No matter what type of birth you have, the most important thing after your baby is born is that you get skin to skin with your baby. Skin to skin means that your baby is not swaddled or clothed, and their bare skin is placed belly down against your bare chest. Being skin to skin stabilizes your baby’s heart rate, breathing, and temperature, and reduces stress in both you and your baby. It also increases your interactions with your baby and increases the likelihood and length of breastfeeding. This article dives into the evidence on skin to skin contact with your baby after birth, the logistics of how it works with any birth, and tips for your partner.
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No matter what type of birth you have, the most important thing after birth is that you get skin to skin with your baby as soon as possible and bond with your baby. Skin to skin means that your baby is not swaddled or clothed, and their bare skin is placed belly down against your bare chest.
Benefits of Skin to Skin Contact
There are many benefits of skin to skin contact. Being skin to skin stabilizes your baby’s heart rate, breathing, and temperature, and reduces stress in both you and your baby. It also increases your interactions with your baby and increases the likelihood and length of breastfeeding. The best way to get breastfeeding off to a great start is to be skin to skin with your baby.
The Evolutionary Perspective
From an evolutionary perspective, skin to skin contact was necessary for the survival of a newborn. This contact provided warmth, protection, and breastmilk. From a scientific standpoint, intimate contact evokes neurobehaviors needed to fulfill basic biological needs. The time just after birth may represent a sensitive period for programming future physiology and behavior. A baby always went on their mom’s chest after birth. It wasn’t until births began taking place in hospitals that mothers and newborns were separated. This separation was either by clothing or keeping a newborn in a cradle next to mom or another room.
Hormones and the Magic Hour
All of the hormones you produce during birth transfer to your baby. Immediately following birth, both you and your baby are going to have high levels of oxytocin, and this is going to help promote bonding. The fight or flight hormones are going to make your baby alert for their first contact with you. Fight or flight hormones are catecholamines, which include adrenaline (epinephrine) and noradrenaline (norepinephrine). The first hour after birth, your baby will be alert. There is a reason this is called the magic hour. The skin to skin contact after birth is going to soothe your baby and oxytocin is going to help to lower levels of catecholamines. It is not an accident that we are designed to be skin to skin after birth. There is a whole biological process going on when this happens.
A review of thirty-four randomized controlled trials involving 2,177 participants breaks down a lot of the evidence behind skin to skin contact. There is good evidence that normal term newborns who are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying, indicating decreased stress. Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Being skin to skin with the mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant’s regulation over time. Normal babies are born with the instinctive skill and motivation to breastfeed and can find the breast and self-attach without assistance when skin to skin. When your newborn is placed skin to skin with you, there are nine observable behaviors that lead to the first breastfeeding. Usually, all of these take place within the first hour after birth.
The evidence to support immediate skin to skin contact is becoming more available all over the world. A study in Russia found that skin to skin contact positively influenced mother-infant interaction one year later when compared with routines involving separation of mother and infant. A study in India found that skin to skin contact improved physical growth of low birth weight infants.
Kangaroo care is a term for skin to skin contact initially developed for preterm babies. Today, kangaroo care is in practice in many neonatal intensive care units around the world with successful results. The World Health Organization has developed a set of guidelines involving other recommendations, in addition to skin to skin contact, called Kangaroo Mother Care. This is something making a major difference in parts of the world where medical care and resources are limited. Even in countries like the US, Canada, Australia, where we have abundant resources, skin to skin is an amazing, easy, cheap thing you can do that will benefit both you and your baby.
There is overwhelming evidence that supports the benefits of skin to skin contact with both parents and babies. In a meta-analysis including 124 studies, researchers found that kangaroo care for low birth weight newborns was associated with 36% lower mortality.
Right before your baby is born, there can be a lot of commotion, especially in a delivery room in a hospital setting. You will have nurses and doctors in and out of your room during labor, and the number of hospital staff goes way up for the actual birth. It can be overwhelming the moment your baby is born, especially emotionally for you. In these minutes after birth, a lot can happen. Picture your baby is born, but the umbilical cord is still attached on one end to your baby, and on the other end to your placenta, which is still attached to your uterine wall. Essentially, your baby is limited in how far they can go from your vagina because the umbilical cord tethers them. But, you want to get skin-to-skin right away, right?
Delayed Cord Clamping
For most of human history, we did not clamp and cut the umbilical cord immediately. This became standard practice in the 1960’s because it was thought to reduce the likelihood of postpartum maternal hemorrhage. The keyword here is thought. Although more research is needed to know the effect of delayed cord clamping on maternal outcomes, immediate clamping does not reduce hemorrhaging.
If the cord is not clamped immediately at birth, blood will continue to flow between the placenta and your baby for a few minutes. The net blood volume transferred to the baby during this time is called placental transfusion. This transfusion can give your baby about a fifth of their blood volume at birth and may make a difference to the health of your baby. Placental transfusion drains the blood left in the placenta, which may help the placenta separate from the womb and may reduce overall blood loss at birth for the mom. There is so much evidence to support delayed cord clamping. There is a full episode on delayed cord clamping that gets into the details of your options and the evidence on delaying cord clamping.
There is evidence that delayed clamping is still beneficial if your baby is born prematurely or if you have a cesarean birth. Delayed cord clamping also does not interfere with placenta encapsulation. Overall, except for a medical emergency, you can delay cord clamping in any birth scenario.
Is the Umbilical Cord Long Enough?
Picture your baby is born, but the umbilical cord is still attached on one end to your baby, and on the other end to your placenta, which has not come out yet. Essentially, they are limited in how far they can go from your vagina because the umbilical cord tethers them. A common question is whether the cord is long enough to allow your baby to be on your chest before cutting the cord.
At birth, the umbilical cord will be about 20 inches, or 50-70 centimeters long. I know this seems short, but it is long enough for you to get skin-to-skin with your little one. Chances are right after birth; you are not going to be lying flat on your back, you will be sitting up, or in a reclined position. When you are holding your baby, their head is going to be on your chest. This means their belly, where the umbilical cord is attached, is going to be lower, near your belly. Now, when you think about the distance from around your belly button to the placenta, which is still attached to your uterine wall right after birth, it is much shorter than 20 inches. For the majority of babies, the umbilical cord should be plenty long enough to be skin-to-skin before it is cut. Not all umbilical cords are identical, and your baby’s cord may be shorter than 20 inches. If this is the case, it is possible you would need to keep your baby a little bit lower, so you are not putting a strain on the cord.
The Positioning of Your Baby Before the Cord is Clamped
In the past, it was thought that you needed to keep the baby lower than the placenta so that gravity could help with the transfer of blood. This is not true. A randomized study of almost 400 babies compared to keeping newborns at the level of the vagina and the mother’s abdomen or chest. The researchers found no difference in the amount of blood transferred between the two groups. Evidence shows your baby can immediately be put on your chest after birth before the cord is clamped and cut.
Skin to Skin Contact in a Cesarean Birth
Getting skin to skin is critical, especially for a baby who is born via a cesarean. One study compared skin to skin cesarean section with a conventional cesarean delivery and found no significant difference in maternal outcomes. Fewer babies who went skin to skin with mom after birth were admitted to the pediatric ward, and fewer had suspected infection. If it is suspected that a baby has an infection, protocols are in place to assess them further, which is likely going to involve separating a baby from their mother to determine whether an infection is present. Mean operation time was about 5 minutes longer in the group of skin to skin cesareans. Pretty crazy to think that just 5 minutes from doctors, nurses, and medical staff could potentially have an enormous impact on your baby’s recovery following a cesarean birth.
A review including seven different papers, found that immediate or early skin-to-skin contact after a cesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress. Another review analyzed data from over 2,000 cesarean births and found a significant difference in the proportion of newborns transferred to the NICU for observation after implementing skin-to-skin contact, and it was associated with fewer transfers.
There is clear evidence to support skin to skin contact after a cesarean birth. You and your baby will be monitored closely for complications after the surgery and during your recovery. A lot of that monitoring can take place with your baby on your chest.
After Birth Procedures
There are many routine procedures that can be done to your baby after birth. Some of these are required, like weighing your baby. Others, like erythromycin, are optional and should involve informed consent. Almost all of these procedures can be performed while your baby is on your chest. Many of the routine procedures can wait at least an hour or more. If your priority is maximizing skin to skin contact and you want to opt-out or wait for any of these procedures, please discuss it beforehand with your doctor or midwife. Some of the newborn procedures are:
- Cord clamping and cutting can be delayed and can be performed on your chest.
- Drying your baby off or wrapping them in a blanket is not necessary. Your baby can go directly on your chest, and a blanket can be placed over your baby to keep them and you warm.
- Your baby will be physically examined to determine their APGAR score by doctor, midwife, or nurse, and this can be done on your chest.
- Taking measurements like your baby’s weight and length can be delayed at least an hour.
- Vitamin K and erythromycin can either be delayed or administered with your baby on your chest.
- Putting an ID tag on your baby’s ankle or wrist can happen with your baby on your chest.
- The third stage of labor when you birth your placenta can also happen while you are holding your baby.
There are exceptions in cases where a baby needs urgent medical attention and would not be skin to skin right away. The majority of babies are healthy at birth and go directly to mom’s chest.
How Long Should You Be Skin to Skin?
Immediately following birth, you should shoot for enjoying skin to skin contact for that magic hour. In the first few days, as you are establishing breastfeeding, the more skin to skin contact, the better. In the first few weeks, 60 minutes is a good time frame to shoot for. An hour is about the length of a sleep cycle for a newborn. Skin to skin contact is most important in the first few weeks, but there is no time limit on when you should stop skin to skin contact.
Skin to Skin With Partners
Skin to skin not only applies to moms, but there are also benefits for partners being skin to skin with a baby as well. Partners can be especially helpful with skin to skin contact in cases of a cesarean where mom may not be able to hold their baby immediately or with multiples. This contact will help regulate your baby temperature, keep them calm, and promote bonding.
Seeing your partner hold your baby for the first time can be a magical moment. The timing of when you want to do that may differ based on how you are feeling. For the purposes of getting breastfeeding established, it makes sense to keep a baby with mom for the majority of the time. There is still plenty of opportunity for partners to hold a newborn skin to skin to promote bonding and give them some time with their new baby.
Skin to Skin Contact and COVID-19
The recent COVID-19 pandemic has created additional challenges to being skin to skin in cases where there is a suspected or confirmed COVID-19 diagnosis. The recommendations for separating mothers and babies have changed over the past few months, and policies may differ in different hospitals. The current position of the American College of Obstetricians and Gynecologists is:
Any determination of whether to keep individuals with known or suspected SARS-CoV-2 infection and their infants together or separate after birth should include a process of shared decision-making with the patient, their family, and the clinical team. This issue should be raised during prenatal care and continue through the intrapartum period. Healthcare providers should respect maternal autonomy in the medical decision-making process. Decision-making around rooming-in or separation should be free of any coercion, and facilities should implement policies that protect an individual’s informed decision.
Early on in this pandemic, the position was much different, and mothers and babies were being separated. Informed consent is crucial, and I recommend talking to your doctor or midwife about the current policies in place in the event you test positive for SARS-CoV-2.
Working With Your Doctor
You can talk to your doctor about how soon you can hold your baby after they are born and let them know that it is a priority for you. Most hospitals are supportive of skin to skin contact right away. Having a conversation before you are in labor will make sure you and your care provider are on the same page. Talk about what procedures can be delayed, or done with your baby on your chest. You will need to work with your doctor or midwife to weave their policies in with your preferences. Do not be intimidated to advocate for yourself and your baby.
Including Skin to Skin Contact in Your Birth Plan
This is an excellent item to include in your birth plan. If you have a copy of the Your Birth Plan book, you can see examples of how to word this in the template. Below are a couple of examples:
- It is very important to me to be skin to skin with my baby immediately following birth.
- Please perform any procedures or evaluations of my baby while they are on my chest.
- In the event I am unable to be skin to skin with my baby immediately after birth, please put my baby skin to skin with my partner.
There is overwhelming evidence of the benefits of getting skin-to-skin immediately after birth. I do recommend that you discuss all of this with your doctor or midwife to make sure you are on the same page well before you go into labor work out all of the details with your care provider, and include these items in your birth plan.
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