Knowledge, attitudes, and perceived barriers to skin-to-skin care following caesarean birth among healthcare professionals: a cross-sectional study

Skin-to-skin care (SSC) offers many benefits such as thermoregulation, decreased hypoglycemia, and increased breastfeeding success. Not all hospitals practice immediate SSC after caesarean birth, due to factors such as lack of staff knowledge, training or concerns for infant health. The World Health Organization recommends immediate and uninterrupted SSC for at least one hour after birth. The study assessed healthcare providers’ awareness of SSC benefits and barriers to implementation, compared perspectives across neonatal and obstetric teams, and explored strategies to address these challenges. We also examined attitudes to infant feeding using a validated scale. This cross-sectional survey was conducted at an urban, tertiary-care center in eastern Canada and included healthcare professionals involved in caesarean births, categorized into neonatal-focused and obstetric-focused teams. A questionnaire was developed and administered to assess knowledge of and barriers to SSC following caesarean birth. Item responses on HCP knowledge of SSC were summarized for the total sample and by team (neonatal- vs. obstetric-focused) and compared using chi-square tests. Barrier-related responses were also analyzed using mean-rank scores. There were 79 healthcare professionals who participated in the study and the majority (68.4%) strongly agreed with implementing SSC immediately following caesarean birth. The most common perceived barriers that prevented SSC from occurring were “unwillingness to change,” “attitudes of staff,” “equipment getting in the way,” and “difficulty monitoring the baby’s wellbeing.” Structural barriers were identified more frequently in the obstetric-focused group. In conclusion, healthcare providers demonstrate strong support for immediate SSC following caesarean birth and recognize its benefits for maternal–infant outcomes. However, consistent implementation is limited by multifactorial barriers, including differences in team perspectives, provider attitudes, communication challenges, and operating room constraints. Addressing these barriers through clear protocols, targeted education, and structural supports, alongside interdisciplinary collaboration and practice champions, will be essential to optimize SSC uptake and improve outcomes.