 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 need for extra oxygen, and keeps them
more stable in other ways as well (See www.kangaroomothercare.com) (See
the information sheet Breastfeeding the Premature Baby).
To appreciate the importance of keeping mother and baby skin to
skin for as long as possible in these first few weeks of life (not just
at feedings) it might help to understand that a human baby, like any
mammal, has a natural habitat: in close contact with the mother (or
father). When a baby or any mammal is taken out of this natural
habitat, it shows all the physiologic signs of being under significant
stress. A baby not in close contact with his mother (or father) by
distance (under a heat lamp or in an incubator) or swaddled in a
blanket, may become too sleepy or lethargic or becomes disassociated
altogether or cry and protest in despair. When a baby is swaddled it
cannot interact with his mother, the way nature intended. With skin to
skin contact, the mother and the baby exchange sensory information that
stimulates and elicits “baby” behaviour: rooting and searching the
breast, staying calm, breathing more naturally, staying warm,
maintaining his body temperature and maintaining his blood sugar.
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. As mentioned in the information sheet Breastfeeding—Starting out Right,
a baby who latches on well gets milk more easily than a baby who
latches on less well. See the video clips of young babies (less than 48
hours old) breastfeeding at the website nbci.ca. 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 have
enough milk, but because it is not abundant, as nature intended, the
baby needs a good latch in order to get that milk. Yes, the milk is
there even if someone has proved to you with the big pump that there
isn’t any. How much does or does not come out in the pump proves
nothing—it is irrelevant. Many mothers with abundant milk supplies have
difficulty expressing or pumping more than a small amount of milk. Also
note, you can’t tell by squeezing the breast whether there is enough milk in there or not.
And a good latch is important to help the baby get the milk that is
available. 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 (and should continue for as many hours as
possible throughout the day and night for the first number of weeks)
has the following positive effects. The baby:
- Is more likely to latch on
- Is more likely to latch on well
- Maintains his body temperature normal better even than in an incubator
- Maintains his heart rate, respiratory rate and blood pressure normal
- Has higher blood sugar
- Is less likely to cry
- Is more likely to breastfeed exclusively and breastfeed longer
- Will indicate to his mother when he is ready to feed
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 baby may be
placed vertically on the mother’s abdomen and chest and be left to find
his way to the breast, while mother supports him if necessary. The
mother, of course, may make some attempts to help the baby, and this
should not be discouraged. This is baby’s first journey in the outside
world and 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 eye drops 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 cæsarean 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. 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 important for the baby and the mother for
all the other reasons mentioned.
If the baby does not take the breast right away, do not panic.
There is almost never any rush, especially in the full term healthy
baby. One of the most harmful approaches to feeding the newborn has
been the bizarre notion that babies must feed every three hours. Babies
should feed when they show signs of being ready, and keeping a baby
next to his mother will make it obvious to her when the baby is ready.
There is actually not a stitch of proof that babies must feed every
three hours or by any schedule, but based on such a notion, many babies
are being pushed into the breast simply because three hours have
passed. The baby who is not yet interested in feeding may object
strenuously, and thus is pushed even more, resulting, in many cases, in
baby refusing the breast because we want to make sure they take the
breast. And it gets worse. If the baby keeps objecting to being pushed
into the breast and gets more and more upset, then the “obvious next
step” is to give a supplement. And it is obvious where we are headed
(see the information sheet When a Baby Has Not Yet Latched).
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
The Importance of Skin to Skin Contact, 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC and Edith Kernerman, IBCLC, 2008, 2009©
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