Skin-to-Skin Care

Perinatal Quality Collaborative of North Carolina

 The Ten Steps
 Maintain a written breastfeeding
policy that is routinely
communicated to all health care
staff.
 Train all health care staff in skills
necessary to implement this
policy.
 Inform all pregnant women about
the benefits and management of
breastfeeding.
 Help mothers initiate
breastfeeding within one
hour of birth.
 Show mothers how to breastfeed
and how to maintain lactation,
even if they are separated from
their infants.
 Give infants no food or drink
other than breastmilk, unless
medically indicated.
 Practice “rooming in”-- allow
mothers and infants to remain
together 24 hours a day.
 Encourage unrestricted
breastfeeding.
 Give no pacifiers or artificial
nipples to breastfeeding infants.
 Foster the establishment of
breastfeeding support groups and
refer mothers to them on
discharge from the hospital or
clinic.
All major health professional organizations
recommend:

“Healthy infants should be placed and

remain in direct skin-to-skin contact with
their mothers immediately after delivery
until the first feeding is accomplished.”

(AAP, Guidelines 2005)

Three factors of Breastfeeding Success:
Let Down

Moving Let
Milk Down

Latch
Skin to skin and starting the first feed

6 Opening the eyes

11 Massage-like hand movement on mother’s breast

12 Hand-to-mouth movement

21 Rooting movement

25 Hand to nipple movement

27 Licking

Median
minutes after
birth 80 Sucking

Matthiesen A-S, et al. Postpartum Maternal Oxytocin Release by Newborns:

Effects of Infant Hand Massage and Sucking. Birth. 2001;28(1):13-19.
Skin to skin

Successful Breastfeeding Breastfeeding Breastfeeding

first feed at discharge at 1-4 months at 12 months
Routine

Bottom line: Mothers who held their infants skin-to-skin breastfed

43 days longer than mothers who did not.

Anderson GC, et al. Early skin-to-skin contact for mothers and their healthy newborn infants.
Cochrane Database of Systematic Reviews. 2007;3.
Homeostasis

Physiology in the first

hours of life
Babies need Mothers

 Randomized trial of STS Cot

50 healthy term
HR 136.6 6.9 140.7  9.0
infants
 Skin to skin at RR* 44.3  7.9 49.8  10.2
delivery, then cot
vs. skin to skin for Glucose* 3.17  0.7 2.56  0.71
90 minutes Change
in base 3.4  2.7 1.8  2.6
excess*

Christensseon et al. Temperature, metabolic adaptation and crying in healthy full-term

newborns cared for skin-to-skin or in a cot. Acta Paediatr 81: 488-93, 1992.
Axillary Temperature

37.1

36.8

36.6

36.5
Number of infants crying
 Cumulative proportions of
neonates that reached 36·50C

Christensson et al. Randomised study of skin-to-skin versus incubator care for

rewarming low-risk hypothermic neonates. The Lancet. 1998;352(9134):1115
 Helping babies handle stress

Gray, L. et al. Pediatrics 2000;105:e14

Copyright ©2000 American Academy of Pediatrics

 Keeping calm

Gray, L. et al. Pediatrics 2000;105:e14

Copyright ©2000 American Academy of Pediatrics

 Salivary cortisol, VAS score, total mood scale score, and heart rate for mothers
before, during, and after the first and fourth SSCs

Morelius, E. et al. Pediatrics 2005;116:1105-1113

Copyright ©2005 American Academy of Pediatrics

 Salivary cortisol, VAS score, total mood scale score, and heart rate for mothers
before, during, and after the first and fourth SSCs

Morelius, E. et al. Pediatrics 2005;116:1105-1113

Copyright ©2005 American Academy of Pediatrics

Homeostasis

 Birth separates mother and infant for the

first time
 Skin-to-skin contact is associated with
physiologic changes in mother and baby
 Mothers need babies, and babies need
mothers.
Take home messages

 Skin-to-skin is a simple, free, evidence-based

practice that’s good for mothers and babies

 The experiences women and infants have around

pregnancy and birth influence them for a
lifetime.

 What we all do matters very, very much