Sunday, December 26, 2010

Early skin-to-skin contact after birth: the more, the better

A new study in the Journal of Human Lactation, available online in advance of the print edition, examined the effect of early skin-to-skin (S2S) contact on exclusive breastfeeding rates at hospital discharge. In Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay, Leslie Bramson and co-authors examined several variables correlated with exclusive breastfeeding. One of these was early S2S contact during the first 3 hours after birth. This relationship was dose-dependent; in other words, the longer the S2S contact, the higher the rates of exclusive breastfeeding. Below is the abstract:
This was a nurse-driven, hospital-based, prospective cohort study of data collected in 19 hospitals in San Bernardino and Riverside counties by California Perinatal Services Network on all mothers (n = 21 842) who delivered a singleton infant (37-40 weeks gestation) between July 2005 through June 2006. Multivariate ordinal logistic regression showed that maternal infant-feeding method intention (measured prior to birth), sociodemographic characteristics, intrapartum variables, and early skin-to-skin mother—infant contact during the first 3 hours following birth (controlling for delivery hospital) were correlated with exclusive breastfeeding during the maternity hospitalization. Compared with mothers with no early skin-to-skin contact, exclusive breastfeeding was higher in mothers who experienced skin-to-skin contact for 1 to 15 minutes (odds ratio [OR] 1.376; 95% confidence interval [CI], 1.189-1.593), 16 to 30 minutes (OR 1.665; 95% CI, 1.468-1.888), 31 to 59 minutes (OR 2.357; 95% CI, 2.061-2.695), and more than 1 hour (OR 3.145; 95% CI, 2.905-3.405). The results demonstrate a dose—response relationship between early skin-to-skin contact and breastfeeding exclusivity.
This study is significant for several reasons. First, it was a prospective (rahter than retrospective) study with a large sample size of over 21,000 mother-infant pairs. It also teased out the true assocation between S2S contact and breastfeeding rates, independent of maternal intention, sociodemographic characteristics, and events occurring during labor (specifically, forms of analgesia/anesthesia used and method of delivery). From the article's introduction:
From July 2005 through June 2006, PSN (Perinatal Services Network of Loma Linda University Medical Center/Children’s Hospital) enacted a prospective cohort, nurse-driven, hospital-based quality assurance intervention (n = 21 842 mother–infant dyads) to promote, support, and improve the development of newborns through bonding and attachment and early mother–infant skin-to-skin contact during the first 3 hours following birth. Analysis of the PSN data provided the opportunity to fill a gap in the early skin-to-skin literature. It was our intention to include in one study maternal infant-feeding intention, sociodemographic characteristics, intrapartum variables, and the length of time spent in early skin-to-skin mother–infant contact during the first 3 hours following birth (controlling for the hospital of birth) to determine their association with exclusive breastfeeding during the maternity hospital stay. In addition, this program allowed us to examine a possible dose–response relationship between early skin-to-skin contact within the first 3 hours post birth and the likelihood of exclusive breastfeeding during the maternity hospital stay.
At the end of the article, the authors discuss the clinical implications of their findings:

The clinical implications for this study are numerous. The current study has provided data demonstrating that early skin-to-skin contact is clinically effective with respect to increasing exclusive breastfeeding during the maternity hospital stay. Results from our study imply that there is a need to increase the length of exposure to early skin-to-skin contact during the early postpartum period. These results provide important information that peripartum staff can include in their postpartum program planning, policies, and intervention. Maternity caregivers can specifically allocate resources to woman who may be less likely to breastfeed by encouraging skin-to-skin contact during the early postpartum period. Walters and colleagues surveyed their hospital peripartum nursing staff after their early skin-to-skin contact (birth kangaroo care) pilot study. The peripartum personnel surveyed after the study stated that implementing early skin-to-skin contact did not take them longer nor did its implementation add to their workload.

Numerous interfering events during the maternity hospital stay can cause problems for mothers who intend to breastfeed. Events that interfere with breastfeeding may be decreased by allowing the mother and infant uninterrupted early skin-to-skin contact. Programs such as PSN’s pave the way to reestablish breastfeeding as the gold standard. One way to accomplish this seems to be facilitating uninterrupted, extended, early skin-to-skin mother–infant contact. We agree with the suggestion by Moore and Anderson that “the ideal intervention would include the mother-infant dyad experiencing skin-to-skin contact not only as early as possible, but also as often as possible, and for as long as possible each time, at least during the entire postpartum stay.” Our findings, if incorporated into hospital-based practices and protocols, can strengthen maternal–infant bonding and attachment and early exclusive breastfeeding behaviors. This is the ultimate goal, but in the interim we recommend the continuation and expansion of programs such as PSN’s early skin-to-skin mother–infant contact, nurse-driven, hospital-based intervention for a minimum of 2 hours during the first 3 hours following birth.
Email me if you'd like to read the full text.


  1. I used to live in that area and I know that Loma Linda and St. Bernadine Medical Center do skin to skin. I had looked into delivering at both of them but had found a birth center instead. Loma Linda is just an amazing hospital overall, My dad's life was saved there twice.

  2. Great Post! This makes 100% sense. Also, great picture of the kids sleeping in by far the most healthy way - on their stomachs. I've reviewed much of the pediatric sleep literature and it's clear that stomach sleeping is far healthier for infants than back sleeping. Since the U.S. and Canada implemented "Back to Sleep" recommendations in the early 1990's the rate of developmental problems with kids has spiked dramatically. Here in the U.S. the SIDS Back to Sleep Campaign is also one of the main barriers to breastfeeding because it is very anti-cosleeping. BTW, I'm not an advocate for or against cosleeping because I've only researched the subject in as much as it is related to infant sleep but clearly skin to skin contact is very important and is clearly increased by cosleeping. Melissa Bartick of the Massachusetts Breastfeeding Coalition has noted how the ostensibly good organizations such as "First Candle" are supported by the formula industry here in the U.S. because infants that don't cosleep are breastfed less. My main concern is that the decrease in the amount of Slow Wave Sleep (SWS) for infants who sleep on their backs compared to infants that sleep on their stomachs is diconcerting because SWS is the most restorative form of sleep and is also necessary for hippocampal-neocortical interactions which is the basis for memory consolidation and learning. The recommend increased "Tummy Time" but increased Tummy Time will do nothing to address the issue of decreased SWS because Tummy Time occurs when a child is awake and not asleep. Tummy Time may address some of the motor skills problems but only as a band-aid solution.

    I just posted two new blogs:
    (1) SIDS Statistics. A summary of peer reviewed journal articles and interviews that suggests the decrease in SIDS in the U.S. since the Back to Sleep campaign may be incorrect and that the apparent decrease is actually due to "code shifting" and other factors.
    (2) Motor Skills Delays associated with Back Sleeping. A summary of peer reviewed journal articles which reports on the motor skills delays and neurocognitive delays that are associated with the infant back sleeping position. These are in addition to the well known problems such as increased rates of plagiocephaly, torticollis, colic, strabismus, and hip subluxation.

    Great Blog!

    T. Joseph McCabe


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