Skin to Skin Care
Baby’s First Touch
ELIZABETH SMITH, MPH, ICCE, IBCLC, RLC
COORDINATOR, PATIENT SERVICES
UNIVERSITY OF UTAH HOSPITAL
Objectives
—  Attendees will be able to define skin-to-skin
—  Attendees will be able to identify three positive
outcomes for skin-to-skin
—  Attendees will be able to verbalize how to implement
skin-to-skin with the mother and / or father
—  Attendees will be able to understand how skin to skin
can be incorporated into the whole postpartum
period
Infant Crying
Crying in the Newborn
—  Increases right atrial pressure – the foramen ovale
opens, venous blood mixes with oxygenated blood,
cynanosis results
—  Increases intra-cranial pressure
—  Initiates a cascade of stress reactions
—  Depletes energy reserves
Interferes with the infant’s ability to adapt to
extra-uterine life
Separation of Mother and Baby
Separation of Mother and Baby
—  The infant develops the ability to better cope with
stresses when he is with his mother
—  Connection allows the infant to expand his or her
responses to cope more effectively with different
stressors
—  “Stresses” are physical and psychological
—  The separation causes a dis-regulation and impacts
the structural organization of the brain
—  Attachment = Regulation = Well-being
New Research
—  A healthy gut is critical to a lifetime of health
—  Colonization of the gut begins immediately after
birth
—  Optimal Health
¡  Vaginal birth and immediate skin to skin contact
—  What to do if ideal doesn’t happen?
So Much Better!
Benefits of Rooming In
—  Moms and Babies sleep an average of ½- 1 hr longer
in a 24 hour period.
—  Mom learns early feeding cues
—  Babies put skin to skin adapt better
Higher glucose
¡  Better HR and Respiratory Rates
¡  Less crying
¡  Feeling of security
¡ 
—  2nd Night!!!!
History of Skin-to-Skin
—  Dr’s Rey and Martinez
¡  Bogota & Cali, Colombia, South America
—  Gene Cranston Anderson, R.N., Ph.D., F.A.A.N.
—  Dr. Nils Bergman
¡  Introduced KMK in South Africa in 1995
Terms for Skin-to-Skin
—  KMC = Kangaroo Mother Care
—  KC = Kangaroo Care
—  STS = Skin-to-skin
—  SSC = Skin-to-skin Contact
Definition of skin-to-skin
—  Place the baby naked or with only a diaper prone on
the mother’s / father’s bare chest
—  Usually takes place at birth or soon after
—  Cover the baby with a warmed blanket
—  Place a hat on the baby’s head
Visual of skin-to-skin
Skin to Skin in the OR
Skin to Skin in Recovery
Skin to Skin with Preemies
Dads and Skin to Skin
Infant Brain
—  By 20 weeks gestation all structures are formed
¡  Billions of neurons will form
—  At birth the highest number synapses will occur
—  From there it’s the environment that determines
outcomes
Wiring and firing
¡  Neurons that aren’t used will die off
¡ 
—  Body will deal with underuse, eustress and distress
¡  Both underuse and distress can have detrimental impacts
¡  The usual place to learn adaptation is with the mother
÷  Another
person can be substituted but mom is ideal
Preterm Brain
—  Significant brain growth occurs between 36 and 40
weeks of gestation
¡ 
One of the reasons the March of Dimes pushed for “no early
delivery unless medically indicated”
—  For early babies, skin to skin is even more critical
¡  In order to adapt and obtain regulation
¡  Organization of the brain occurs skin to skin
÷  Complex
and subtle neurological/biological cues and behaviors
Baby Friendly USA
Baby Friendly Hospital Initiative
Step 4: Help
mothers initiate breastfeeding
within an hour of birth.
Uninterrupted Skin to Skin in the first hour
is the critical piece
The W.H.O. Evidence for Skin-to-Skin
—  Takes advantage of the “alert” 1-2 hours after birth
—  “Contact” and “suckling” are interrelated
¡  Suckling movements start at a peak of 45 minutes
—  Increase in breastfeeding rates at 2 to 3 months
—  Promotes maternal behavior
—  Newborn skin temperatures were higher, higher
blood glucose levels, and plasma base-excess
returned to normal faster
—  The newborn cried less
Impact on breastfeeding duration
of early infant-mother contact
Percent still breastfeeding at 3 months
70%
60%
Early contact: 15-20 min suckling and
skin-to-skin contact
within first hour after
delivery
58%
50%
Control:
40%
No contact within first
hour
26%
30%
20%
10%
0%
Early contact (n=21)
Control (n=19)
Adapted from: DeChateau P, Wiberg B. Long term effect on mother-infant behavior of extra
contact during the first hour postpartum. Acta Peadiatr, 1977, 66:145-151.
World Health Organization - Evidence for the 10
Steps
The Cochrane Criteria for Studies of Skin-to-Skin
—  Looked at all randomized or quasi-randomized
studies that encouraged skin-to-skin and was
“compared to usual hospital care” (Cochrane, p.7).
—  Looked only at studies with a control group, and that
were of high quality, looked for bias.
—  With inclusion criteria – 30 studies, 29 were
randomized control and one was quasi-randomized.
The Cochrane Evidence for Skin-to-Skin
—  Breastfeeding outcomes
—  Maternal feelings
—  The Infant
The Cochrane Evidence for Skin-to-Skin
•  Breastfeeding outcomes
• 
More likely to breastfeed successfully during the first feed post
birth than those babies who were swaddled in blankets
• 
Infants held STS had more mouthing movements than those
who were not.
• 
Statistically significant and better overall performance on all
measures of breastfeeding status: duration (2-4 months)
The Cochrane Evidence for Skin-to-Skin
•  Maternal feelings
• 
Had less anxiety at 3 days post birth
• 
No difference in milk supply, number of breastfeeding
problems, or parenting confidence
• 
Those who held their infant STS had a strong desire to do it for
future deliveries
• 
Maternal attachment behavior
The Cochrane Evidence for Skin-to-Skin
•  Maternal attachment behavior
• 
STS increased the amount of maternal affectionate behaviors –
kissing, smiling, en-face (face-to-face contact)
• 
Bias and questionable validity of multiple studies were noted
• 
Hard to differentiate a mother’s perception of bonding/
connection
• 
One study from Vietnam, when Baby Friendly was
implemented as a nation, showed a decrease in the
abandonment rate and incidence of child abuse
The Cochrane Evidence for Skin-to-Skin
—  Infant temperatures
Mom warms and cools
¡  Others can warm a baby
¡ 
—  Infant physiological
outcomes
The Cochrane Evidence for Skin-to-Skin
•  Infant temperatures
• 
STS infants had more skin temperatures in the neutral range
than baby under the radiant warmer
• 
Mean temperature for STS infants was higher than in control
group
The Cochrane Evidence for Skin-to-Skin
•  Infant Physiological outcomes
• 
STS infant had lower mean ht rate, respiratory rate
• 
Blood glucose was statistically higher in one study (10.56 mg/
dl higher)
• 
Better stabilization using SCRIP scores (measures infant
cardio-respiratory stability that uses ht rate, respiratory rate,
and o2 sat)
• 
No difference in the length of stay for late preterm infant
• 
Multiple studies have shown that STS infants cry less
The Cochrane Discussion for Skin-to-Skin
—  Success of first breastfeed
—  Breastfeeding success at day three postpartum
—  Breastfeeding duration at one to four months
—  Maternal breast engorgement pain
—  State anxiety
—  Infant recognition of their mother's milk odor
—  Maintenance of infant’s temperature
—  Infant crying, blood glucose, SCRIP scores,
physiological parameters
What about the father?
—  Father’s many times feel like outsiders
—  Gives the father an opportunity to be a care-giver
from the time of birth
—  Showed that when the father did skin-to-skin –
Infant temperatures were within normal range
¡  Blood glucose levels were up
¡  Catecholamine levels were within normal range
¡ 
References
—  Baby Friendly Hospital Initiative (n.d.). Retrieved from the World Health
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Organization web page on February 23, 2008 at site:
http://www.who.int/nutrition/topics/bfhi/en/
Bergman, N. (2009), Breastfeeding and Skin-to-Skin, SWAG Conference,
Berkeley, CA.
Christensson, k. (1996). Fathers can effectively achieve heat conservation in
healthy newborn infants. Acta Paediatics. 85, p 1354-60.
Ferber, S.G. & Makhoul, I.R., (2004). The effect of skin-to-skin contact
shortly after birth on the neurobehavioral responses of the term newborn:
a randomized, controlled trial. Pediatrics, 113(4), p. 858-865.
Gill, N.E., White, M.A., & Anderson, G.C. (1984), Transitional newborn
infants in a hospital nursery: from first oral cue to first sustained cry,
Nursing Research, 33(4).
Moore, E.R., Anderson, G.C., Bergman, N., (2008). Early skin-to-skin
contact for mothers and their healthy newborn infants. Cochrane
Collaboration.
Schore, A.N. (2001), Effects of a secure attachment relationship on right
brain development, affect regulation, and infant mental health, Infant
Mental Health Journal, 22(1-2), 7-66.
Vallenas, C. & Savage, F. (1998) Evidence for the ten steps to successful
breastfeeding . World Health Organization, Geneva.