The rate of cesarean birth continues to increase in the world and in our country. As with all surgeries, the risks of cesarean birth include the possibility of bleeding and infection, prolonged recovery time after birth, delays in initiating breastfeeding and skin-to-skin contact (SSC), and increased likelihood of complications in future pregnancies.

While many hospitals apply SSC after normal births, it is known that the number of hospitals that apply SSC in the operating room after cesarean birth is very few. Factors that prevent the initiation of SSC after cesarean birth include the effect of the current operating room culture, the physiological evaluation process of the baby after birth, the presence of procedures such as measuring body weight, aspiration, and Apgar score evaluation.

Since the mother and baby are separated after cesarean birth, the mother's initiation of breastfeeding in the first hour of life may be delayed, and the duration of exclusive breastfeeding may be shortened. The 90-minute uninterrupted skin-to-skin contact during which the baby is dried and placed directly on the mother's bare chest after birth maximizes the chance that babies are physically ready to breastfeed.

Although there are studies showing the benefits of SSC application in the operating room such as breastfeeding rates, maintaining the body temperature of the newborn, reducing maternal stress levels, and increasing oxytocin levels, a limited number of studies have been reached in the literature using SSC application guidelines developed to ensure the sustainability of SSC application in the operating room, post-op care unit, and obstetrics clinic. The first contribution of this planned study to the literature will be to standardize SSC application with SSC checklists prepared for use in the cesarean operation room, post-op care unit, and obstetrics ward based on SSC application guidelines. As a second contribution, considering the conditions of the health institution where the study will be conducted, the effects of starting SSC as early as possible and applying it in the cesarean operation room, post-op care unit, and obstetrics ward on the stress level of newborns, sucking success, and pain and salivary cortisol (stress) levels of mothers will be evaluated.

The main purpose of the proposed study is to evaluate the effect of SSC initiated in different units of the hospital after cesarean delivery with spinal anesthesia on the stress level of newborns, sucking success, pain and salivary cortisol (stress) levels of mothers and physiological parameters of mothers and babies.

The secondary purpose of the study is to evaluate the satisfaction levels of mothers regarding the SSC application initiated in different units of the hospital after cesarean delivery.

Hypotheses of the Study H1: Early initiated SSC is more effective than late initiated SSC in reducing the pain level of mothers after cesarean deliveries.

H2: Early initiated SSC is more effective than late initiated SSC in reducing the salivary cortisol level of mothers after cesarean deliveries.

H3: Early initiated SSC is more effective than late initiated SSC in reducing the stress level of newborns after cesarean deliveries.

H4: Early initiated SSC is more effective than late initiated SSC on the sucking success of newborns after cesarean deliveries.

H5: Early initiation of SSC is more effective than late initiation of SSC in increasing the satisfaction level of mothers after cesarean births.

Inclusion Criteria:

Mothers;

• Planning a cesarean section with spinal anesthesia
• Being between the ages of 18-45
• Having a singleton pregnancy
• Being between the gestational age of 37-40 weeks
• Not having any known health problems (diabetes, gestational diabetes, hypertension, preeclampsia, renal failure, cardiac problems, psychiatric disorders, etc.)
• Agreeing to participate in the study
• Having stable general conditions and vital signs before the skin-to-skin contact procedure
• Residing in Kütahya

Newborns (0-28 days)

• Having a gestational age between 37-40 weeks
• Having a birth weight between 2500-4500 grams
• 1-5. Apgar score ≥ 7 per minute
• No health problems, anomalies or congenital diseases
• No conditions that prevent sucking such as frenulum (tongue tie) or palate problems

Exclusion Criteria:

• Caesarean births performed with general anesthesia
• Normal births

Pregnant women with gestational age 37 and above

Individual participant data may be shared by the corresponding author if requested by the journal editorship in which the study was published.