Closing the first-hour gap: nurse- and midwife-led interventions during the golden hour after birth and their impact on maternal and newborn outcomes

The first hour after birth, commonly referred to as the golden hour, is a critical period for implementing evidence-based interventions that optimize maternal recovery and neonatal physiological adaptation. Nurses and midwives play a central role in delivering timely, coordinated care during this period through interventions such as immediate skin-to-skin contact, early initiation of breastfeeding, delayed umbilical cord clamping, thermal protection, maternal surveillance, infection prevention, and parental education. This systematic review aimed to synthesize current evidence on the effectiveness of nurse- and midwife-led golden hour interventions and their impact on maternal and newborn outcomes. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library was conducted for studies published between January 2015 and June 2026, following the PRISMA 2020 guidelines. Eligible studies included randomized controlled trials, quasi-experimental studies, cohort studies, and observational studies evaluating golden hour interventions delivered by nurses or midwives. The evidence consistently demonstrated that these interventions improve breastfeeding initiation, neonatal thermoregulation, cardiorespiratory stability, maternal satisfaction, mother-infant bonding, and early detection of postpartum complications while reducing neonatal hypothermia, hypoglycemia, preventable morbidity, and unnecessary neonatal intensive care admissions. Delayed umbilical cord clamping also improved neonatal hemoglobin concentration and iron stores without increasing maternal adverse outcomes. Overall, nurse- and midwife-led golden hour care represents a safe, effective, and evidence-based approach to improving maternal and newborn health. Strengthening standardized protocols, workforce training, and implementation strategies may further enhance the quality, safety, and equity of postnatal care worldwide.