Key messages
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Mothers who have skin-to-skin contact with their babies in the first hour after birth are probably more likely to breastfeed exclusively up to one month later and from six weeks to six months later.
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Skin-to-skin contact between mothers and newborns probably helps newborns adapt to life outside the womb by keeping their body temperature stable and increasing their blood sugar levels. It may also help their breathing and heart rate.
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Skin-to-skin contact may result in little to no difference in the time until the delivery of the placenta. The effect on the mother's blood loss after a vaginal birth is unclear.
What is the issue?
Major global health groups like the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) advise that right after birth, a newborn should be placed directly on the mother's bare skin. The baby should be naked and stay there without interruption for at least an hour, ideally until after the first breastfeeding. This is called skin-to-skin contact. However, in many settings, it is common practice to separate newborn infants from their mothers, wrap or dress them, or place them in open cribs or under radiant warmers. Skin-to-skin contact is less common in low-income countries and lower-middle-income countries. Because this practice can help mothers breastfeed successfully, lower rates of skin-to-skin contact may be one reason breastfeeding levels vary between nations with different income levels.
What did we want to find out?
We wanted to expand our understanding of how skin-to-skin contact at birth affects breastfeeding duration and exclusivity and the baby's transition to life outside the womb. Specifically, we wanted to know if skin-to-skin contact is better than standard contact for improving:
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exclusive breastfeeding;
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infant body temperature;
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infant blood sugar levels;
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infant breathing and heart rate;
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time to delivery of the placenta;
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maternal bleeding after vaginal birth.
What did we do?
We searched for randomized studies of immediate skin-to-skin contact (starting less than 10 minutes after birth) and early skin-to-skin contact (between 10 minutes and 24 hours after birth) in major databases. In randomized studies, participants are randomly put into two or more groups to ensure the groups are similar. We summarized the results and evaluated our confidence in their findings based on factors like study size and methods.
What did we find?
We found 69 studies with 7290 mother-infant pairs. Most studies compared immediate skin-to-skin contact (within 10 minutes of birth) with standard hospital care for women with healthy full-term babies. In 15 studies, women had a cesarean birth, and in 10 studies, the babies were healthy but born preterm (from 34 weeks but before 37 weeks of pregnancy). Thirty-two studies were conducted in high-income countries, 25 in upper-middle-income countries, and 12 in lower-middle-income countries, including India, Nepal, Pakistan, Vietnam, and Zambia. No studies were conducted in low-income countries.
Main results
Women who have immediate skin-to-skin contact with their newborns are probably more likely to exclusively breastfeed at hospital discharge and up to one month after birth (12 studies, 1556 mother-infant pairs) and from six weeks to six months after birth (11 studies, 1135 mother-infant pairs).
Babies who have immediate skin-to-skin contact with their mothers probably have higher body temperatures 30 minutes to 2.5 hours after birth, although the difference is not clinically meaningful (11 studies, 1349 newborns). Skin-to-skin contact probably increases infants' blood glucose levels (3 studies, 144 newborns) and may improve their breathing and heart rate (2 studies, 81 newborns). Skin-to-skin contact may have little to no effect on the time until the delivery of the placenta (4 studies, 450 women) or maternal bleeding after a vaginal birth (2 studies, 143 women), although the result for maternal bleeding is very uncertain.
What are the limitations of the evidence?
We are moderately confident in most findings, though we are less confident in the results for breathing and heart rate and time to delivery of the placenta, and we are not confident in the result for maternal bleeding. Descriptions and definitions of skin-to-skin contact, breastfeeding, other interventions, and standard contact were inconsistent between studies. In addition, the mothers and staff knew which mothers were receiving skin-to-skin contact, which could have affected the results. Finally, many studies were small, with fewer than 100 women and newborns participating.
How up to date is this evidence?
This review updates our previous review. The evidence is current to 22 March 2024.
Read the full abstract
Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother’s arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.
Objectives
To assess the effects of immediate skin-to-skin contact (< 10 minutes postbirth) or early skin-to-skin contact (10 minutes–24 hours postbirth) compared with existing hospital practices (standard contact) on the establishment and maintenance of breastfeeding and on maternal and infant physiology among healthy newborn infants and their mothers.
Search strategy
We searched CENTRAL, MEDLINE, Embase, and CINAHL up to 22 March 2024 and two trial registers up to 3 July 2025, along with reference checking and contact with experts.
Selection criteria
Randomized controlled trials that compared immediate or early SSC with usual hospital care.
Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.
Main results
We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups.
Results for women
SSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE: low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).
Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%).
Results for infants
SSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality).
Women and infants after cesarean birth
Women practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences.
Subgroups
We found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).
Authors' conclusions
This review supports immediate SSC after birth, regardless of mode of birth, for mothers and their healthy full-term and late preterm infants in middle-income and high-income countries. No included studies were conducted in low-income countries. SSC probably promotes exclusive breastfeeding and improves infant thermoregulation and blood glucose levels. In addition, SSC may increase infant stabilization measured by the SCRIP score. The evidence about maternal physiological outcomes was inconclusive.
Future research should prioritize methodological rigor. This includes providing clear descriptions of interventions and standard contact, carefully selecting relevant outcomes, and using reliable and objective measurement tools. Understudied areas include: the impact of medications and anesthetics, in terms of dose-response and other variables during SSC; biological and psychosocial mechanisms; additional physiological effects of SSC; and longer-term impacts. Instances of harm should be recorded. As WHO/UNICEF recommends immediate, uninterrupted SSC as the standard of care, randomizing to separation of mother and newborn may no longer be justifiable.
Funding
This Cochrane review had no dedicated funding.
Registration
Review Update (2016) https://doi.org/10.1002/14651858.CD003519.pub4
Review Update (2012) https://doi.org/10.1002/14651858.CD003519.pub3
Review Update (2007) https://doi.org/10.1002/14651858.CD003519.pub2
Original review (2003) https://doi.org/10.1002/14651858.CD003519
Protocol (2002) DOI unavailable
