Early skin-to-skin contact for mothers and their healthy newborn infants

Skin-to-skin contact between a mother and her baby at birth reduces crying, and helps the mother to breastfeed successfully.

In many cultures, babies are generally cradled naked on their mother's bare chest at birth. Historically, this was necessary for the baby's survival. In recent times, in some societies such as in industrialized countries more babies are born in hospital, and as part of usual hospital care babies are often separated and swaddled or dressed before being given to their mothers. It has been suggested that  hospital routines may significantly disrupt early mother and baby interactions and have harmful effects. This review was done to see if there was any impact of early skin-to-skin contact between the mother and her newborn baby on infant health, behavior, and breastfeeding.

The review included 34 randomized studies involving 2177 mothers and their babies. It showed that babies exposed to skin-to-skin contact interacted more with their mothers and cried less than babies receiving usual hospital care. Mothers were more likely to breastfeed in the first one to four months, and tended to breastfeed longer, if they had early skin-to-skin contact with their babies. Babies were possibly more likely to have a good early relationship with their mothers but this was difficult to measure. The overall methodological quality of trials was mixed. There was variation in how the intervention was implemented, including the time of skin-to-skin contact started after the birth and how long it lasted, the outcomes looked at and how they were measured. No clear negative outcomes were reported in association with skin-to-skin contact.

Authors' conclusions: 

Limitations included methodological quality, variations in intervention implementation, and outcomes. The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations and exact probability values.

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Background: 

Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior.

Objectives: 

To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), made personal contact with trialists, and consulted the bibliography on kangaroo mother care (KMC) maintained by Dr. Susan Ludington.

Selection criteria: 

Randomized controlled trials comparing early SSC with usual hospital care.

Data collection and analysis: 

We independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results: 

Thirty-four randomized controlled trials were included involving 2177 participants (mother-infant dyads). Data from more than two trials were available for only eight outcome measures. For primary outcomes, we found a statistically significant positive effect of early SSC on breastfeeding at one to four months postbirth (13 trials; 702 participants) (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.06 to 1.53, and SSC increased breastfeeding duration (seven trials; 324 participants) (mean difference (MD) 42.55 days, 95% CI -1.69 to 86.79) but the results did not quite reach statistical significance (P = 0.06). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 31 participants) (MD 2.88, 95% CI 0.53 to 5.23). Blood glucose 75 to 90 minutes following the birth was significantly higher in SSC infants (two trials, 94 infants) (MD 10.56 mg/dL, 95% CI 8.40 to 12.72).

The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes.