Knowledge and practice on skin-to-skin contact and early breastfeeding methods of women with vaginal delivery at ha noi obstetrics and gynecology hospital

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Journal of Nursing Science - Vol. 04 - No. 01
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 
that the benefit of skin-to-skin care is to keep 
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]
According to UNICEF, in Viet Nam, the 
report on survey of children and women 
objectives (MICS 2014) found that only 
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.
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
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skin method between mother and infant 
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].
Hanoi Obstetrics and Gynecology 
Hospital always wants to take care of 
pregnant women and newborns with the new 
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.
2. RESEARCH METHOD
2.1. Participants: Postpartum women at 
ward A2, Hanoi Obstetrics and Gynecology 
Hospital were recruited to the study.
2.1.1. Inclusion criteria:
- Over 18 years;
- Fullterm pregnancy from 37-41 weeks 
as expected;
- Healthy babies;
- Can speak, read, listen and understand 
VietNamese;
- Volunteer to participate in research;
2.1.2. Exclusion criteria:
- Women with deformity;
- Women with some internal and surgical 
diseases: cardiovascular, hypertension, 
bronchial asthma, ...
- Women with cognitive impairment.
2.2. Methods:
2.2.1. Research design: The research 
used cross-sectional descriptive design.
2.2.2. Sample size:
* Skin to skin part
Sample size using the formula for 
descriptive study: n= z2(1- a/2)p(1-p)/d2
* In which:
n: required sample size;
a ... skin care of women.
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.4. DISCUSSION
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 
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.
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.
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 
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.
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.
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 
knew but only 38.9% practiced to warm the 
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.
4.2. Discuss on knowledge and 
practice about early breastfeeding for 
women
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 
accounted for 89.9% of them that they should 
breastfeed immediately after birth. This 
proved that the knowledge of breastfeeding 
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].
 Although the knowledge of breastfeeding 
timing and the benefits of early breastfeeding 
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
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% of the women received the assistance 
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 
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and support for the baby to breastfeed the 
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.
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].
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.
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 
education level and skin-to-skin practice and 
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. 
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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to-skin contact with mothers;
- There was no relationship between 
the age, education level and occupation 
and the skin-to-skin practice and early 
breastfeeding of women.
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