One of my personal highlights of birth is (obviously) the moment when the baby is born AND either the mum herself or the midwife places the baby on the mother’s naked chest.

That moment of total exhaustion and total triumph.

That moment when the mum feels her baby on the outside for the first time. When she holds her baby on her chest after holding it in her womb for nine months.

That moment of mother and child being skin-to-skin.

It seems quite natural that the baby is immediately given to the mother after it is born and stays with her for a while. Unfortunately, this isn’t always the case and it is on the mother and her birthing partner to know the benefits and stand up for it.

“What does the baby most need at the moment of birth? Only mother.” (NCBI)

I would add the question: What does the mother most need at the moment of birth? Only her baby.

Mothers and Babies have a physiological need to be together after birth. Keeping them together at the moment of birth is a safe and healthy practice. Evidence supports immediate, uninterrupted skin-to-skin care after birth for all stable mothers and babies. (NCBI)

What is skin-to-skin care?

We talk about skin to skin when the naked baby is placed on the bare chest of the mother- meaning mother and child are skin-to-skin. They both can be covered with a towel or blanket, so the baby stays warm. Placing the baby wrapped in a blanket in your arm is not skin-to-skin care. Why this is important becomes obvious when we talk about the impact and benefits of skin-to-skin care later on. It is okay though for the baby to wear a nappy whilst doing skin-to-skin in the following days and weeks.

The World Health Organisation and United Nations Children’s Fund recommend “that all healthy mothers and babies, regardless of feeding preference and method of birth, have uninterrupted skin-to-skin care beginning immediately after birth for at least an hour, and until after the first feeding, for breastfeeding women.” (WHO)

This means that all routine medical procedures like weighting the baby should be done after this initial bonding period.

Why is skin-to-skin care not standard?

When births started to move from homes to hospitals around 120 years ago most women received general anesthesia as labour pain relief which made mother and child affected them both after birth and so nurses took care of the baby in a nursery, separating mother and child for most of the time during their hospital stay.

Today, regional anesthesia is more common which keeps mothers alert and able to take care of their newborns right after birth. There is also more and more research and awareness of the importance of immediate skin-to-skin care today. (EBB)

What are the benefits for the baby?

• Enables early self-regulation

• Reduces stress

• Helps heart rate, breathing, and oxygen levels to remain stable

• Helps regulate temperature

The moment the baby is born it leaves the mum’s womb which was its warm, safe, and known home, and enters a cold and bright world with its first breath.

The warm chest of the mum is a safe space for the newborn where it can hear the mum’s heartbeat and smell colostrum. The mother keeps her newborn warm as her chest adjusts in temperature to regulate her baby’s temperature. It also enables early self-regulation and reduces stress, helping the baby’s heart rate, breathing, and oxygen levels to remain stable. (NCBI)

What are the benefits for the mum?

• Release of Oxytocin (which helps with bonding and breastfeeding and the uterus to contract)

• Less anxiety three days after birth

• Higher satisfaction

Skin-to-skin contact with her baby releases more of the hormone oxytocin in the mum’s body which helps the uterus contract, the placenta to be born, and the bleeding to stop. It also stimulates mothering feelings and helps the mum to bond and fall in love with her newborn.

Research also shows that mums experience less anxiety three days after birth and have higher satisfaction. (EBB)

What are the benefits for breastfeeding?

• More effective suckling during initial breastfeed

• More likely to exclusively breastfeed

• Longer breastfeeding

Studies have shown that babies who had early skin-to-skin care were more likely to exclusively breastfeed at and after hospital discharge and to breastfeed for longer durations. This might be explained by the high levels of Oxytocin and the newborn’s instinctive behaviour that happens when it is provided skin-to-skin contact immediately after birth. (NCBI)

This instinctive behaviour was observed and documented in the 1970s by Ann-Marie Widström, a Swedish midwife-nurse. She discovered a sequence of nine behaviours that newborns move through when left undisturbed on the mother’s chest that include 1) Birth Cry, 2) Relaxation, 3) Awakening, 4) Activity, 5) Rest, 6) Crawling towards the breast and nipple, 7) Familiarisation with the nipple, 8) Suckling, 9) Sleep. (EBB, NCBI)

This shows that newborns are usually capable of finding the breast, latching and, suckling without help.

What about skin-to-skin after cesarean?

The WHO recommends immediate skin-to-skin care for all methods of birth. Evidence has shown that it is possible and best for mother and child to stay together after a c-section and comes with all the above-discussed benefits. (EBB)

Most women today receive regional anesthesia, are awake during the surgery, and would be able to have the baby placed skin-to-skin.

Unfortunately, skin-to-skin care after cesarean is not the norm, and there are two main reasons for it.

Firstly, operation rooms are kept cold and the mum's body temperature may be cold too due to the surgery, so the newborn is taken to a warmer room to have the routine newborn check-up and keep it warm.

However, according to Evidenced Based Birth, there is evidence that newborns "who undergo skin-to-skin care 30-50 minutes after a Cesarean are NOT at higher risk for hypothermia (low temperature) compared to infants who are kept in a warmer" place (EBB). If the newborn can't keep its temperature on the mother's chest it can be held skin-to-skin with the father.

Secondly, the routine in the operating room doesn't naturally favour skin-to-skin care due to the number of personnel, the space around the mother's head, and the placement of heart monitor stickers, blood pressure cuff, and oxygen monitor on the mother's chest, arm, and finger for example.

To provide immediate skin-to-skin care with the mother in the operating room, some routines would need to change.

If immediate skin-to-skin care with the mother is not possible, it might be possible with the father or at least have skin-to-skin care in the recovery room.

You can read more about skin-to-skin care after cesarean on Evidence Based Birth.

What’s next?

The importance and benefits of immediate skin-to-skin care are more and more recognised and implemented. Whereas it’s standard at homebirths, the practices in hospitals vary from place to place. That’s why it is a good idea to ask your care provider about skin-to-skin care at your birthplace and write your preferences down in your birth plan.

References:

Bergman J., Bergman N. (2013). Whose Choice? Advocating Birthing Practices According to Baby's Biological Needs. The Journal of perinatal education, 22(1), 8–13. https://doi.org/10.1891/1058-1243.22.1.8

Bertone A., Dekker R. (2017). Evidence on: Skin-To-Skin After Cesarean.

Crenshaw J. T. (2014). Healthy Birth Practice #6: Keep Mother and Baby Together- It's Best for Mother, Baby, and Breastfeeding. The Journal of perinatal education, 23(4), 211–217. https://doi.org/10.1891/1058-1243.23.4.211

World Health Organization, United Nations Children’s Fund (2009). Baby-Friendly Hospital Initiative: Revised, updated, and expanded for integrated care. Geneva, Switzerland: World Health Organization