The Importance of Skin to
Skin Contact
by Jack Newman, M.D., FRCPC
There
are now a multitude of studies that show that mothers and babies
should be together, skin to skin (baby naked, not wrapped in a
blanket) immediately after birth, as well as later. The baby is
happier, the baby's temperature is more stable and more normal, the
baby's heart and breathing rates are more stable and more normal,
and the baby's blood sugar is more elevated. Not only that, skin to
skin contact immediately after birth allows the baby to be colonized
by the same bacteria as the mother. This, plus breastfeeding, are
thought to be important in the prevention of allergic diseases. When
a baby is put into an incubator, his skin and gut are often
colonized by bacteria different from his mother's.
We now know that this is true not only for the baby born at term and
in good health, but also even for the premature baby. Skin to skin
contact and Kangaroo Mother Care can contribute much to the care of
the premature baby. Even babies on oxygen can be cared for skin to
skin, and this helps reduce their needs for oxygen, and keeps them
more stable in other ways as well.
From the point of view of breastfeeding, babies who are kept skin to
skin with the mother immediately after birth for at least an hour,
are more likely to latch on without any help and they are more
likely to latch on well, especially if the mother did not receive
medication during the labour or birth. A baby who latches on well
gets milk more easily than a baby who latches on less well. When a
baby latches on well, the mother is less likely to be sore. When a
mother's milk is abundant, the baby can take the breast poorly and
still get lots of milk, though the feedings may then be long or
frequent or both, and the mother is more prone to develop problems
such as blocked ducts and mastitis. In the first few days, however,
the mother does not have a lot of milk (but she has enough!), and a
good latch is important to help the baby get the milk that is
available (yes, the milk is there even if someone has "proved" to
you with the big pump that there isn't any). If the baby does not
latch on well, the mother may be sore, and if the baby does not get
milk well, the baby will want to be on the breast for long periods
of time worsening the soreness.
To recap, skin to skin contact immediately after birth, which lasts
for at least an hour has the following positive effects on the baby:
Are more likely to latch on
Are more likely to latch on well
Have more stable and normal skin temperatures
Have more stable and normal heart rates and blood pressures
Have higher blood sugars
Are less likely to cry
Are more likely to breastfeed exclusively longer
There is no reason that the vast majority of babies cannot be skin
to skin with the mother immediately after birth for at least an
hour. Hospital routines, such as weighing the baby, should not take
precedence.
The baby should be dried off and put on the mother. Nobody should be
pushing the baby to do anything; nobody should be trying to help the
baby latch on during this time. The mother, of course, may make some
attempts to help the baby, and this should not be discouraged. The
mother and baby should just be left in peace to enjoy each other's
company. (The mother and baby should not be left alone, however,
especially if the mother has received medication, and it is
important that not only the mother's partner, but also a nurse,
midwife, doula or physician stay with them-occasionally, some babies
do need medical help and someone qualified should be there "just in
case"). The eyedrops and the injection of vitamin K can wait a
couple of hours. By the way, immediate skin to skin contact can also
be done after cęsarean section, even while the mother is getting
stitched up, unless there are medical reasons which prevent it.
Studies have shown that even premature babies, as small as 1200 g (2
lb 10 oz) are more stable metabolically (including the level of
their blood sugars) and breathe better if they are skin to skin
immediately after birth. The need for an intravenous infusion,
oxygen therapy or a nasogastric tube, for example, or all the
preceding, does not preclude skin to skin contact. Skin to skin
contact is quite compatible with other measures taken to keep the
baby healthy. Of course, if the baby is quite sick, the baby's
health must not be compromised, but any premature baby who is not
suffering from respiratory distress syndrome can be skin to skin
with the mother immediately after birth. Indeed, in the premature
baby, as in the full term baby, skin to skin contact may decrease
rapid breathing into the normal range.
Even if the baby does not latch on during the first hour or two,
skin to skin contact is still good and important for the baby and
the mother for all the other reasons mentioned.
Written by Jack Newman, drjacknewman@sympatico.ca drjacknewman@sympatico.ca
MD, FRCPC. © 2005
This handout may be copied and distributed without further
permission, on the condition that it is not used in any context in
which the WHO code on the marketing of breast milk substitutes is
violated.
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