Brief skin-to-skin contact at caesarean and newborn pain during the first injection

Design

Randomised controlled trial, single centre

Population

60 healthy term newborns of women having elective caesarean under spinal anaesthesia

Primary outcome

Newborn pain and stress score around the first intramuscular injection

Effect

Mean difference -2.633 (95% CI -3.135 to -2.132) during injection favouring skin-to-skin contact

Sixty healthy term newborns of women having elective caesarean delivery under spinal anaesthesia were randomised to about three minutes of skin-to-skin contact during the operation or routine care. Pain and stress were scored with the Newborn Pain and Stress Assessment Scale at four timepoints.

Scores were similar at baseline and lower in the skin-to-skin group before, during and after the first intramuscular injection. During the injection the mean difference was -2.633 points (95% CI -3.135 to -2.132), a very large standardised effect (Hedges' g -2.68).

The trial was small, single-centre and nursing-led, and the scale depends on an observer who may know the allocation. An effect this large from three minutes of contact deserves replication before it shapes protocols. Skin-to-skin contact is already encouraged on other grounds where the mother and baby are stable.

• Newborn pain scores during the first injection were lower after brief skin-to-skin contact.
• The trial enrolled only 60 healthy term babies after elective caesarean.
• Mean difference during injection was -2.633 points on the scale (95% CI -3.135 to -2.132).
• Keep the baby warm and monitored during theatre skin-to-skin contact.
• Outcome was a behavioural scale scored by observers, not a physiological measure.

Why it matters

It suggests a no-cost step in theatre may carry benefits beyond bonding, though only a small trial supports it.

Don't overread it

A single small trial in elective, uncomplicated caesareans cannot support a change in protocol for emergency or preterm deliveries.

The statistics, in plain English

A standardised effect near -2.7 is unusually large for a behavioural outcome, which in a 60-baby trial often signals that the estimate will shrink on replication. The narrow confidence interval reflects low variance in scores, not certainty about generalisability.

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