Payor status is associated with guideline-concordant skin-to-skin contact at an urban hospital in south central United States: a retrospective cohort study

Abstract

Background: Skin-to-skin contact (SSC) is independently associated with improved breastfeeding outcomes. We sought to evaluate guideline-concordant SSC practices at an urban hospital in central Texas, which does not have baby-friendly designation. Given racial and ethnic disparities in breastfeeding outcomes, we hypothesized that Black and Hispanic women would be less likely to receive the recommended SSC. Methods: This was a retrospective review of births at our institution from 1 January, 2021, to 31 July, 2021. Eligible mother-baby dyads were those with spontaneous, singleton, term vaginal deliveries with 1- and 5-minute Apgar scores of greater than 7.Patients with maternal or fetal complications at the time of delivery were excluded. The primary outcome, receipt of recommended SSC, was defined as 60 min of continuous contact between mother and infant following delivery. The secondary outcome was whether SSC occurred immediately post-partum. Using logistic regression, we compared the odds of receiving 60 min of SSC and of getting immediate SSC by race and ethnicity, adjusted for patient and provider factors. Results: Of the 1,237 patients who met inclusion criteria, 23 were excluded for missing data. The majority (66.8%, n = 822) received at least 60 min of SSC. There was no difference in the primary and secondary outcomes by race or ethnicity. However, those insured with Medicaid had a 43% lower odds of receiving the 60 min compared to those with private insurance (aOR = 0.57; 95% CI 0.39,0.82) and a 39% lower odds of receiving immediate SSC (aOR = 0.61, 95% CI 0.387,0.961). Conclusion: Findings show that while race and ethnicity were not associated with SSC, those with Medicaid were significantly less likely to receive guideline-concordant SSC. In our context, Medicaid payor status is likely a surrogate for other reasons that this group receives less SSC, likely patient-provider language discordance. Identifying and addressing barriers to implementation of baby friendly practices like SSC is important to improving breastfeeding outcomes.