Barriers and potential enablers of the routine implementation of skin-to-skin contact after caesarean section at Kawempe National Referral Hospital, Uganda : a qualitative study among healthcare providers

Abstract

Background: Skin-to-skin Contact (SSC) is recommended by the World Health Organization (WHO) for all stable mothers and newborns, regardless of mode of birth. It improves newborn outcomes but is often omitted after Caesarean section (CS). This study explored the barriers and potential enablers of the routine implementation of SSC after CS at a tertiary Ugandan facility. Purpose: To explore the barriers and potential enablers of the implementation of routine SSC after CS at Kawempe National Referral Hospital (KNRH), Uganda. Methods: An exploratory qualitative study was conducted among Healthcare Providers (HCPs) with direct involvement in CS births at KNRH. Participants were purposively selected to achieve maximum variation in age, professional cadre, experience and work area. Data was collected using in-depth interviews and unstructured observations, analysed inductively and interpreted using the Socio-Ecological model (SEM). Results: SSC after CS was not routinely implemented at KNRH but could be enabled by providers’ disposition towards evidence-based practice, a family-centered care approach, guidance and training, an enabling work environment and a clear policy. It was hindered by perceived risks, lack of competence, postpartum norms and maternal hesitancy, competing priorities, resource limitations, practical constraints and a gap in policy. These factors operate at different levels of the SEM and interact to influence implementation of SSC after CS. Conclusion and recommendation: Observations showed that SSC was not routinely implemented after CS at KNRH. Barriers existed across all levels of the SEM. However, factors that could enable routine implementation were identified. Addressing these factors could enhance SSC implementation after CS.