April 7, 2009

Study Finds Benefits For Skin to Skin contact with Newborn

Part of my job as a doula is to hold a prenatal meeting with the couple I’m working with, then type up notes from that meeting and return them to the couple for review. Over the years I have established a format for the questions I ask, although I do change them each time according to the couple’s intentions for their birth. One question that remains unchanged, though, is this: “Would you like immediate skin-to-skin contact (SSC)?” Rarely do I hear a parent say no to this question. After my notes are typed up, I encourage the parents to share these birth preferences with their care provider – this ensures everyone is on the same page. The feedback about SSC is generally the same and unless there is a medical reason, new mothers always get skin-to-skin contact with their babies. It’s no surprise that new parents would want the mother to hold her delicious new bundle, allow the oxytocin to flow, look deeply into her baby’s innocent eyes and fall in love with her child immediately after giving birth. Additionally, if her baby is interested in breastfeeding right away, the mother will continue to produce oxytocin, which allows her to have the contractions that will help expel the placenta and shrink the uterus.

Despite these benefits, I usually witness the mother holding baby for mere moments before that baby is whisked away and placed under the heater, administered the vitamin K shot and eye drops, weighed, foot-printed, swaddled and then returned to the mother. Though parents have the option to postpone these hospital procedures for up to an hour, they often (unfortunately) take precedence over prolonged and immediate SSC, delaying the mother receiving her baby by about 30 minutes. During this time, the mother is delivering the placenta, which can take anywhere from 5 to 30 minutes, and being stitched up in the event of tearing or an episotomy. It is possible, as long as everything looks normal and there is no hemorrhaging, for the mother to keep the baby on her chest during these procedures and spend time with her baby.

Why is it so important that the moments immediately after birth be undisturbed? The Cochrane Review, an authority on evidence-based maternity care, concluded in a study which included over 30 studies and involves 1,925 mothers, that “Skin-to-skin contact between mother and baby at birth reduces crying, improves mother-baby interaction, keeps the baby warmer, and helps women breastfeed successfully.” In his article The Importance of Skin to Skin Contact, Dr. Jack Newman says: “Skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.”

Another study from Boston Medical Center that studied 30 newborns found that during a standard heel lancing (a procedure where the newborn gets a heel-stick to screen for inborn errors of the metabolism), if the baby was receiving SSC, crying and grimacing were reduced by 82% and 65%, respectively, from control infant levels during the same procedure. Heart rate also was reduced substantially by contact.

The separation of mother and newborn is unique to humans, something other mammals do not experience. It is also newer to our culture, and results from the fact that more births are taking place in hospitals where immediate separation is more commonly seen. “In order for a mammalian species to survive, newborns must learn to nurse, and their mothers must learn to protect and care for them. Researchers have described a ‘sensitive period’ in the first hour after birth, during which hormonal changes and innate behaviors coincide to produce optimal outcomes. They have also identified care practices that disrupt these processes with detrimental effects. Even apparently benign practices can disrupt their innate behaviors if they occur in the first 1-2 hours after birth.” (Journal of Perinatal Education, Volume 16, Number 4, pg 71)

But what can you do if the baby has to be separated from mom due to complications or cesarean birth? According to a new study by Swedish researchers published in the journal Birth: Issues in Perinatal Care, “A father providing skin-to-skin contact with his newborn immediately after a cesarean birth offers the same calming and comforting benefits as a mother.” This might take some negotiating with your care provider and will be difficult in the operating room (OR) since everything is sterile and the father can not expose his skin. It is not unusual for the baby to be separated from the parents anywhere from 1 to 3 hours after the baby is born via cesarean. However, once the baby has been cleared by the pediatrician, it is in the best interest of the baby to have the father, a family member or even a doula have SSC with the baby outside the OR. The Swedish study shows that a father can soothe his newborn as effectively as a mother, and more effectively than if the baby is placed in a crib during the first two hours after birth.

I have yet to find a study that demonstrates negative side effects or outcomes from SSC between mother and newborn. In most cases, since the majority of births these days take place in a hospital, it will likely take some orchestrating and persistence to have prolonged, immediate skin-to-skin contact, but it is unarguably extremely beneficial for the newest member of your family, your baby.



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