Last week, I was fortunate enough to attend the Alberta Breastfeeding Committee’s conference, Infant feeding: Best practice steps for primary preventative care. Louise Dumas and Marianne Brophy spoke at the event, and it was an inspiring day for me to say the least.
The information which Louise Dumas presented provided substantial weight to the view that the simple act of placing an infant on his mother’s skin immediately after birth has a profound, far-reaching impact. Dumas’ presentation, backed by documentation of 176 mother-baby dyads conducted by a Russian-Sweedish-Canadian team at the Karolinska Instituetet, highlighted the breastfeeding, physical, and psycosocial effects of skin-to-skin care.
Four of the papers based on this research:
I’m quite excited at the depth of evidence being accumulated from this research. I firmly believe that this information will pave the way for change in birth and postpartum care to incorporate uninterrupted skin-to-skin time for mothers and babies. In Dumas’ words, backed by this evidence, skin-to-skin is “not something nice to do. It’s something we have to do.”
Skin-to-skin care as practiced in this research is described as the nude newborn being placed vertically between the mother’s breasts immediately after birth. The amniotic fluid is dried off the infant’s back and head, then a dry blanket is placed over top of him. The amniotic fluid not being dried off of the newborn’s front is important, as is the absence of any separation at all of the mother and the infant for 1-2 hours following birth.
The data taken from the infants in this research included temperature, breathing and heart rates, cortisol and oxytocin levels in venous blood in the umbilical cord, scalp blood, weight, number and duration of breastfeeding episodes, number and type of supplements, and Reutor scale for neurobehavioral development. The data from the mothers included physical assessment, temperature, breathing and heart rate, multiple questionnaires, and a breastfeeding diary. Also recorded were the temperatures of the birthing room, the nursery and the mother’s room as well as videos taken when the infant was placed skin-to-skin, during a breastfeed on day for, and again at 12 months.
The physiological impacts on the infant were numerous. Infants placed skin-to-skin with their mothers’ and left uninterrupted for 1-2 hours always had temperatures within normal limits and they re-warmed faster than infants in an incubator or in a warmer. They had better glycemia and arterial gasses at 90 minutes of life and better oxygen saturation. In other words, skin-to-skin helped newborns to overcome the “stress of being born”.
During their first four hours of life the infants had more episodes of calm sleep and they were more coordinated and stable. They also had reduced pain reaction during painful procedures such as vitamin K injection and PKU heel lance.
For mothers, the skin-to-skin time resulted in quicker placental explusion, which results in less bleeding and less anemia.
The impact of skin-to-skin also could be seen in the breastfeeding relationship. Starting at around 10 minutes of life, infants started creeping towards the breast, turning towards mom’s voice and breast, salivating when smelling the nipple, and finally licking then attaching to the breast. In babies who have been exposed to medications during mother’s labor, these behaviors might start to take place closer to twenty minutes after birth.
This skin-to-skin time resulted in an infant with a more effective suck. On days three and four, there were more suckings, less engorgement, and more milk ingested. Babies re-gained their initial weight loss three to five days faster than swaddled babies in the nursery did, even if the babies in the nursery received more supplements with formula. There was also found to be a significant link between the duration of skin-to-skin and the exclusivity of breastfeeding at discharge.
They psychosocial benefits from skin-to-skin were also numerous. Infants were found to cry less at birth, during the first 90 minutes of life, and during the first three months. They were more alert after their first cry, they had more vocalizations, and they focused more on mother’s face and breast. At one year of life, infants who had experienced uninterrupted skin-to-skin time at birth were more able to calm themselves and there was more mutual reciprocity between mother and infant.
Mothers who experienced uninterrupted skin-to-skin were noted to have touched their infants more and kept their babies with them more. They also tended to follow whoever took her baby away, such as for medical exam or bathing. During the day four breastfeeding sessions that were videotaped, mothers were observed to be more patient with their infants. They also responded more softly to the infants’ cues, whereas the mothers of the swaddled babies demonstrated a clear tendency to be rougher with their infants.
“We should respect the baby and mother instinctive behavioral and endocrine interaction sequence.” Ann-Marie Widstrom,
So, based on this information, what does Dumas suggest? There are a few key pieces.
There should be immediate and uninterrupted skin-to-skin for the first one to two hours after birth, unless medical situation absolutely requires it. Any procedures such as vitamin K injection, application of erythromycin, and weighing/measuring should be delayed until after this time. The environment should be calm and respectful, and the mother should have effective support. Following the birth, the baby should not receive any medically-unjustified supplementation and should room in with his mother 24 hours a day. All exams should be done in the mother’s room.
Dumas spoke about situations where patients bringing this information to their doctors created change. Although these skin-to-skin practices might not be standard here in Canada, individual patients requesting change do add up and can result in change within the medical system.