the importance of skin to skin

WHAT IS SKIN TO SKIN?
Also known as 'Kangaroo Care', skin to skin is placing a naked newborn on the mother’s bare chest and covering the infant with blankets to keep it dry and warm. Ideally, skin-to-skin care starts immediately after birth or shortly after birth. The baby typically remains on the mother’s chest until at least the end of the first breastfeeding session.

WHAT ISN'T SKIN TO SKIN?
Laying a baby on top of mother’s gown or wrapped in a towel.

TYPES OF SKIN TO SKIN:
Skin-to-skin care can start at different times. There are 3 main types of early skin-to-skin care, but please note this is in regards to healthy at-term infants:

1. Birth or immediate skin-to-skin care starts during the first minute after birth
2. Very early skin-to-skin care begins 30-40 minutes post-birth
3. Early skin-to-skin is any skin-to-skin time that takes place during the first 24 hours

​*For healthy, at-term vaginal births, immediate is recommended. 
For C-Sections, the typical time for skin to skin seems to be about 30 minutes after birth. 

​SKIN TO SKIN USE TO BE THE NORM:
Separation of human mothers and newborns started in the early 1900's, when birthing moved from home to hospital, and birth was medicalized. This is a complete switch from natural human history. In the past, infant survival depended upon close and virtually continuous mother-newborn contact.

Research consistently shows that skin to skin immediately after birth improves outcomes and is BENEFICIAL AND SAFE, yet hospitals are slow to make changes.

BENEFITS OF SKIN TO SKIN:

1. Longer and more effective breastfeeding, more likely to exclusively breastfeed, more effective suckling during the initial breastfeeding session
2. Less breast engorgement/pain at three days for Mom
3. Less anxiety three days after birth for Mom
4. Mothers are six times more likely to want the same care in the future when they held their babies skin-to-skin rather than swaddled, increasing satisfaction of their birth experience
5. Less crying– babies who received skin-to-skin care were 12 times less likely to cry during the observation period
6. Heart rate, breathing, and oxygen levels were more likely to remain stable for baby
7. A beneficial increase in blood sugar for baby
   
   

These benefits are SO HUGE that the World Health Organization recommends that ALL newborns receive skin-to-skin care, no matter the baby’s weight, gestational age, birth setting, or clinical condition. Skin-to-skin should begin immediately after birth and continue uninterrupted for at least one hour or until the first breastfeeding session for mothers who are breastfeeding.

RISKS OF SKIN TO SKIN:
Sudden unexpected postnatal collapse (SUPC)
This is when a seemingly healthy infant becomes rapidly unstable within the first two hours after the birth, often during the first breastfeeding session. This happens in 3-5 babies out of every 100,000.


SUPC is most likely to occur when an infant has an internal risk factor, like an infection or heart defect, combined with an external risk factor, like exposure to pain medication or magnesium sulfate medication during labor or risky positioning after the birth. Studies have found that in 77% of cases, the mother or both parents were alone with the newborn at the time of the episode .


To decrease the risk of SUPC during skin-to-skin care:

1. Ensure your nurse or midwife observes the mother-infant pair during the first two hours after birth
2. Educate yourself on abnormal newborn appearance and behaviours—such as pale or bluish skin color, difficulty breathing, or limp muscle tone to identify it as soon as possible
   
3. Delay the use of smartphones until the first two hours after birth -so you are fully present
4. Elevate the head of the bed so baby isn’t lying flat/face-down on the mother’s chest
5. Ask questions about safe breastfeeding and check frequently to be sure that the baby’s neck is straight and nose and mouth are not blocked
   
   CAN I STILL DO SKIN TO SKIN AFTER A C SECTION?

​Unfortunately the evidence for skin to skin after a caesarean is lacking, although the evidence currently suggests there are many benefits to skin to skin after C Section (even if you can't hold baby immediately, within the first hour still has many benefits!) Here are my tips:
​

1. Your provider may not be comfortable/open to allowing skin to skin immediately following a C section. This is because babies born through C Section are at higher risk for hypothermia, and you may not be able to keep baby warm enough or be alert enough to safely hold baby. If you are very alert (only received regional anaesthesia, did not have a prolonged labour/are not sleep deprived) you can advocate for immediate skin to skin under the supervision of a nurse. Your provider may or may not be open to this.
2. If baby is not able to stay warm enough with you, you can request baby be placed skin to skin on your birth partner or family member in the recovery room, until you can get there to perform skin to skin (about 30 minutes later).

This is a brief overview and is in regards to healthy, at-term infants. Always discuss your plan with your healthcare provider to determine the best plan for your pregnancy. This is for informational purposes only and should not be used as medical advice.