الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pregnancy and childbirth are natural and special event in women’s life and in the lives of their families. This can be a time of great hope; it can also be a time of fear, suffering and even death. Complications of pregnancy and childbirth are often the leading causes of morbidity and mortality among women in childbearing ages in the developing countries. Most of this maternal morbidity can occur during the third stage of labor. The third stage of labor is one of the most important time of the health and wellbeing of both woman and newborn, and the beginning of their special life long relationship, which begin immediately after the delivery of the newborn. World health organization (WHO) recommended that all newborns should have access to skin to skin contact (SSC) immediately after vaginal delivery and cesarean section. As early skin to skin contact during the third stage of labor has a positive effect on its duration, completeness of placental separation, immediate contraction of the uterus, position of the uterus, amount of blood loss, mother satisfaction and also preference in future delivery. Moreover, SSC at birth along with the breastfeeding process may be protective against both the incidence and the severity of primary postpartum hemorrhage (PPH). Therefore this study aimed at evaluating the effect of early maternal/newborn skin- to- skin contact after birth on the duration of third stage of labor and initiation of breastfeeding. To fulfill the study aim:- - This study was conducted at labor unit in obstetric departments at two settings; Tanta University Hospital and El-Menshawy Hospital. The study was conducted on 100 parturient women. They were divided alternatively and equally into two groups: 1. Study group: 50 laboring woman who were applied the skin- to- skin contact practice. 2. Control group: 50 laboring woman who were exposed to routine hospital care. The criteria for inclusion in the study were as follows:- Women with normal course of pregnancy, primigravida, woman free from any medical or obstetrical complications, anticipated normal vaginal delivery and strong desire to breastfeed her newborn at birth, mother’s breast and nipples with normal shape and size, full-term infant (38- 42 weeks of gestation) and single viable fetus. Tools of data collection: To achieve the aim of the study the following tools were used. Tool (I): Bio Socio-demographic and reproductive history structured interview schedule: - It included two parts; Part a: The socio-demographic data as age, marital status, residence, level of education, occupation, duration of marriage, family income and type of family and Part b: Reproductive history as gestational age (weeks), number of abortions, stillbirth, time of initial antenatal visit, number of antenatal care visits, place of antenatal care, and if they were attending antenatal care classes regarding breastfeeding. Tool (II): Women’s breastfeeding knowledge assessment tool: It included five main groups of questions entail the following information: General knowledge of breastfeeding, positions during breastfeeding, technique used in breastfeeding, benefits of breastfeeding for mother and benefits of breastfeeding for baby. Tool (III): Assessment of the third stage of labor: It included assessment of uterine contractility pattern immediately after birth, intake of any uterotonic drugs, presence of any abnormal signs of uterine atony or excessive blood loss, firmness of the uterus, position of the uterus, applying of immediate cord traction with counter pressure, performing of uterine massage, easily separation of placenta, completeness of placental and fetal membranes, and also composition of cord. It included also presence of episiotomy, duration of third stage of labor and assessment of the newborn immediately after delivery which included; sex, birth weight, gestational age(weeks) and also prescribed medications. Chapter VII Summary 138 Tool (IV): Breastfeeding assessment tool: It included; Part a: The Infant Breastfeeding Assessment Tool (IBFAT)(102): it included readiness to feed, rooting reflex, fixing (latch on) and suckling pattern; Part b: Assessment of initial breastfeeding outcome: it included, duration (minutes) of initial effective breastfeeding, the time in minutes between delivery and first effective breastfeeding, number of trials before the first effective breastfeeding and whether the newborn end the first breastfeeding by own self or not and Part c: Assessment of successful latch on: It measured latch on, audible swallowing, type of nipple, comfort, and also holding. Tool (5): Exclusive breastfeeding: Follow- up assessment tool: It included questions related to continuation, discontinuation of breastfeeding, reasons and barriers of exclusive breastfeeding.