BackgroundDespite the World Health Organization’s (WHO) recommendation for immediate skin-to-skin contact (SSC) after birth, separation of mothers and infants seems to be common practice in many hospitals. It is unknown how common the practice of SSC is worldwide. Therefore, we aimed to determine the reported prevalence of SSC for healthy mothers and infants immediately after normal birth.MethodsWe systematically searched CINAHL, Medline, ProQuest Central, PubMed and the Cochrane Library for articles published between January 2007 and October 2017 using the keywords "kangaroo care" or "skin to skin contact" or "breastfeeding initiation" or "breast crawl" or "maternal infant contact" or "maternal newborn contact" or "baby friendly hospital initiative" or "ten steps for successful breastfeeding”.ResultsAfter an initial screening of 5266 records, 84 full text articles were assessed for eligibility, and 35 of these met the inclusion criteria. The studies were from 28 countries representing all six WHO world regions. There was a wide range in the practice of SSC for mother-infant dyads around the world: from 1% to 98%. Only 15 studies clearly defined SSC. Most of the studies were from high-income countries, and these reported higher rates of SSC than studies from low and middle-income countries.ConclusionThere was a great heterogeneity in the definition of SSC as well as study designs, which makes cross-county comparison difficult. National studies reporting SSC rates are lacking. Future studies and guidelines to enhance SSC practice should include a standardised set of indicators and measurement tools that document SSC starting time and duration of SSC.

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Realist interviews are a data collection method used in realist evaluations. There is little available guidance for realist interviewing in cross-cultural contexts. Few published realist evaluations have included cross-cultural interviews, providing limited analyses of the cross-cultural application of realist methodology. This study integrated realist and cross-cultural qualitative methods in a realist evaluation of an Australian doula support program. The interviews were conducted with Arabic speaking clients of the program. The process included collaboration with a bicultural researcher, philosophically situating the study for methodologically coherent integration, bicultural review of the appropriateness of realist ‘how’ and ‘why’ questions, decisions about language translation and interpretation, pilot interviews, and co-facilitation of the interviews. Integration of the methods was feasible and valuable. This study may support other realist evaluators to give voice to people from culturally diverse groups, in a manner that is culturally safe, methodologically coherent and rigorous, and that produces trustworthy results.

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