Experience of perceived barriers and enablers of safe uninterrupted skin-to-skin contact during the first hour after birth in Uganda

Abstract

Abstract
Objective
To identify barriers and enablers to conducting safe uninterrupted skin-to-skin contact (SSC) in the first hour after birth in a low-resource setting and to evaluate how health care professionals coped with the identified barriers after completion of an intervention package.
Design and setting
A qualitative method using focus-group and individual interviews with health professionals at a governmental hospital in Uganda.
Participants
81 health professionals.
Interventions
A 6-step intervention package including, amongst other things, showing a DVD on safe uninterrupted SSC following birth and discussing with the professionals what barriers and possibilities there were to changing practice to allow SSC for one hour.
Measurements and findings
The thematic analysis of the intervention interviews yielded the following themes: Perceived barriers including medical events, psychosocial issues and standard midwifery practice; Pragmatic barriers including economic constraints in the hospital and community; Anticipated barriers by staff and families; Enabling events including staff involvement.
Most of the barriers involving expenses were not solved. When the mother and infant had to move to the postnatal ward within one hour after birth, there were difficulties in keeping SSC during the transportation, but this obstacle was partly solved. A few mothers (i.e. depressed and/or adolescent) were considered to be unwilling to keep the infant skin-to-skin; this difficulty was not solved. Practising SSC led the participants to find advantages such as reduced work load and positive effects on pain during suturing.
Conclusions
SSC following birth was shown to be applicable and accepted by the health professionals. The involvement of professionals had clinical implications, such as initiatives to broadcast the message of SSC by radio to the community and introduce SSC to women having a Caesarean section.