Effects of Mother Position in Skin-to-skin Contact Newborn on Oxygen Saturation Levels.
Effects of Mother Position in Skin-to-skin Contact Newborn on Oxygen Saturation Levels.
The purpose of this study is to determine if the position of the mother in the first two
 hours after delivery, while she is in skin to skin contact with your child, influences the
 oxygen saturation and/or heart rate of the newborn. In this way it could provide some useful
 information for the prevention of seemingly lethal episodes or sudden death of the child
 when, following current recommendations is skin to skin contact in the first hours of life.
 These episodes are communicating in all developed countries and have caused great concern and
 interest in the scientific community. So far we only have information from case series.
The early skin to skin contact between mother and child in the first two hours postpartum is
 essential for bonding and breastfeeding. Coinciding with the widespread application of this
 procedure in hospitals have been described, in different countries, cases of children who
 have suffered episodes of apparent life threatening events (ALTEs) or early sudden deaths
 during the same procedure. The cause of these events is unclarified, it is unknown whether
 the position of the mother during the first two hours of a child's life affects their
 stability.

 The investigators's hypothesis is that the frequency of episodes of oxygen saturation less
 than 91% in the first 2 hours of life of the newborn is reduced by one third in children
 whose mothers are incorporated at 45° above the horizontal plane of the bed compared with
 children whose mothers are incorporated to 15º.

 This is a multicenter, randomized and controlled study in 10 Spanish hospitals with blind
 evaluation. 5866 participants will be enrolled in this study (a total of 1275 children are
 required in each arm of the study).

 Mother/child (defined as a dyad) will be randomized in two groups:

 Group A: head-of-bed elevated 15°. Group B: head-of-bed elevated 45°.
Inclusion criteria:

 1. Single fetus pregnancy

 2. Pregnancy controlled or partially controlled(1)

 3. Normal pregnancy or with gestational diabetes treated with diet, high blood pressure
 controlled with only a drug as maximum (without preeclampsia)

 4. Gestation to term (between 37 weeks to 41 weeks and 6 days of gestational age).

 5. Maternal temperature at onset of labor ≤38 degrees Celsius

 6. Presence of a companion during the 2 hours after delivery

 7. Desire of the mother to perform early skin-to-skin

 Exclusion criteria pre-randomization:

 1. Consumption of tobacco, alcohol, drugs or any medication with sedative or relaxing(2)
 effect or any pathology during pregnancy.

 2. Prenatal diagnosis of chromosomal abnormalities or major malformations.

 3. Prenatal diagnosis of intrauterine growth restriction with any degree of alteration in
 the flow as well as the abnormal small-for-gestational-age fetuses (due to
 malformations, intrauterine infection ...).

 4. No companion during the first two hours postpartum

 Notes:

 1. Partially controlled pregnancy: she has the 20 weeks ultrasound but lack the first
 and/or third trimester of pregnancy and/or analytical (serology, O'Sullivan test ...).

 2. Medicinal products with sedative or relaxing effect: opioids, anticonvulsants,
 antipsychotics, benzodiazepines, anxiolytics, hypnotics, antidepressants and sedative
 plants.

 Post randomization exclusion criteria (at the end of delivery)

 1. Related to childbirth:

 -  Caesarean section or instrumental delivery (forceps, vacuum)

 -  Maternal fever >38 degrees Celsius

 -  Mother hemodynamic instability (hypotension, tachycardia, altered level of
 consciousness, poor perfusion, striking pallor)

 -  Cord prolapse

 -  Signs of fetal distress with lower pH fetal scalp <7.25 or umbilical artery pH
 <7.20

 -  Any other obstetrical complication

 2. Related mother:

 -  Any type of illness

 -  Sedatives or relaxants during or after birth(3)

 3. Related Newborn (RN)

 -  Need for resuscitation measures

 -  Major malformation diagnosed intrapartum

 -  Apgar ≤7 at one minute, 5 or 10 minutes

 -  Presence of clinic(4) before the 10 minutes of life

 -  Birth weight <2300 g or>4500 g

 4. Interruption of skin contact because the mother present a problem

 Notes:

 (3) Sedatives or relaxants during or after birth: Pethidine (Dolantina®), scopolamine
 (Buscapina®), haloperidol, benzodiazepines and opiates.

 (4) Clinic: general discomfort, fever, hypothermia, pallor, mottled skin (cutis marmorata),
 cyanosis, petechiae, purpura, lethargy, weakness, poor responsiveness, seizures, tremors,
 poor perfusion, maintained tachycardia, bradycardia, hypotension, apnea, tachypnea,
 respiratory distress (grunting, nasal flaring, intercostal or subcostal or substernal
 retractions, thoracoabdominal dissociation), vomiting, abdominal distesion, etc.

 Clarifications:

 It can include:

 1. Newborns with intrauterine diagnosis of ectasia pyelocaliceal grades I and/or II,
 choroid plexus cysts, aberrant right subclavian artery or single umbilical artery
 (minor malformations).

 2. Newborns whose time broken bag is ≥ to 18 hours provided that they do not present
 clinic(4).

 3. Newborn with risk of infection without symptoms at birth.

 4. Newborn with stained amniotic fluid, born crying, who does not require tracheal
 aspiration, or resuscitation and shows no clinical(4) signs during the first 10
 minutes after birth.

 5. Small for normal fetal gestational age (genetic-family origin)