on the parents’ experience. Clinical implication: There is no good reason for separation between a healthy newborn infant and its parents after an elective caesarean section. Training of health care providers in the implementation of a continuous model of parental care after caesarean section as a caring model enhancing extrauterine adaptation during mother-child separation needs to be prioritized.