Extended Skin-to-Skin Contact Linked to Better Postpartum Mental Health

Immediate skin-to-skin contact between a newborn and its mother after delivery is associated with higher birth satisfaction and fewer signs of postpartum depression and childbirth-related post-traumatic stress, according to a retrospective study of 985 women in the Czech Republic. The findings, published in Nursing Open, also suggest that the duration of contact may matter: any amount of skin-to-skin contact was linked to greater satisfaction, while sessions lasting more than 30 minutes were associated with lower adjusted odds of screening positive for depression or traumatic stress. The study does not establish that contact caused the psychological outcomes, but its results reinforce the case for protecting prolonged, uninterrupted contact after birth.

Skin-to-skin contact means placing a naked newborn directly on the mother’s bare chest, usually immediately after birth and without interruption. The practice is an evidence-based component of postpartum care and is associated with physiological and breastfeeding benefits, including support for temperature regulation, milk production and the infant’s transition to extrauterine life. It is also recommended for clinically stable newborns delivered vaginally or by caesarean section, with assistance when needed. Researchers behind the new analysis wanted to examine an area less fully described in the scientific literature: how long mothers and babies actually remain in contact, and whether the duration of that contact corresponds with mothers’ satisfaction and psychological wellbeing.

The investigators recruited Czech-speaking women aged 18 or older who had given birth during the previous 24 months. Volunteers were invited through six online forums for mothers and parents on maternity or parental leave in October and November 2022, and data were collected through an anonymous questionnaire. Of 1,318 respondents, 1,013 completed questionnaires that met the inclusion criteria; screening for multivariate outliers reduced the final analytic sample to 985. Their ages ranged from 18 to 44 years, with a mean of 30.76 years, and approximately half were within 12 months of delivery while the other half were more than 12 months postpartum. Because recruitment was internet-based and non-probabilistic, the results cannot be treated as representative estimates for all women giving birth in the Czech Republic.

Participants reported whether they had experienced uninterrupted skin-to-skin contact after birth and, if so, whether it lasted no more than 30 minutes, more than 30 to 120 minutes, or more than 120 minutes. Of the 985 women, 339 reported no contact, 246 reported up to 30 minutes, 315 reported more than 30 to 120 minutes and 85 reported more than two hours. The researchers assessed three dimensions of maternal wellbeing: birth satisfaction through the Czech version of the Birth Satisfaction Scale–Revised, depressive symptoms through the Edinburgh Postnatal Depression Scale, and trauma-related symptoms through an adapted Czech version of the Primary Care PTSD Screen for DSM-5. The latter is a screening instrument rather than a diagnostic test.

Clear differences emerged across the contact-duration groups. Women reporting no skin-to-skin contact had the lowest average birth-satisfaction score, 18.46 on the revised scale, compared with 24.02 after up to 30 minutes, 25.96 after more than 30 to 120 minutes and 28.86 after more than two hours. Their average depressive-symptom score was highest without contact, at 11.15, and declined to 9.57, 8.01 and 7.42 as contact duration increased. Average trauma-screening scores followed a similar gradient, falling from 1.92 among women without contact to 0.94 among those with more than two hours. Overall, 39.19% of participants screened at or above the depression threshold, while 20.91% met the trauma-symptom screening threshold.

The analysis went beyond simple group comparisons by using regression models to account for measured differences between mothers. Linear regression estimated adjusted birth-satisfaction differences, and logistic regression estimated adjusted odds of positive depression and trauma screens. The models included age, time since birth, parity, course of pregnancy, psychological state before delivery, mode of birth, gestational timing and newborn health status. Compared with no contact, all three skin-to-skin groups had higher adjusted satisfaction scores: by 2.31 points for contact up to 30 minutes, 3.30 points for more than 30 to 120 minutes and 6.10 points for more than two hours. These estimates were statistically significant, with 95% confidence intervals excluding zero.

For the mental-health screening outcomes, the strongest associations appeared after contact exceeded 30 minutes. Women with more than 30 to 120 minutes of contact had about half the adjusted odds of a positive depression screen compared with women who had no contact, with an adjusted odds ratio of 0.50 and a 95% confidence interval of 0.33 to 0.76. For more than two hours, the adjusted odds ratio was 0.46, with a 95% confidence interval of 0.26 to 0.84. The corresponding adjusted odds ratios for a positive trauma screen were 0.45 and 0.35. By contrast, contact lasting 30 minutes or less did not have a statistically significant adjusted association with either outcome, despite unadjusted differences between groups.

Skin-to-skin contact was not distributed evenly across childbirth experiences, highlighting potential organizational and clinical barriers. The no-contact group contained higher proportions of acute and planned caesarean births, preterm delivery, pathological pregnancy and newborn health problems, while spontaneous vaginal births accounted for only 15.3% of that group compared with 49.2% to 57.8% of the contact groups. These figures describe the composition of each category and do not show the probability of receiving contact within a particular type of birth. The pattern nevertheless points to an implementation gap during caesarean delivery and complicated births, where separation, procedural requirements or limited staffing may interrupt the opportunity for immediate contact.

Several biological pathways could help explain the observed associations, although the study did not measure them. Tactile contact with the infant may activate maternal oxytocin, dopamine and serotonin systems involved in bonding, reward, attachment and social behavior. It may also dampen activity in the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, which are involved in stress responses. Immediate contact could strengthen mother-infant interaction and coping skills, while offering women recovering from a difficult birth a direct, participatory route into motherhood. These mechanisms remain plausible hypotheses rather than demonstrated mediators because the analysis did not include hormone measurements or tests of bonding and stress response.

The results should nevertheless be interpreted cautiously. The retrospective cross-sectional design cannot establish the order of events or causation, and participants may have remembered contact duration or symptoms inaccurately. The online convenience sample may overrepresent women who are more engaged with motherhood, more psychologically affected by childbirth or more likely to seek support, while excluding people with limited internet access or lower digital literacy. Previous mental-health diagnoses, social support, breastfeeding support, hospital policies, quality of intrapartum care and detailed neonatal condition were not fully measured, leaving possible residual confounding. The findings therefore support further prospective research rather than a definitive causal claim. For clinical practice, they reinforce the importance of initiating safe skin-to-skin contact after birth and doing more than merely starting it: midwives, obstetricians and neonatal nurses should work to sustain contact beyond 30 minutes when clinically feasible, particularly during caesarean delivery, preterm birth and when the newborn has health problems.

Subject of Research: Associations between early skin-to-skin contact duration and postpartum maternal wellbeing

Article Title: Association Between Early Skin‐To‐Skin Contact and Postpartum Maternal Wellbeing: A Retrospective Cross‐Sectional Study

Article References: Lorenzová, E. H., Mainz, D., Lochmannová, A., Martin, C. R., & Ratislavová, K. (2026). Association Between Early Skin‐To‐Skin Contact and Postpartum Maternal Wellbeing: A Retrospective Cross‐Sectional Study. Nursing Open, 13(10), Article e70851. https://doi.org/10.1002/nop2.70851

Image Credits: AI Generated

DOI: 10.1002/nop2.70851

Keywords: skin-to-skin contact, postpartum depression, birth satisfaction, post-traumatic stress, maternal wellbeing, postpartum care, caesarean birth, newborn bonding, breastfeeding support, retrospective study, Association, Between