HCA Virginia Physicians June 28, 2018

by Ashlie Buell, CNM, Virginia Complete Care for Women

Leaving the peaceful, warm comfort of the pregnant belly and entering the outside world is a big transition for a newborn. Beginning life outside of the womb means the baby’s body undergoes many changes, including taking first breaths, beginning to manage body temperature, and regulating blood sugars without a constant source of nutrition. Depending on the birth setting, the baby may be suddenly exposed to bright lights and sounds that are much different from what they have experienced on the inside. This initial exposure to life on the outside can be stressful for a new baby, but early skin-to-skin contact may help to ease the transition.

What is skin-to-skin contact?

Skin-to-skin contact means laying a naked baby, belly down, on the mother’s bare chest and then covering baby with a blanket. There should be no gowns, blankets or clothing between the baby and the mother. Skin-to-skin contact should first occur as soon as possible after birth. It can also be done with a non-birthing parent or other family member.

What are the benefits of skin-to-skin contact?

Skin-to-skin contact is known to have many benefits, both for the parents and the baby, including:

  1. Calm and Steady
    During skin-to-skin contact, babies and mothers release hormones that have a calming effect and baby also recognizes and is comforted by the familiar smell of mother and the sound of her voice. Because they are more relaxed, babies with skin-to-skin contact tend to have earlier and stronger signs of attention and exploration, as well as longer times of quiet sleep in the first day. Babies kept skin-to-skin just after birth also have more normal breathing patterns, which means improved oxygen delivery to the brain.
  2. Just the Right Temperature
    The temperature inside of the womb is regulated by the mother’s body and doesn’t change much. After the baby is born, his or her body has to take over the job of maintaining an appropriate temperature. This, along with the air temperature in the hospital or other birth setting, can cause temperature fluctuations in the hours after birth. Skin-to-skin contact shortly after birth is linked to better temperature control in infants. The surface of the mother’s skin provides a temperature that is most similar to that inside the womb. Babies allowed to have skin-to-skin contact tend to warm up and remain warm more easily than those swaddled in blankets.
  3. Immune Boost
    Part of our immune system includes the good bacteria that are present on our skin and in our intestinal system. These bacteria make it difficult for bad bacteria to attach and grow in our bodies. A baby’s skin starts as a clean slate. Contact with the mother’s skin allows the mother’s good bacteria to pass to the baby’s skin. The growth of good bacteria helps protect the baby from some type of infection. This protection is good for any newborn, but is especially important for babies who are born prematurely and those with weak immune systems.
  4. Improved Feeding Start
    Babies who are allowed undisturbed skin-to-skin with mothers will generally begin to move toward the breast on their own within the first hour. This contact also stimulates hormones to be released in the mother’s body that lead to milk production. Skin-to-skin contact should begin immediately after birth and continue at least until the baby has completed the first breastfeeding. Research shows that early and undisturbed skin-to-skin contact improves rates of successful initiation and continuation of breastfeeding.
  5. Pain Management
    Some studies indicate that skin-to-skin contact may decrease infant pain during certain medical procedures. Crying time and heart rate were used to assess pain in the studies. Infants who received skin-to-skin contact had less evidence of pain at 60 and 90 seconds after a painful procedure when compared to infants who did not receive skin-to-skin care. Skin-to-skin contact is a safe method to calm and comfort infants. If your infant is having a procedure that may be painful, such as a vaccine or blood draw, talk to your provider about the possibility of providing skin-to-skin contact during or after the procedure.
  6. Bonding
    Keeping a baby skin-to-skin after birth, with or without breastfeeding, causes a release of the hormone oxytocin in both the parent and baby. This hormone causes feelings of relaxation and love, which allows for the beginning of a strong bond. Skin-to-skin can be beneficial for creating connections with birth parents, adoptive parents, siblings, grandparents, etc.
  7. Reduced Risk of Hemorrhage
    Oxytocin, the same hormone that provides feelings of relaxation and love, also keeps the mother’s uterus contracting which helps reduce the risk of extra bleeding.

Babies Born by Cesarean Section

Babies who are born by C-section are often taken to a warming table to be examined and weighed immediately after birth. If there is no need for immediate medical attention or help with starting to breathe, a baby born in the operating room should be placed skin-to-skin with the mother as soon as possible. This can be more easily achieved by using a drape that can be lowered at the time of delivery to allow a baby to be passed directly from the doctor’s hands to the mother’s chest, just as with a vaginal birth. Even if a hospital does not have this type of drape, the baby can easily be handed to a nurse who can then place the baby on the mother’s chest.

If a C-section was done in an emergency, the mother may have been given medicine to go to sleep during the birth. In this case, the other parent or another family member or support person can stand in for the mother, placing the baby against their bare chest until the mother is ready. Some babies may need medical attention right after birth, but skin-to-skin contact should be started as soon as they are stable. Again, if your medical team knows your wishes ahead of time they can work to help you reach your goals.

Making Skin-to-Skin Contact Part of Your Birth Plan

Many hospitals now include skin-to-skin contact as a regular part of care after birth. The length of contact may differ, but organizations like the World Health Organization (WHO) suggest uninterrupted contact continue until the baby completes the first breastfeeding, usually about an hour after birth. If a mother is choosing not to breastfeed, she should still have at least an hour of undisturbed skin-to-skin with her baby after birth. The WHO recommends that skin-to-skin contact occur for every baby after birth, regardless of where they are born and whether it is a vaginal or cesarean birth. This process should not be disturbed for weighing or giving optional medications like erythromycin or Vitamin K, which can be done after the first hour. Talk to your midwife or doctor about your wishes before you go into labor.

Skin-to-skin contact should occur as much as possible throughout the first few days of a baby’s life and continues to have benefits when used throughout infancy. Some parents find that this contact can help calm the baby and many simply enjoy the bond they feel when snuggling with their baby skin-to-skin.

Schedule Appointment with Ashlie Buell, CNM

Sources:

American College of Cardiology. www.cardiosource.org

American Heart Association. www.heart.org

Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane (2016). http://www.cochrane.org/CD003519/PREG_early-skin-skin-contact-mothers-and-their-healthy-newborn-infants

Evidence on: skin-to-skin after cesarean. Evidence Based Birth (2017). https://evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/

Early skin-to-skin contact for mothers and their healthy newborn infants. World Health Organization (2013). https://extranet.who.int/rhl/topics/newborn-health/care-newborn-infant/early-skin-skin-contact-mothers-and-their-healthy-newborn-infants

Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term. American Academy of Pediatrics (2016). http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1889

Skin-to-Skin Contact with Baby in Neonatal Unit Decreases Maternal Stress Levels. American Academy of Pediatrics (2015). https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Skin-to-Skin-Contact-with-Baby-in-Neonatal-Unit-Decreases-Maternal-Stress-Levels.aspx