Article Critique: Skin-to-Skin Contact Post Caesarean Section

This report presents an article critique of three distinct studies concerning skin-to-skin contact following caesarean sections. The first study employs a qualitative approach, utilizing ethnography to explore mothers' experiences during skin-to-skin contact, highlighting the importance of observation and interview techniques in understanding maternal behavior and neonatal care. The second study is a randomized controlled pilot study, comparing early versus late skin-to-skin contact, focusing on clinical outcomes such as temperature, heart rate, and Apgar scores, while acknowledging the limitations of its small sample size and lack of significant differences between groups. The third study is a systematic review, examining existing literature to assess the benefits of immediate skin-to-skin contact, emphasizing the use of keywords, database searches, and quality assessment tools to synthesize findings from multiple studies, and concluding with the clinical benefits of the practice. The critique analyzes the strengths and weaknesses of each study, including methodological approaches, sample sizes, and the generalizability of the findings, providing insights into the impact of skin-to-skin contact in healthcare practices.

Running head: ARTICLE CRITIQUE 1
Article critique
Student’s Name
University

ARTICLE CRITIQUE 2
Article critique
Qualitative study: Frederick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M.,
& Schneider, K. M. (2015). Exploring the skin-to-skin contact experience during cesarean
section. Journal of the American Association of Nurse Practitioners, 10(5).
The aim of the study was to explore and describe the experience of mothers when holding
the baby during neonatal skin-to-skin contact after caesarian delivery. The study was a
qualitative approach since it focused on the use of ethnography to gather data for the study
(Hammarberg, Kirkman, & De-Lacey, 2016). This is due to the research design that was used
which sought to provide a lens on the experience of the mother. The observation process allows
the researcher to interact with the subjects during the whole process of study. The research
appropriately addressed the aims of the research is focused on observing the experience of
mothers during the process of post caesarian contact.
The role of ethnography and interviews is to determine patterns of behavior that influence
the way mothers behave and how they take care of the neonatal. Since the process involves more
observation the researcher is able to below the surface and understand the challenges or
assumptions that revolve around the research topic (Mannik & McGarry, 2017). Participants of
the study were recruited by pre-surgical appointments by the nurse so that they are aware of the
aim of the research.
Frederick, Busen, Engebretson, Hurst, & Schneider (2015) observed ethical issues for the
study to ensure that the rights of the respondent are observed. First of all the researchers sought
permission from the hospital so that the researcher can recruit and observe the respondents
freely. Secondly, the recruitment of the respondents into the sample was done purposively so that
those who met the criteria and were willing to participate in the study are the only ones that were

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involved in the study (Hulst, Koster, & Vermeulen, 2016). The data analysis process of the study
was iterative and recursive starting from the observation of the caesarian process to the end of
the study. This led to the conclusion of the importance of the skin-to-skin process during the
process since mothers who had not experienced the process had a different view of the caesarian
room.
One strength of the study is its bearing on the importance of using skin-to-skin contact
during the caesarian process has several advantages that benefit both the mother and the baby.
This research thus proposed the need for further research and development of policies that can
lead to the application of the process in all caesarian procedures thus allowing mothers and their
newborns to enjoy the benefits of this process. However, the weakness is that the sample used is
too low to be generalized to the whole population, thus the need for further research. It also fails
to highlight any challenges during application of skin-to-skin contact.
Randomized control trial: Kollman, M., Adrian, L., Scheuchenegger, A., Mautner, E.,
Herzog, S., Urlesberger, B., Klaritsch, P. (2017). Early skin-to-skin contact after
cesarean section: A randomised clinical pilot study. PLOS One, 12(2).
The study aimed to address the issue of early skin-to-skin contact after the caesarian
section in clinical settings. The study was a randomized controlled pilot study on a single
institution between periods of five months. The participants were randomized before entering the
operating room and assigned to one of the two groups. Glennerster & Takavarasha (2013)
suggest that clinical trials allow the research to control the participants to measure the effects of
the control group. However, the study was not a blind study since all the patients and
practitioners were informed before the patients were entered into either group. All the patients in
the group were similar but after the caesarian section and presenting the newborns to the mothers

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they were all taken away. Alok (2013) suggested that open-label control trials offer better results
since it allows participants to understand the groups that they are in rather than in blinded trials.
However, the patients in the early skin-to-skin contact group had babies brought to the operating
room within five minutes and placed to the mother’s chest while those in the late group stayed in
the neonatal ward.
From Duffy & Conrad (2013) the treatment effect was between five minutes and the end
of the surgery. In this case, those in the early group had babies brought in after five minutes
while those in the late group had their babies in the neonatal ward. The estimate of the treatment
was precise since the difference in the timing was five minutes after the baby had been taken
away between the two groups.
One weakness of this study is that the results of the study cannot be applied to the local
population since the margin of the study was very small. Further, there was a small variation
between the participants in the early stage as compared to those in the late stage. The clinical
important outcomes like temperature, heart rate, Apgar-scores, and arterial oxygen saturation
were all put into consideration (Kollman, et al., 2017). However, despite this, there was no
difference in neonatal transition, salivary free cortisol level and maternal well-being and pain in
both groups as supported by Singh, et al. (2017). This means that there are no direct benefits that
can be attained from the study that can be applied to the cost of presenting the baby early to an
anesthetic mother. However, one strength of the study is its non-blind approach that allowed
participants to understand what was going thus increasing the validity of the results.
Systematic review: Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or
early skin-to-skin contact after a Caesarean section: a review of the literature.
Maternal and Child Nutrition, 10, 456-473.

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The review clearly addressed the focused question by describing the context of skin-to-
skin care of newborns and the connection that they have with the mother. Existing databases like
CINAHL (EBSCO host), PubMed (NCBI), Health Collection (Informit, RMIT), US National
Library of Medicine, Wiley Online Library (John Wiley & Sons), Wiley, Health, Cochrane,
Health Source, Medline (OvidSP Scopus, & Medical Complete (ProQuest) and Joanna Briggs
Institute were used in the review. Clarke (2015) argue that a good review uses key words or
phrases to search for literature. The search was based on the use of keywords like skin-to-skin
and caesarian, kangaroo care, and breastfeeding and narrowed down to the period of 2003 to
2013.
Mallett, Hagen-Zanker, & Duvendack (2012), suggests that a good review uses key
words to search literature. The search led to 6746 papers which were narrowed down to 2106,
which the researchers screened using their abstracts thus removing those that were not relevant
remaining with only 376 papers that specifically covered skin-to-skin implementation after
caesarian. This refining of the findings went on until only seven papers were left that met the
criteria of caesarian births, the introduction of skin-to-skin within five minutes and reporting the
findings. Bilotta, Milner, & Boyd (2014)suggest that a good review needs to adress the quality of
the papers used. From this, the researchers did enough to assess the quality of the papers to be
included in the study and further, their quality assessment was tested using the Critical Appraisal
Skills Programme (CASP) tool.
The papers had different findings on the implementation of skin-to-skin during caesarian
operations but all the papers reported that there are clinical benefits of using the program in
medical settings. The results of these finding are precise since they are based on critically
reviewed papers that met the inclusion-exclusion criteria. Gopalakrishnan & Ganeshkumar

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(2013) suggests that a good systematic review should be organised in themes. The findings are
precise since the authors have combined the findings based on themes and topics that the articles
were based.
Mallett, Hagen-Zanker, Slater, & Duvendack (2012), suggests that the role of systematic
reviews is to examine the impacts of certain medical processes by reviewing what has been
researched and putting them together to form a clear conclusion. The strength of this review is
providing evidence that immediate application of skin-to-skin after caesarian operation reveals
there are more benefits than challenges. This is based on proper planning and education of the
practitioners and even the mothers before the surgery begins. However, the article fails to
highlight the challenges that arise in the cases of the skin-to-skin contact that can risk the health
of the child.

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References
Alok, B. (2013). Randomized controlled experiments in health and social sciences: Some
conceptual issues. Economics and Human Biology, 6, 293–298.
Bilotta, G. S., Milner, A. M., & Boyd, I. (2014). On the use of systematic reviews to inform
environmental policies. Environmental Science & Policy, 42, 67-77.
Clarke, J. (2015). What is a systematic review? Evidence-Based Nursing, 14(3).
Duffy, D., & Conrad, C. (2013). Skin-to-skin cesarean delivery. Journal of Obstetric,
Gynecologic, & Neonatal Nursing, 42.
Frederick, A. C., Busen, N. H., Engebretson, J. C., Hurst, N. M., & Schneider, K. M. (2015).
Exploring the skin-to-skin contact experience during cesarean section. Journal of the
American Association of Nurse Practitioners, 10(5). doi:10.1002/2327-6924.12229
Glennerster, R., & Takavarasha, K. (2013). Running randomized evaluations: a practical guide.
Princeton: Princeton University Press.
Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic Reviews and Meta-analysis:
Understanding the Best Evidence in Primary Healthcare. Journal of Family Medicine and
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Hammarberg, K., Kirkman, M., & De-Lacey, S. (2016). Qualitative research methods: when to
use them and how to judge them. Human Reproduction,, 31(3), 498-501.
Hulst, M. v., Koster, M., & Vermeulen, J. (2016). Encyclopedia of Public Administration and
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Francis.
Kollman, M., Adrian, L., Scheuchenegger, A., Mautner, E., Herzog, S., Urlesberger, B., . . .
Klaritsch, P. (2017). Early skin-to-skin contact after cesarean section: A randomised
clinical pilot study. PLOS One, 12(2).
Mallett, R., Hagen-Zanker, J., & Duvendack, R. S. (2012). The benefits and challenges of using
systematic reviews in international development research. Journal of Development
Effectiv, 4(3), 445-455.
Mallett, R., Hagen-Zanker, J., Slater, R., & Duvendack, M. (2012). The benefits and challenges
of using systematic reviews in international development research. Journal of
Development Effectiveness,, 4(3), 445-455.
Mannik, L., & McGarry, K. (2017). Practicing Ethnography: A Student Guide to Method and
Methodology. Toronto: University of Toronto Press.
Singh, K., Khan, S. M., Carvajal–Aguirre, L., Brodish, P., Amouzou, A., & Moran, A. (2017).
The importance of skin–to–skin contact for early initiation of breastfeeding in Nigeria
and Bangladesh. Journal of Global Health, 7(2).

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Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin-to-skin
contact after a Caesarean section: a review of the literature. Maternal and Child
Nutrition, 10, 456-473.