Skin-to-Skin Contact - La Leche League International

Skin-to-skin contact (also known as SSC) starts while enjoying the bonding time with your newborn baby. The physiologically normal place for a baby to be immediately after birth is in your arms and against your skin. When placed skin-to-skin, your baby instinctively feels safe and protected. Skin-to-skin contact helps ease the transition to life outside the womb and decreases the stress of birth for both you and your baby. Ideally, it begins immediately after birth and continues until after the first breastfeeding/chestfeeding. However, it is important whenever you can initiate it. History of skin-to-skin contact and kangaroo careNon-continuous skin-to-skin contactSkin-to-skin contact after birth and early postpartumSkin-to-skin contact helps mothers tooDr. Bergman’s prescription for skin-to-skin contactBeginning skin-to-skin contactImportance of skin-to-skin contact in infant care beyond the newborn periodPreparation for skin-to-skin contactProfessional support for skin-to-skin contactResourcesReferences The idea of placing babies skin-to-skin is not new. It is as old as the dawn of primates; however, it was replaced in modern times by hospital routines such as central baby nurseries and the use of incubators for premature babies. In 1978, at Instituto Materno Infantil, a large maternity hospital in Bogotá, Colombia, many premature babies were dying because the hospital didn’t have enough incubators. Dr. Rey, a pediatrician at the hospital, read an article on the physiology of marsupials and their newborns. He was inspired to overcome the shortage of incubators in the hospital by trying what has become known as kangaroo mother care (also known as KMC). Kangaroo mother care provides continuous skin-to-skin contact with the mother 24 hours a day. When no incubator was available for his newest patient, Dr. Rey wanted to give the mother a chance to be with her baby and possibly, say goodbye. He gave the mother her baby; she placed her baby on her chest, skin-to-skin, and cared for the newborn. Imagine how this mother felt: she was frightened for her baby, but she sensed that she could provide the love, warmth, and breastmilk her baby needed. She had the opportunity to get to know her baby intimately. The experience empowered her to give the lifesaving care her baby needed. Staff doctors decided they should try to duplicate this success with more patients (Kangaroo Care: The Radical Skin-To-Skin Approach to Saving Premature Babies, 2017). When the doctors evaluated the experience with kangaroo care, they found the number of hospital-acquired infections decreased significantly as did the number of babies getting sicker and dying. They needed fewer nurses to care for the babies. Soon benches in Colombia were filled with parents providing kangaroo care in the hospital and clinics, and kangaroo care began. (Charpak, 2007) Since 1987, beginning in a small mission hospital in Zimbabwe, Dr. Nils Bergman has demonstrated that even the tiniest premature infants can be skin-to-skin with their mother and have zero separation from their mother. This is the biologically normal place for an infant. Bergman has used his own research and research from neuroscientists to show that the infant needs skin-to-skin contact as the place for basic physiological regulation of temperature, heart rate, and respiration. When the newborn isn’t in skin-to-skin contact, the infant instinctually feels unsafe, which dysregulates the infant’s brain. All the necessary care can be provided while in skin-to-skin contact with the mother. Breastfeeding and the mothers’ own milk are vital to this life-saving care. Nils Bergman says fathers and surrogates chosen by the mother can also help the mother in providing this intensive care. (Bergman, 2014; 2024) For low birth weight infants, kangaroo mother care can reduce infants dying by 40% after birth and before they are discharged. (Moore, 2016) Another recent analysis found that the risk of the premature infants dying could be reduced by 32% and the risk of a severe infection reduced by 15% when kangaroo mother care was begun in the first 24 hours. The researchers found that it results in a greater benefit if the baby is skin-to-skin for more than eight hours a day. They concluded that kangaroo care should begin at birth unless the infant or mother is critically ill. This research was done with preterm and low birth weight babies who are the most vulnerable group of newborns for poor outcomes. (Sivanandan, 2023) Many countries now encourage and practice kangaroo care. However, 24-hour skin-to-skin contact is not considered practical in many hospitals. Skin-to-skin contact care is valuable even for a shorter period. The more time the baby spends skin-to-skin, the greater the benefits. Skin-to-skin contact is a time to learn about your baby’s needs and feeding cues. It helps rewire your brain to love this new little being and wires your baby’s brain to bond and be loved. The connection of neural pathways is maximized when your baby is positioned flat against your chest. Stimulates the release of oxytocin, the “love hormone” that helps you and your baby to bond and relax. Enables you to be more in tune with your instincts to care for your baby and learn to breastfeed. Helps your baby acquire your healthy microbes and to develop a healthy microbiome of their own. This healthy microbiome can provide lifelong immunological benefits for the baby. Your baby recognizes your smell and the sound of your heartbeat and is calmed. Skin-to-skin contact immediately after birth is one of the most effective methods for promoting exclusive breastfeeding. Helps babies to learn to latch and suckle at the breast. Increases prolactin levels and milk production. Increases the likelihood of exclusive breastfeeding at and after discharge, and the length of the breastfeeding relationship. When breastfeeding cannot be initiated immediately, skin-to-skin contact: Prepares for earlier initiation of the first breastfeeding experience. Helps the baby maintain body temperature similar to a hospital warmer. Regulates the baby’s breathing and heart rate and keeps the baby’s blood sugar level stable. Skin-to-skin contact reduces crying.  It can decrease pain for the baby from any procedures done while skin-to-skin. It helps the baby to feel calmer and more regulated. Researchers have found that during the time the babies were separated from their mothers, the babies’ autonomic activity averaged 176 percent higher and quiet sleep 86 percent lower than when they slept skin-to-skin with their mothers (Morgan, Horn & Bergman, 2011) We made a startling discovery, Dr. Bergman says. “When babies sleep separate from their mothers their heart rate variability triples, deep sleep is significantly reduced; there is no sleep cycling.” (Kangaroology: The First 1000 Minutes, n.d.) Skin-to-skin contact helps the mother have a more positive birth experience even in situations that might not have felt positive. It can reduce postpartum hemorrhage and stress for mother and baby. Skin-to-skin contact can also decrease postpartum depression. It increases parental confidence and enhances the mother’s experience of giving birth. (Widström et al, 2019) The more skin-to-skin the better in the first hours, days, weeks, months and years. But, to start, he recommends the first six hours skin-to-skin to stabilize the newborn; the first one thousand minutes to wire the mother for resilience; and the second or third hour skin-to-skin with the father to profoundly and permanently alter his brain for fatherhood.” (Kangaroo Mother Care – Nino Overview, n.d.) How is skin-to-skin contact initiated right after birth? You will be in a slightly reclined position with support for your arms and back. Your baby is placed on your chest, dried, and covered with a blanket until the cord is clamped. Once the cord is clamped, your baby should remain chest-to-chest with you. Ideally skin-to-skin contact remains uninterrupted for at least 90 minutes, which is the length of 2 sleep cycles for a baby. Longer periods of skin-to-skin contact should be encouraged. The baby’s face is easily visible and uncovered, the neck is straight, and the knees are bent. The baby may be naked or wearing a diaper or nappy. Most standard procedures can be done while the baby is on your chest. Measuring a baby can be delayed for up to six hours; the measurement will not change dramatically in that time frame. Your body will keep your baby warm. You can learn about your baby’s feeding cues, like rooting or sucking on their hands, and can guide your baby to the breast for the first feeding. Regardless of the birth setting – hospital, birth center, or home – skin-to-skin contact can and should be part of the routine care of the newborn. Skin-to-skin contact can continue as you and your baby are moved from the labor suite to the postpartum setting while receiving observation and support for early breastfeeding. Your partner, other family members, or the labor support person, can also hold your baby skin-to-skin if you cannot hold your baby for medical or other reasons. In some special or medical circumstances, you may need assistance from a support person or nurse to position yourself and your baby comfortably. Twins may be positioned side to side on your body.  If you have a cesarean birth, check your hospital’s policy for skin-to-skin contact in the operating room. Your support person can hold your baby skin-to-skin until you are ready. After a cesarean birth, the baby may be placed on your chest above the drape. Many hospitals have a policy for skin-to-skin contact and cesarean births. Skin-to-skin contact can begin while your incision is being closed. Sometimes a premature or sick baby is transferred to the neonatal intensive unit (NICU).  Then, skin-to-skin contact should occur as soon as possible. The KMC Study Group found that current research supports that all babies can benefit from immediate skin-to-skin contact and they will be healthier in the short and long term if they are not separated from their mother. (Brimdyr et al, 2023) Skin-to-skin contact can be a valuable parenting tool through infancy and into toddlerhood. This tool is valuable long-term because the parents will be more confident about how to read the baby’s cues and less stressed. Skin-to-skin contact enhances parents’ responsiveness and connectedness. Attend a childbirth class while pregnant. The instructor will have a good sense of the practices of the hospitals in your area. If you are preparing a birth plan, include a request for skin-to-skin contact in your plan. Ask your healthcare team, family member or friend to advocate for you if the hospital where you plan to give birth does not have skin-to-skin contact as part of their standard of care for childbirth. If you are able to choose another hospital, let the hospital you are leaving know why you have made the switch. Skin-to-skin contact promotes breastfeeding and helps babies grow and thrive. Because of the many benefits of skin-to-skin contact, many respected maternal-infant care organizations endorse skin-to-skin contact. These include La Leche League International (LLLI), the World Health Organization (WHO), Baby-Friendly Hospital Initiative (BFHI), the Academy of Breastfeeding Medicine (ABM), and the American Academy of Pediatrics (AAP). Baby Friendly hospitals are required to ensure that skin-to-skin contact is valued and supported in their maternity and neonatal units. In some instances, skin-to-skin contact may not be possible immediately after a cesarean birth, but Baby Friendly protocols require it to be available as soon as possible after birth. (UNICEF, 2023) The recent WHO guidelines recommend that immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and babies, after all modes of birth. (WHO, 2023) Hospitals that are up to date with best practice and evidence-based medicine will strive to keep mother and baby together for the first hour. New knowledge extends the critical first hour after birth in skin-to-skin contact to the first day. The first 1000 minutes is the important time to keep uninterrupted skin-to-skin contact and togetherness. One thousand minutes is over 16 hours, practically speaking the first day and night. “Zero separation” time can be achieved with the help of the father or any other family member, but mainly to support the mother to be able to spend as much time as possible with the baby. In this way they can synchronize their wake-sleep time and learn each other’s body language. The newly fired pathways in both their brains become stronger and coordinated: this is what bonding is actually about. (Kangaroo Mother Care – Nino Overview, n.d.) Skin-to-Skin ContactMultilingual infographic Skin-to-skin is as easy as 1-2-3!Breastfeeding Premature BabiesBreastfeeding Skin-to-Skin Helps Baby Build a Healthy Immune SystemVulnerable Pretoria Baby gets Skin to SkinIt Takes a VillageWhat’s the big deal with skin-to-skin?Kangaroo Mother CareSSC – evidence-based information for health professionalsSkin-to-skin contact is a key part of the UNICEF UK Baby Friendly Initiative standards Anderson, G. C. (2007). Early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, 2. https://doi.org/DOI:10.1002/14651858.CD003519 Bergman, N. (2014). The neuroscience of birth – and the case for Zero Separation. Curationis, Vol 37, No 2, a1440. DOI: https://doi.org/10.4102/curationis.v37i2.1440. Bergman, N. J. (2024). 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