Skin-to-skin care

What is skin-to-skin care?

Skin-to-skin care means direct contact between the mother and baby. This starts right after birth when the naked baby is placed tummy down on the mothers’ tummy and allowed to crawl to the breast and breastfeed. After breastfeeding, the baby remains tummy down and is placed on the mother’s naked chest with the top of the head just under the mother’s chin and the legs curled up under the breasts. Skin-to-skin care helps the baby adjust to life outside the womb, stabilizing breathing and heart rate and reducing stress in both mother and baby. It is also associated with breastfeeding success. Healthy newborns should be kept in skin-to-skin contact with their mothers for at least the first two hours after birth and regularly thereafter. This also applies to mothers who have had a Caesarean birth.

A) Describing skin-to-skin care

A baby in skin-to-skin care with her mother.

In skin-to-skin care, babies are in direct contact with the mother’s tummy (abdomen) and chest for extended periods of time.

Skin-to-skin care is one part of kangaroo mother care, an approach to caring for premature babies (WHO 2003).

B) Benefits of skin-to-skin care

The practice of mother-baby separation started in the late 1800s with the invention of the baby incubator. The use of infant formula, also popularized in the late 1800s, made the separation practical. Incubators and infant formula were introduced without any reasonable scientific evidence yet remain standard features in mother-baby care. Mothers and babies were only re-united with the start of kangaroo mother care in Colombia in the 1970s (Bergman 2019).

The mother’s body is the biologically normal place of care and the baby’s natural habitat (Bergman 2014). Keeping the baby skin-to-skin removes all barriers between mother and baby, optimizing this habitat, and strengthens the long-term relationship between the two (Gupta 2021; Norholt 2020).

There is a growing evidence that good psychological and physical health is strongly related to healthy, close social relations. Not surprisingly, both mother and baby benefit from skin-to-skin care. 

1) Skin-to-skin benefits for babies

Spending time skin-to-skin benefits babies by: 

  • Helping them adjust to the world outside the uterus (Moore 2016).
  • Providing familiar sensations such as the mother’s heartbeat, touch, and smell (Moore 2012; Morgan 2011).
  • Increasing their interaction with their mother.
  • Helping their emotional and behavioural control (Feldman 2002).
  • Improving their sleep (Feldman 2014; Morgan 2011).
  • Keeping them warm (Gupta 2021).
  • Helping them get healthy bacteria from the mother (Hendricks-Muñoz 2015).
  • Reducing their stress and crying (Ludington-Hoe 2000; Takahashi 2011).

As a result of these benefits, they: 

  • Are better able to stabilize their heart rate and breathing (Gupta 2021).
  • Are less sleepy (Nunes 2017).
  • Are less likely to have low blood sugar (glucose) levels (hypoglycemia) and can increase their sugar stores (glycogen) (Dalsgaard 2019; Takahashi 2018; Winberg 2005).
  • Are less likely to need admission to a neonatal intensive care unit (Agudelo 2020; Schneider 2017).
  • Temporarily have a lower risk of sudden unexpected infant death (SUIDS) (Bartick 2020).

 Skin-to-skin care is associated with more breastfeeding including (Cohen 2018):

  • Starting to breastfeed while in hospital (Karimi 2019; Lau 2018; Li 2020).
  • Exclusive breastfeeding while in hospital (Bramson 2010; Guala 2017; Li 2020).
  • Exclusive breastfeeding after leaving hospital (Moore 2016).
  • Longer duration of breastfeeding (Moore 2016).

Skin-to-skin care has additional benefits for preterm infants.

2) Skin-to-skin benefits for mothers

Skin-to-skin care benefits mothers by:

  • Reducing stress and signs of depression in the period after vaginal and Caesarean section birth (Beake 2017; Bigelow 2012; Cong 2015).
  • Creating a more positive birth experience for them (Brubaker 2018).
  • Exposing them to the baby’s smell:
    • So mothers can learn to recognize their baby (Kaitz 1987).
    • Which stimulates the brain to create positive feelings and helps with bonding (Lundström 2013).
  • Increasing the release of oxytocin (Scatliffe 2019; Uvnas-Mobert 2003).

3) Skin-to-skin benefits for fathers

Fathers who keep their babies in skin-to-skin care have reduced signs of stress, increased oxytocin levels, and increases responsiveness towards their babies (Cong 2015; Vittner 2018; Scatliffe 2019).

C) When to use skin-to-skin care

Ideally, immediately after birth, the baby is placed naked on the mother’s tummy. Healthy babies are able to crawl towards the mother’s breast and start breastfeeding. Those babies who are unable to crawl, should be helped to breastfeed.

The first hour after birth is a unique, short but intense time of change with the start of breathing and breastfeeding for the baby, hormonal and physical changes for the mother, and the start of the mother-baby bond.

Healthy newborns should be kept in skin-to-skin contact with their mothers for two hours after birth, even after having finished breastfeeding (Hernández-Aguilar 2018). This also applies to mothers who have had a Caesarean birth. As long as the baby is stable and the mother is willing and able, skin-to-skin care should not be limited.

D) How to do skin-to-skin care

In skin-to-skin care:

  • The mother is lying down or semi-reclined.
  • The baby is placed tummy down on the mother's naked chest with:
    • The top of the head just under the mother’s chin.
    • The arms and chest above the breasts.
    • The trunk between the breasts.
    • The legs curled up below the breasts.
  • The baby’s head is turned to the side and the chin is slightly raised into the sniffing position.

Ideally, the baby is in the skin-to-skin position frequently or nearly constantly. Immediately after birth, both the baby and the mother’s chest and tummy are naked. The baby’s back can be dried with a towel and then covered with a blanket.

Afterward, the baby wears a diaper. Mothers may find a specialized wrap helpful in keeping the baby in place and warm. Some wraps allow the mother to move around without holding the baby. The face should be visible and the mouth and nose uncovered.  

Babies in skin-to-skin care should be regularly monitored. At the very least, this includes their skin colour, breathing, and temperature. Vulnerable babies need extra monitoring and your health-care providers will guide you in this. It is possible but extremely rare that a baby’s heart and breathing may suddenly stopThis appears to affect 2.5 to 5 births in 100,000, and is most common in the first two hours after birth (Moore 2012; Poets 2011).

If the mother wants to sleep, skin-to-skin care can be provided by the mother’s partner and this too, is beneficial for babies (Ayala 2021; Shorey 2016).  

E) When not to use skin-to-skin

Skin-to-skin care is not appropriate if (Feldman-Winter 2016):

  • A baby has any condition that may create problems with breathing or heart function.
  • The baby is at risk of falling.
  • The baby is not well and needs active care.
  • The mother has medical problems and is not available to the baby. In these cases, another family member can provide skin-to-skin care.

Sleeping while holding the baby increases the risk of the baby falling (Hughes Driscol 2019).

F) Unnecessary barriers to skin-to-skin care

Avoidable barriers to keeping babies skin-to-skin include (Allen 2019):


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