Knowledge and practice on skin-to-skin contact and early breastfeeding methods of women with vaginal delivery at Ha Noi obstetrics and gynecology hospital
RESEARCH ARTICLE
KNOWLEDGE AND PRACTICE ON SKIN-TO-SKIN CONTACT
AND EARLY BREASTFEEDING METHODS OF WOMEN WITH VAGINAL DELIVERY
AT HA NOI OBSTETRICS AND GYNECOLOGY HOSPITAL
Pham Thuy Quynh1, Pham Van Tan1,
Tran Mai Huyen1, Pham Thi Kim Hoan1, Le Tung Lam1
1Hanoi Medical College
ABSTRACT
Objective: To describe the knowledge,
practice of skin to skin and early
breastfeeding of women with vaginal
delivery at the Hanoi Obstetrics and
Gynecology Hospital. 2. To examine the
factors related to the practice of skin-to-
skin and early breastfeeding of women with
vaginal delivery at the Hanoi Obstetrics and
Gynecology Hospital. Method: Postpartum
women at ward A2, Hanoi Obstetrics and
Gynecology Hospital were recruited to the
study. Results: 97% of pregnant women
knew the method of skin-to-skin treatment
for their infants; 81.5% of the women knew
thatthebenefitofskin-to-skincareistokeep
the baby warm; Only 38.9% of infants were
allowed to skin-to-skin contact with their
mothers in the postpartum room. 79.4% of
pregnant women reported that colostrum is
rich in antibodies, 37.7% of children were
breastfed immediately after skin-to-skin
contact with mother; 19.1% of women were
not supported while breastfeeding the first
meal, 19.1% of the women were assisted
to breastfeed their baby. No relationship
has been found between women ’s age,
education and occupation, and skin-to-
skin practice and early breastfeeding.
Conclusion: 38.9% of children were skin-
to-skin contact with their mothers in the
postpartum room; 37.7% of children were
breastfed the immediately after skin-to-skin
contact with their mothers.
Keywords: Knowledge, practice, skin
to skin, early breastfeeding
1. INTRODUCTION
Newborn health care is a problem that is
attracting the attention of countries around
the world. Therefore, the Ministry of Health
identified infant health as a priority in the
National Child Survival Action Plan for the
period 2015-2020 [1]
24.3% of children under 6 months of age
were exclusively breastfed and only about
26.5 % of infants were breastfed within the
first hour of life [2]. EENC implementation in
8 priority countries in the Western Pacific,
only 32% of children were breastfed before
isolating with mother.
According to UNICEF, in Viet Nam, the
report on survey of children and women
objectives (MICS 2014) found that only
The
consequences
of
neonatal
morbidity and mortality were severe, and
interventions available within the maternity-
child health care program may save the
lives of most infants. Warm incubation with
skin-to-skin method and early breastfeeding
were simple and easy interventions that
contributed to improving health and
reducing infant mortality. In addition to
adjusting body temperature, the skin-to-
Cor. author: Pham Thuy Quynh
Email: phamthuyquynhcdythn@gmail.com
Received: Feb 08, 2021
Revised: Feb 15, 2021
Accepted: Mar 05, 2021
Journal of Nursing Science - Vol. 04 - No. 01
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RESEARCH ARTICLE
skin method between mother and infant
- Women with cognitive impairment.
immediately after birth also had many other
effects such as: increasing the rate of early
and exclusive breastfeeding, increasing the
affection of mother and child, developing
cognitition, reducing stress, and reducing
infections in infants [1], [3].
2.2. Methods:
2.2.1. Research design: The research
used cross-sectional descriptive design.
2.2.2. Sample size:
* Skin to skin part
Hanoi Obstetrics and Gynecology
Hospital always wants to take care of
pregnantwomenandnewbornswiththenew
and most effective methods. In order to be
able to apply skin-to-skin and early lactation
in the first days after birth, there is a need
to assess the practice of women on skin-
to-skin and early breastfeeding of women
after giving birth. Therefore, the research
was conducted with 2 objectives: Describe
the current state of knowledge, practice
of skin to skin and early breastfeeding of
women after giving birth at Hanoi Obstetrics
and Gynecology Hospital. Examine factors
related to skin-to-skin practice and early
breastfeeding of women after giving birth at
Hanoi Obstetrics and Gynecology Hospital.
Sample size using the formula for
descriptive study: n= z2(1- a/2)p(1-p)/d2
* In which:
n: required sample size;
a: statistical significance level;
z(1-a/2): confidence index (với a = 0,05 thì
z(1-a/2) = 1,96);
p1 = 0.867 (rate of women with skin to
skin at Hanoi Obstetrics Hospital) [4];
d = 0.05 (maximum permissible error);
Therfore, we have the sample size of the
study: n1 = 1.962 x 0.867 x 0.133 / 0.052
(women).
→ according to the above formula was
calculated: n1 = 177,19
2. RESEARCH METHOD
2.1. Participants: Postpartum women at
ward A2, Hanoi Obstetrics and Gynecology
Hospital were recruited to the study.
* Breastfeeding:
Sample size using sample size formula
for descriptive study: n= z2(1- a/2)p(1-p)/d2
2.1.1. Inclusion criteria:
In which:
- Over 18 years;
n: required sample size;
a: statistical significance level;
- Fullterm pregnancy from 37-41 weeks
as expected;
z(1-a/2): confidence limit factor (với a =
0,05 thì z(1-a/2) = 1,96);
- Healthy babies;
- Can speak, read, listen and understand
VietNamese;
p2 = 0.779 (rate of women breast-
feeding early in the first hour after birth) [5];
- Volunteer to participate in research;
2.1.2. Exclusion criteria:
d = 0.05 (maximum permissible error).
Therfore, we have the sample size of the
study: n2 = 1.962 x 0.779 x 0.221 / 0.052
(women).
- Women with deformity;
- Women with some internal and surgical
diseases: cardiovascular, hypertension,
bronchial asthma, ...
→ according to the above formula is
calculated: n2 = 264.54
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Becausen1>n2, thewomenparticipating
3. RESULTS
in the study were 265 women.
3.1. General information of paticipants
* The research sampling: a convenient
sampling method was used to recruit the
sample until n enough.
Table 1. General information of
women (n=265)
Number
%
2.3. Research period: from October
2020 to January 2021
18-24 years
old
54
20,4
2.4. Instruments:
Age
25-34 years
old
≥35 years old
Primary
school
High school
Professional
school
186
25
4
70,2
9,4
Data was collected using pre-designed
questionnaires and skin-to-skin and early
breastfeeing procedures based on research
objectives and clinical experience. The
questionnaire consists of 3 parts:
1,5
47
5
17,7
1,9
Education
level
Part 1: General information: 9 questions;
College,
university,
postgraduate
Officer
Part 2: Measuring knowledge and
practicing warming by skin-to-skin method:
18 questions;
209
78,9
138
7
23
9
52,1
2,6
8,7
3,4
33,2
Student
Worker
Farmer
Other
Part 3: Measuring knowledge and
practice of early breastfeeding: 15
questions.
Occupation
88
The questionnaire was referenced from
a number of other research topics such as
authors Truong Thi Hai and Pham Van Tung
[6], [7]. The toolkit was tested by Cronbach
alpha before the study.
The most common age of study
participants was the 25-34 group,
accounting for 70.2%.
3.2. Knowledge and practice of
mother about skin-to-skin method
Training research assistant: before
conducting the measurements, research
assistant were trained. The training content
was mainly for research assistant to
understand the content of the questionnaire
and the purpose of the study.
Table 2. Knowledge of skin-to-skin method
Number
%
97,0
Know
skin to
skin
Yes
No
257
8
3,0
100
81,5
2.5. Ethical issues
Total
265
216
This was a study aimed at contributing
to the health of women and their babies.
The information obtained is only used for
research purposes and not for any other
purpose. Before conducting the study,
all participants were asked to agree to
participate in the study. The research did
not affect the care and childbirth process of
the women.
Keep your baby
warm
mother and child
pounding
to-skin Breastfeeding
benefits early
209
160
78,9
60,4
Skin-
Easy to follow
children
Do not know
90
2
34,0
0,8
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RESEARCH ARTICLE
97% of pregnant women knew the skin-
3.3. Knowledge and practice on early
to-skin method for their newborn babies. breastfeeding
81.5% of women knew that the benefit of
skin-to-skin care is to keep the baby warm,
only 13.6% of women knew all 4 benefits
above.
Figure 2. Knowledge of the benefits
of colostrum (n=257)
o
o
o
79.4% of women knew that colostrum is
rich in antibodies.
Figure 1. Practice adjusting the
temperature while the skin-to-skin (n=257)
Table 4. Knowledge of time when
babies were breastfed for the first time
12.5% of women adjusted the room
temperature suitable for children under
28oC; 2.3% of women adjusted the room
temperature above 30oC
Number Proportion %
Within the
first hour after
giving birth
Over the first
hour after
231
21
89,9
8,2
Table 3. Practice lying position of
babies in the postpartum room
giving birth
Do not know
Total
Number Proportion %
5
257
1,9
100
Skin to skin
with mother
100
157
257
38,9
61,1
100
89.9% of women know that they need
to breastfeed in the first hour after giving
birth.
Lying next to
mother
3.5. Knowledge of early breastfeeding
Total
Table 5. A person supporting woman to
breastfeed her baby for the first time
38.9% of children were lying skin-to-
skin contact with their mothers, 61.1% of
children had no skin-to-skin contact with
their mothers in the postpartum room.
Number
49
%
A midwife
Other medical staff
Relatives, friends
None
19,1
33,0
28,8
19,1
100
85
74
49
Total
257
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19.1% of women were not supported while breastfeeding the first time, 19.1% of the
midwives assisted mother in breastfeeding their baby
Figure 3. The time the baby was breastfed for the first time
37.7% of children were breastfed the first meal immediately after skin-to-skin contact
with their mothers.
Table 6. Relationship between several common characteristics to skin-to-skin
practice and early breastfeeding (n=257)
Practice skin to
early breastfeed
OR,
95%CI
OR
95%CI
skin
Factor
p
p
Yes
No
Yes
No
90
143
89
144
<35
≥35
TS
(38,6%) (61,4%)
(38,2%) 61,8%)
10 14
(41,7%) (58,3%)
8
16
Age
0,88
(0,35-2,32)
1,23
(0,47-3,47)
>0,05 (33,3%) (66,7%)
>0,05
100
157
97
160
(38,9%) (61,1%)
(37,7%) (62,3%)
75
133
81
127
CĐ,ĐH, SĐH
≤THPT
TS
(36,0%) (64,0%)
(38,9%) (61,1%)
Education
25 24
(51,0%) (49,0%)
16 33
>0,05 (32,7%) (67,3%)
0,54
(0,27-1,06)
1,31
(0,65-2,72)
level
>0,05
100
157
97
160
(38,9%) (61,1%)
(37,7%) (62,3%)
48 87
(35,6%) (64,4%)
47 88
(34,8%) (65,2%)
CBCC
52 70
(42,6%) 57,4%)
50 72
>0,05 (41,0%) (59,0%)
Occupation CN,ND, Khác
0,74
(0,43-1,26)
0,77
(0,45-1,31)
>0,05
100
157
97
160
TS
(38,9%) (61,1%)
(37,7%) (62,3%)
The study results indicated that there were no relationship between age, education
level and occupation, and early breastfeeding practice and skin-to-skin care of women.
Journal of Nursing Science - Vol. 04 - No. 01
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RESEARCH ARTICLE
.4. DISCUSSION
According to Lozoff’s research, in
underdeveloped countries, infant skin-to-
skin warming is rarely practiced because
there was no special effort to help mothers
and babies come into skin-to-skin contact
during the first minutes after birth [9].
However, a number of studies where
applied, supported, and instructed pregnant
women to practice skin-to-skin warming for
4.1. Discuss on knowledge and
practice of of women to skin-to-skin
method
When studying over 265 pregnant women
giving birth at the Hanoi Obstetrics and
Gynecology Hospital, 97% of women knew
about the method of skin to skin for babies.
The high rate of women who knew about their babies, this practice was significantly
higher. According to Awi, the proportion
of women applying the skin-to-skin warm
method to their babies within 30 minutes
of giving birth in a Nigerian hospital (2005)
was 38.4% [10]. At Hanoi Obstetrics and
Gynecology Hospital, skin-to-skin care
immediately after giving birth was done
quite well (86.7%) [4], however, in order for
women to take initiative of skin-to-skin care
for their newborn babies, there was a need
more specific instructions from the medical
staff.
skin-to-skin method because this method
had been very interested in women recently,
the people’s intellectual level had been
increasingly improved. In addition, it was
impossible not to mention the development
of media as well as social networks that had
provided mass of knowledge for pregnant
women about infant care, including skin-to-
skin methods. On July 14, 2015, in Hanoi,
the World Health Organization launched
the campaign “The first hug” in Viet Nam,
highlighting simple steps that could save
thousands of babies and prevent Hundreds
of thousands of complications each year are
caused by harmful or obsolete practices in
infant care in Viet Nam [8], which also partly
made pregnant women knew skin-to-skin.
As well as the results of studies
performed where the skin-to-skin method
had not been introduced and was only
applied to infants immediately after birth,
the study was also considered as a primary
investigation at Department A2, Hanoi
Obstetrics and Gynecology Hospital. The
rate of women who practice skin-to-skin for
their children was low because this method
was hardly applied here. The women in
the study had not received consultation,
training and support in applying skin-to-skin
care for newborn babies after giving birth
from health workers and midwives as well
as at prenatal antenatal check-ups. Women
knew this method mainly through the mass
media.
When analyzed further, women’s
understanding of this method was quite
high, but not enough. With the question
of multiple choices about the benefits of
skin-to-skin contact, the percentage of the
keep-warm effect accounted for the highest
percentage (81.5%), followed by the benefit
of mother-to-child attachment (78.9%), the
benefit for early breastfeeding 60.4%, the
lowest was the follow-up benefit (34%).
With the knowledge of women on skin
to skin, only 13.6% of women knew all 4
above benefits because there was limited
knowledge about skin-to-skin benefits,
therefore, the rate of women keeping their
babies warm was very low proportion to
practice skin-to-skin method immediately
after delivery. Only 100 women (38.9%)
had this practice for their babies.
The hot and humid weather conditions in
Viet Nam may also be one of the reasons
why the rate of women practicing skin-to-
skin warming for their children was low.
In addition, the inadequate understanding
of the skin-to-skin method also explained
the difference between the knowledge and
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practice levels of women (81.5% of women proved that the knowledge of breastfeeding
knew but only 38.9% practiced to warm the timing after giving birth of women was very
good, it was quite reasonable because
76.7% of women believed that colostrum
contained many antibodies, helping the
baby increase resistance. The results
were higher than those of Ton Thi Anh Tu
and Nguyen Thu Tinh while the number of
women who believed that breastfeeding
within the first hour after birth was 69.45%
[13].
baby).
To prevent hypothermia in infants, the
ideal room temperature should be 28-30ºc.
In this study, it was also shown that 12.5%
of women said that the room temperature
should only be below 28oC, which also
greatly affected the hypothermia of the
newborn. Especially in the total number of
newborns dying at the hospital in the first 24
hours after delivery, up to 32% of mothers
showed signs of hypothermia. A study
in Hai Phong showed that hypothermia
accounted for 35% of all neonatal deaths
[11]. The results in the study showed that
it was necessary to further improve the
understanding of pregnant women and
health workers about knowledge and
practice of keeping warm babies after
birth, through communication, education.
Providing appropriate information may
limit hypothermia, prevent morbidity and
mortality related to the cause of hypothermia
in infants.
Althoughtheknowledgeofbreastfeeding
timingandthebenefitsofearlybreastfeeding
was quite good, the results showed that
the proportion of women who breastfeed
within the first hour after birth was quite
low. (37.7%), most children (57.2%)
were breastfed after the first 2-6 hours
postpartum. Currently, breastfeeding was a
popular practice in the world, however, the
rate of breastfeeding within the first hour
after birth was generally low. In Asia, only
nearly 20% of babies were breastfed within
the first 24 hours of life. Research in Jinan
City, China showed that 51% of women
breastfed for the first time after an hour
4.2. Discuss on knowledge and
practice about early breastfeeding for
women
According to a study by Le Thi Huong
and Do Huu Hanh in Yen Bai province in
2008, 66% of pregnant women breastfed
early within the first half hour after birth [14].
The reasons not to breastfeed within the
first hour of birth were mainly due to lack of
understanding of the benefits of colostrum,
the benefits of early breastfeeding, and in
many places, old and long-term customs
of local life or tired women after birth. Only
19.1%ofthewomenreceivedtheassistance
of the midwife to breastfeed their baby
and 33% were from other health workers.
Department of Pediatrics A2 is assigning
care to teams, groups, so each team and
group will have their own specific work, such
as taking care of pregnant women in labor,
taking care of women after giving birth.
Care for pregnant women in stage II labor
also needed to better complete counseling
Breast milk is the best food for babies
and young children. Women ‘s knowledge
about the benefits of colostrum was
relatively high. Up to 79.4% of women knew
that colostrum contained many antibodies
and 76.7% knew colostrum contained many
nutrients. Meanwhile, according to research
results of Le Thi Yen Phi, the number of
women who knew the benefits of colostrum
was 95% and that of Truong Thi Hai was
99.8% [6], [12].
Along with the proportion of women who
knew the concept of colostrum, the women
who had the correct knowledge about the
time of first breastfeeding in the study
accountedfor89.9%ofthemthattheyshould
breastfeed immediately after birth. This
Journal of Nursing Science - Vol. 04 - No. 01
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RESEARCH ARTICLE
and support for the baby to breastfeed the
Another study conducted in Nigerian
mothers in 2004 on skin-to-skin contact
practice found that maternal education did
not have a statistically significant effect
on skin-to-skin practice. The research
results showed that mother’s education
level was similar to the above results on
skin-to-skin practice and early postpartum
breastfeeding. Specifically, for mothers’
education, those with college, university
or post-graduate education had practiced
breastfeeding within the first hour after birth
(38.9%) for women with upper secondary
education (32.7%), however this difference
was statistically significant with p <0.05.
first breast-feeding meal. For that reason,
19.1% of women were not supported to
breastfeed their babies, so they ate some
other foods to replace breast milk. This was
completely not beneficial for the newborn
because the baby does not receive breast
milk with antibodies.
In India, 70% of the rural women and
more than 50% of the educated women in
Bombay gave their babies other foods and
drinks before the first breastfeeding. Another
study by Chhabra in Delhi, India also showed
that 76.9% of babies were given other foods
and drinks before their first breast-feeding.
In some rural Nigeria, 100% of women gave
their babies water, formula or herbal tea
before their first breastfeed [15]. The results
above showed that this practice was very
popular in many countries. In Asia, usually
babies were not fed colostrum and so the
first feeding usually occurs after 24 hours
after birth. According to the population and
health survey, only 28% of newborns were
breastfed for one hour after giving birth, while
other babies were fed cow’s milk, honey
before the first breastfeeding. The high rate
of women giving another food / drink before
the first breastfeeding (19.1%) reflected the
situation of infants not exclusively breastfed
in the first 6 months.
Other maternal factors, such as
occupation, did not have a statistically
significant effect on the first breastfeeding
within one hour of birth. Maternal education
was considered to be the most important
factor in deciding to practice breastfeeding.
The knowledge and skills to find information
to help mothers grasp information about the
benefits of colostrum for babies as well as
the benefit of breastfeeding the infant early
on to herself shortly after birth, however,
within this study no association between
educationlevelandskin-to-skinpracticeand
early breastfeeding was found. However,
the research results on this relationship
were also very different, this relationship
must also take into account the interaction
between factors of individual characteristics
with the living environment, and access to
health care services.
4.3. Discussion on factors related
to practice of skin-to-skin and early
breastfeeding of women
The results of the study were not similar
to that of Truong Thi Hai, in this result, skin-
to-skin practice in mothers of the group
above 35 and group below 35 had no
difference, no statistical significance with
p> 0.05. In Truong Thi Hai’s study, maternal
education was related to skin-to-skin
warming practice. Specifically, in those with
higher educational attainment (intermediate
and above), the practice rate of skin-to-skin
warming was 11.9 times higher with OR =
11.9; 95% CI (1.9 - 489.7) [6].
5. CONCLUSION
- 97% of women knew the method of
skin-to-skin for their newborns, 81.5% of
women knew that the benefit of skin-to-skin
care was keeping their babies warm, and
only 38.9% of babies had skin-to-skin-to-
skin care in the postpartum room.
- 79.4% of women knew that colostrum
was rich in antibodies, 37.7% of children
were breastfed for the first time after skin-
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Journal of Nursing Science - Vol. 04 - No. 01
RESEARCH ARTICLE
to-skin contact with mothers;
with children aged 0-6 months in Nam Dinh
city in 2017 after educational intervention,
Master’s thesis in nursing, Nam Dinh
University of Nursing. [In VietNamese]
- There was no relationship between
the age, education level and occupation
and the skin-to-skin practice and early
breastfeeding of women.
8. Western Pacific Regional Office
who.int/Viet Nam/topics /newborn_health/
factsheet/en/
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