What is “Skin to Skin” and why should it be in my birth plan?

Skin to Skin contact refers to when our babies are placed skin to skin immediately on their Mothers bare chest at birth or within the first 180 min (Gupta et al., 2021). 

The benefits of skin to skin contact at birth are now well established in the literacy.  Thankfully, the Baby friendly initiative, a joint UNICEF and WHO project to promote breastfeeding, has meant that it is being more widely recognised and adopted into hospital policies (2023). Which is fantastic. With that in mind it is worth noting what exactly occurs during skin to skin, its many benefits and why it is so important that this time remains uninterrupted (if Mother and Baby are both healthy and well). 

This awareness is important because, for many hospitals – including the ones that have adopted the “baby friendly initiative”, women may still find themselves on a “clock” so to speak and this crucial bonding time can sadly sometimes be rushed and interrupted with procedures such as weighing, vaccines, vit k injections, active management of third stage of labour etc. Additionally, sometimes the babies natural feeding processes can be interrupted by well intended Midwives (I have been one of these myself before I learnt all about baby led attachment) to “assist” a baby to feed rather than letting a “baby led attachment” naturally occur. This is not trying to shame or go against the hospital setting and what can occur. Because while in some instances this interruption can be from a lack of awareness and a lack of trust in the physiological process, I believe that often its just the reality of an incredibly busy workplace where staff shortages and shortage of birthing rooms creates extra pressure and demands to “rush” or interrupt this time. So how can we optimise this process and why should this be a priority ?

This article aims to bring awareness, for both birth workers and parents, surrounding the many proven advantages of skin to skin contact, an understanding of the physiology behind these benefits and what a baby led attachment actually is. In addition this article aims to provide ways to which we can promote and optimise this process rather than inhibit it.

The benefits of Skin to Skin

There is a growing body of evidence that skin to skin contact at birth has physiological, neurological and emotional benefits to both Mother and Baby and this includes premature babies (Sehgal et al., 2020, Gupta et al., 2021). In fact, a world-first study led by Monash University demonstrated significant benefits to a premature baby’s heart and brain function when held by the parent in skin-to-skin contact (Sehgal et al., 2020). This study, published in the Journal of Paediatrics, provides scientific evidence and rationale as to “why the infant’s heart rhythm and neurodevelopment is better with regular kangaroo care. Improving blood supply is important as it carries oxygen and nutrients to the brain and other organs, and guides neurodevelopment.” (Sehgal et al., 2020). Professor Sehgal stated that “The findings of our study are significant as this is a low cost intervention, easily applicable to infants in neonatal units across the world, and helps the most vulnerable of the populations we care for,”(Sehgal et al., 2020). These findings align with previously documented physiologic benefits in cardiorespiratory stability and cardiac rhythm in preterm infants, and may be mediated through modulation of the autonomic nervous system (Moore et al., 2012).

Other benefits of skin to skin include;

• Optimised maternal and baby bonding
• Calms and relaxes both mother and baby
• Regulated blood sugar levels
• Assists in the birth of the placenta (third stage)
• Reduces complications such a postpartum haemorrhage (when breastfeeding is initiated)
• Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
• Stimulates the babies digestion and an interest in feeding
• Regulates temperature
• Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection (2023)
• Stimulates the release of hormones to support breastfeeding and mothering.

For babies that have been separated due to prematurity or other complications and are placed in a Neonatal unit- skin to skin benefits can include;Improvement in oxygen saturation

• Reduced cortisol (stress) levels, particularly following painful procedures
• Encourages pre-feeding behaviour
• Assists with growth
• May reduce hospital stay
• Improves milk volume if the mother expresses following a period of skin-to-skin contact, with the expressed milk containing the most up-to-date antibodies.

(2021, 2023, Moore et al., 2012, Sehgal et al., 2020)

Lets take a little deeper look into the physiology behind what is actually occurring.

During the second  stage of labour both Mother and Baby have a high peak in catecholamine secretion (epinephrine). This is a beautiful orchestra from nature to provide Mother with the energy needed to birth her baby (Buckley, 2020). After the birth, if the baby is able to be placed skin to skin on Mothers chest and both baby and mother are kept warm (this is important as if they are cold they will continue to secrete adrenaline which inhibits the release of Oxytocin) then Mother and Baby will experience strong instinctive behaviours and hormonal surges of Oxytocin and Endorphins (Buckley, 2020, 2023). Both are feel good hormones which facilitate bonding, calmness and connection and helps calm the nervous system for both Mother and Baby, taking them both from a fight or flight response (systemic nervous system) to one of calm (parasympathetic). In addition oxytocin also causes the uterine muscles to contract and to shrink. This surge in oxytocin and contraction of the uterine muscles helps to naturally birth the placenta and decreases the risk of postpartum haemorrhage. For the baby being more calm whilst skin to skin helps initiate a baby led attachment, which is when the baby will naturally start to crawl, bob its head and move towards the breast. They will use their hands and tongue to taste, smell and find the breast and initiate feeding (2023). In fact, research now shows that when babies are  enabled to familiarise themselves with their mother’s breast and achieve self-attachment, it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems (2023). Its almost like riding a bike- something gets switched on and stays switched on. 

This surge of hormones and above processes when left to happen uninterrupted help forge a strong Mother and Baby bond (i’d like to add that if for whatever reason skin to skin cannot be done immediately that you can still do it later on – it is never to late to bond).

For the Mother this initiates a beautiful and complex hormonal process. Her levels of prolactin rise which is the major hormone for breastfeeding synthesis which helps configures her whole system for the journey into breastfeeding and also has neurological affects on the maternal brain- preparing her for motherhood it would seem (2023). 

Some research (2023) defines this process as being complete when baby has found the boob, fed and comes off on its own- I would go a step further and say this process is complete when this occurs AND when the Mother is ready for this time to end (or pause rather until next time/feed).

So how can we promote and optimise skin to skin contact and baby led attachment?

Here are my top tips on how we can achieve skin to skin;

• Choose your caregivers. It’s so essential that you choose caregivers that support not only your birthing wishes but also your POST birth wishes.
• Discuss clearly your intention for this time with your caregivers during your antenatal visits AND include it in your birth plan. You may need to be really clear with what you do and don’t want during this time- for example procedures like weighing the baby, measurements and checks are not something that warrant immediate attention (in the absence of complications). Be super clear exactly what you want and ensure you are on the same page. Perhaps even ask your birth provider all of the things that occur directly after birth- that way you can then have the discussion together regarding which things you may not want to have or which things can be delayed.
• Leave babies alone– vigorous drying or wrapping of the baby is not needed, a warm blanket gently placed over both mum and baby will ensure baby remains warm. Further, in a natural physiological birth when baby is left alone skin to skin they will start to crawl and initiate a baby led attachment- they do not need to be shown and physically put on the breast. 
• Environment– ensure your environment promotes the hormones that facilitate this process- a warm room, warm blankets, dim lights, minimal noise helps you AND baby feel safe and calm and aids in reducing you and your babies adrenaline hormones and promotes the release of your oxytocin hormones (Buckley, 2020)
• Physiological third stage– allowing your body to naturally birth your placenta. This article has not gone into the depths of physiological verse active management of third stage, it is beyond the scope of this article. Both are your choice and there is a time and place where active management is needed for third stage (such as following induction of labour). I certainly don’t dispute this. But in a normal uncomplicated birth where interventions have not occurred, a physiological third stage may be a option you wish to look into. This is when our bodies naturally birth our placenta- skin to skin and breastfeeding assist this process through the hormonal process mentioned above. Additionally,  the physical act of the baby crawling over the belly to get to the breast puts pressure on the uterus which helps tone and contract the uterus. 

What if we cannot do skin to skin at birth?

There are situations that may occur during labour where skin to skin immediately following birth is unable to occur. These may include general anaesthesia for caesarean (note if you are having a elective caesarean skin to skin CAN still take place in the theatre room), labour complications, premature birth, resuscitation etc. In these cases babies may need to be taken to a Neonatal unit until stabilised or to undergo treatment. I want to emphasise that if this occurs than it is never too late to do skin to skin and the above benefits can still be facilitated during this time. In fact I would go as far as to state that for babies that are separated at birth for whatever reason, then skin to skin should be a priority as soon as safely possible and to do this as much as possible during the days to weeks following birth. This will help the Mother and Baby bonding, facilitate breastfeeding and help regulate the babies blood sugars and temps (2023). I also would add that I strongly encourage fathers to do skin to skin with their babies following the Mother and/or in the event that the Mother cannot immediately do this. This facilities father and baby bonding and facilities colonisation of normal bacteria not to mention is a beautiful time for the Fathers to meet their new little member of their family.

In summary, the benefits of skin to skin are well established. Even in the event of special circumstances where skin to skin is delayed, it should then be a priority to achieve this as soon as possible. Skin to skin does not need to be limited to directly after the birth, in contrast I would encourage as much skin to skin with Mother and Father during the days, weeks and months following birth. 

If you would like to see a video outlining skin to skin and a baby led attachment click HERE

References 

Buckley, S. (2020) Leaving well alone: A natural approach to the third stage of…, Dr Sarah Buckley. Available at: https://sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/ (Accessed: March 3, 2023). 

Buckley, S. (2022) Gentle natural birth for modern mamas, Dr Sarah Buckley. Available at: https://sarahbuckley.com/gentle-natural-birth-for-modern-mamas/ (Accessed: March 3, 2023). 

Gupta, N. et al. (2021) “Systematic review confirmed the benefits of early skin‐to‐skin contact but highlighted lack of studies on very and extremely preterm infants,” Acta Paediatrica, 110(8), pp. 2310–2315. Available at: https://doi.org/10.1111/apa.15913. 

Home (2023) BFHI Australia. Available at: https://bfhi.org.au/ (Accessed: March 3, 2023). 

Moore, E.R. et al. (2012) “Early skin-to-skin contact for mothers and their healthy newborn infants,” Cochrane Database of Systematic Reviews [Preprint]. Available at: https://doi.org/10.1002/14651858.cd003519.pub3. 

Sehgal, A. et al. (2020) “Impact of skin-to-skin parent-infant care on preterm circulatory physiology,” The Journal of Pediatrics, 222. Available at: https://doi.org/10.1016/j.jpeds.2020.03.041. 

Skin-to-skin archives (no date) Dr Sara Wickham. Available at: https://www.sarawickham.com/tag/skin-to-skin/ (Accessed: March 3, 2023). 

Skin-to-skin contact (2023) Baby Friendly Initiative. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/ (Accessed: March 3, 2023). 

Skin-to-skin ‘kangaroo care’ shows important benefits for premature babies (2020) ScienceDaily. ScienceDaily. Available at: https://www.sciencedaily.com/releases/2020/05/200507102434.htm (Accessed: March 3, 2023).