Actualizing the implementation of the underutilized low-cost, life-saving intervention of skin-to-skin contact immediately after birth in a regional referral hospital in Uganda

As a low-resource opportunity to decrease neonatal mortality, skin-to-skin contact during the first hour after birth is an evidence-based best practice which is implemented inconsistently world-wide. As described in the 2023 international research and practice guideline, skin-to-skin contact is the recommended standard of care for all mothers and babies after all modes of birth. The practice intends that newborns (1000 g and up) receive immediate, continuous, and uninterrupted skin-to-skin contact. In Uganda, skin-to-skin contact is included in the Clinical Guidelines but has had a low level of uptake. This prospective observational study with sequential cohorts, set in a Ugandan regional referral hospital, sought to delineate and interpret the change in practice from baseline to the 2023 international skin-to-skin guideline, using a care-flow algorithm. The algorithm includes documentation of Widström’s 9 stages of instinctive newborn behaviors. Consent was obtained from parents to video-record their newborns. The standard includes immediate, continuous, uninterrupted skin-to-skin contact including achieving Widström’s 8th stage, suckling within the first hour after birth. The first hour after birth was documented with video-recordings of three birthing cohorts: Cohort A, baseline practice, 92 dyads, Cohort B, after education and protocol change, 105 dyads, and Cohort C, six weeks later, 128 dyads. The behaviors of the newborns during the first hour after birth was extracted from the videos and plotted on a care-flow algorithm. Cohorts were separately analyzed on care-flow algorithms. In Cohort A, 51 of 92 newborns had immediate skin-to-skin contact, 0 achieved continuous or uninterrupted skin-to-skin contact for an hour and 0 achieved the standard of progressing through Widström’s 9 Stages. For Cohort B, 102 of 105 newborns had immediate skin-to-skin contact, 101 achieved continuous and uninterrupted skin-to-skin contact for an hour and 27% (28) achieved the standard. For Cohort C, 125 of 128 newborns had immediate skin-to-skin contact, 125 achieved continuous and uninterrupted skin-to-skin contact for an hour and 44% (55) achieved the standard. Analysis of the implementation of the 2023 international skin-to skin research and practice guideline indicates that it is possible to achieve and sustain the evidence-based life-saving practice of skin-to-skin contact in a low resource setting like a regional referral hospital in Uganda.