2. Materials and Methods
This study was designed as a Randomized Clinical Trial (RCT) conducted in Asali Hospital (west of Iran). The inclusion criteria for the mothers included singleton pregnancy, gestational age of 38–42 weeks, age range of 18–40 years old, and elective cesarean section surgery under spinal anesthesia. The exclusion criteria for the mothers included problems such as severe bleeding, uterine inertia, gestational diabetes and hypertension, and heart disease. The inclusion criteria for the infants included being full-term and having first- and fifth-minute Apgar above seven. The study excluded the infants with high risks and abnormalities or any other problems which needed hospitalization, according to the doctor’s advice. According to sample size formula and considering the loss of samples 96 mother-infant dyads were selected. Then the samples were randomized to skin-to-skin () and routine care () groups via a random number table.
The data collection tools consisted of four parts. The first part included the demographic data of the mothers including age, weight, and gestational age, number of miscarriages, number of children, history of lactation, and history of problems during pregnancy, along with the demographic data of the infants including height, weight, head circumference, chest circumference, and first and fifth-minute Apgar. The second part was a form to record temperatures of the mothers and infants infrared ray thermometer on the forehead, IN4K8210 model. The third part was the standard Infant Breastfeeding Assessment Tool (IBAT), which included four subscales of sucking, rooting, readiness, and latching, each having 0–3 scores and 0–12 scores in total, which were completed through direct observation of infant breastfeeding. IBAT is a reliable tool for assessing infant success in first breastfeeding which has been used in several studies [11, 12]. The questionnaire was prepared from authentic scientific resources. Its validity was confirmed through the content validity based on the expert viewpoints of faculty members in the Faculty of Nursing and Midwifery in Khorramabad (west of Iran), and its reliability was confirmed through direct observation in a random sample of 20 cases of breastfeeding in the pilot study in which correlation coefficient was 0.95.
The fourth part was a form of maternal satisfaction with skin-to-skin contact, which consisted of 11 questions (yes, no, and not know) and was completed as a self-report with a confirmed validity in previous studies.
To perform the study, the researcher first arranged with the authorities of the Obstetrics Ward of Asalaian Hospital of Lorestan University of Medical Sciences (west of Iran) and then attended the hospital. The samples were selected from July 2011 to September 2011, according to the inclusion criteria of the study and their informed consent to participate in the study. Subsequently, the mothers’ temperatures in the two groups before and after of surgery were recorded via the forehead infrared thermometer; infants temperatures were recorded on arrival at the operating room after their umbilical cords were cut and a general assessment of the infants then their first and fifth-minute Apgar scores were measured. The infants were then wrapped in blankets and taken to the nursery ward. In this unit, their temperatures were recorded after anthropometric measurements and vitamin K injections were performed. Then the babies were delivered to their mothers when mother back from operation room, and in the experimental group the naked infants in diapers were positioned between their mother breasts in a prone position. To preserve the infants’ temperatures, their heads were covered with hats and their backs with suitable covers. The mothers and infants’ temperatures were measured and recorded at the start of skin-to-skin contact, half an hour, and one hour after with infrared ray thermometer on the forehead. In the control group, the infants were dressed and embraced by their mothers to be breastfed, and their temperatures were measured at the time they were delivered to their mothers, after half an hour, and after one hour. Also, the mothers in the two groups were trained how to breastfeed. Then the Infant Breastfeeding Assessment Tool (IBAT) was applied to assess breastfeeding in the two groups, and the satisfaction form was completed by the mothers in the skin-to-skin contact group. Moreover, the temperatures of the nursery ward, the operation room, and the mother’s ward were measured and recorded in all the steps.