Running head: THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 1

The Benefits of Uninterrupted Skin-to-Skin Contact Immediately After Birth

Jeanine M. Diaz

Cedar Crest College

THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 2

Abstract
Skin-to-skin contact has proven to provide many benefits to mom, baby and even the father.

Immediate, uninterrupted skin-to-skin contact has shown to help regulate both the infant’s and

mother’s physiological postpartum state, and provide the mother with enhanced benefits of her

psychological state both short and long term. Skin-to-skin contact provided right after birth can

be provided in both vaginal and cesarean births as long as both the mom and baby are healthy,

and has shown to cut down on transfer rates of newborn infants to the neonatal intensive care

unit. Additionally, skin-to-skin contact aids in the successful completion of the first

breastfeeding, and even adds to the long term success of exclusive breastfeeding between mother

and infant.

Keywords: skin-to-skin contact, benefits, breastfeeding, kangaroo care

THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 3

The Benefits of Uninterrupted Skin-to-Skin Contact Immediately After Birth

The initial moments following birth have a magnitude of implications on both the mother

and newborn infant. Skin-to-skin contact (STS) can be described as placing the unclothed

newborn, who may or may not be diapered, on the bare chest of their mother instantly following

birth. Immediate skin to skin contact between a mother and infant has proven to be one of the

most powerful interventions to provide an array of positive benefits both short and long term.

Some of these benefits consist of physiological stability in both mother and baby, an increase in

maternal attachment behaviors, protection against the adverse effects of maternal-infant

separation, provides optimal infant brain development, and promotes the initiation of the first

breastfeeding (Phillips, 2013). Additionally, the physiological stabilization that immediate STS

contact promotes in newborns includes respirations and oxygenation, increased glucose levels,

warming of the infant to maintain optimal temperature, reduced stress hormones, regulation of

blood pressure and heart rate, decreased crying and increased quiet alert state (Phillips, 2013).

Furthermore, immediate STS contact has also shown to have a positive outcome on long-term

bonding between a mother and child (Phillips, 2013).

Timing of Skin-to-Skin Contact

The initiation of STS should begin immediately after birth. It is recommended that in a

healthy newborn the infant should be given directly to the mother where the initial drying, Apgar

scores and physical assessments can take place (Phillips, 2013). Additionally, it has also been

recommended that routine care practices can be delayed until the first STS contact has been

concluded (AWHONN, 2016). The amount of time a newborn should remain in STS contact can

vary, but STS contact should be encouraged for at least one hour following birth, or until the

initial breastfeeding is finished (AWHONN, 2016). It has even been shown that sessions as little
THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 4

as 20 minutes have positive benefits to the newborn and mother, so it is imperative that any

amount of time the infant can be left in STS contact is encouraged.

Benefits of Skin-to-Skin Contact in Breastfeeding

Breastfeeding has been proven to be the most beneficial feeding method for an infant,

although breastfeeding is not always possible, optimal promotion of breastfeeding is important.

Immediate STS contact provides the opportunity for the first breastfeeding to take place. As all

mammals are born to breastfeed, newborns, and not the mother, are the ones who initiate

breastfeeding (Phillips, 2013). As such, when newborns are given the perfect environment, their

basic instincts are able to take over. Early initiation of breastfeeding is important to allow the

infant to receive what is called the “first milk”, or in other words colostrum which is packed with

protective factors for the infant (World Health Organization [WHO], 2017). Furthermore,

immediate STS contact breastfeeding initiation increases the chances of exclusive breastfeeding

for one to four months of life, as well as the long term duration of breastfeeding (WHO, 2017).

Influence of Immediate Skin-to-Skin Contact in Cesarean Births and NICU

Although a natural vaginal delivery may be ideal, sometimes a cesarean birth may by

necessary. Immediate STS contact is easiest to initiate after a vaginal delivery, but can also be

done following a cesarean delivery when proper hospital protocols are put into place. STS

contact following a cesarean birth was found to have all the same positive benefits on mother and

infant following vaginal births, but was also found to decrease the amount of newborns

transferred to the neonatal intensive care unit (NICU) for observation significantly (Schneider,

Crenshaw & Gilder, 2017). Since any transport of a patient can lead to more opportunities for

adverse events to occur, decreasing transfer rates of the newborn to the NICU is important. Not
THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 5

only does the effects of immediate STS contact on the transfer rates to the NICU decrease the

amount of time mothers and newborns are separated, but also cuts down the likelihood of a

sentinel event to occur (Schneider et al., 2017). It was also found that when immediate STS

contact cannot take place, kangaroo care which is the act of skin-to-skin contact between a

mother and infant, has shown to have positive results on infants who are transferred to the NICU.

Kangaroo care given to NICU infants have both physiological and psychological impact on both

the mother and infant, and has also been shown to have long term developmental impact on the

infant (Moore, 2015).

Skin-to-Skin Contact Given by Fathers

Customarily, immediate STS contact is given from a mother to her infant. However, there

are some instances when the mother is unavailable such as emergency situations. Given that the

mother may not be available for immediate STS contact, it is important to understand the effects

of STS contact between a father and the infant. Shorey, He Hong-Gu and Morelius (2016) have

found that the same physiological benefits of STS contact between a mother and infant were also

found with STS contact between a father and infant including heat conservation, respiration,

oxygenation, glucose levels and stress hormone regulation, and less crying. Furthermore, even

when a mother is available for STS contact, the father can benefit from kangaroo care given for

bonding purposes. These benefits include helping the father attain a parental role, less stress and

anxiety for the father, and better interaction with their infant (Shorey et al., 2016).

Effects of Skin-to-Skin Contact on Maternal Postpartum Depression

Given that the postpartum period brings an onslaught of psychological changes, the

mother can be at an increased risk for depressive symptoms to occur. STS contact has not only
THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 6

proven to be greatly beneficial for the infant, but can also provide many advantages for maternal

behavior including more positive feelings toward infants, less depression, and more

empowerment in their parenting role (Bigelow, Power, MacLellan-Peters, Alex & McDonald,

2012). These effects were shown to be both short and long term. Additionally, depressive

symptoms were found to be lessened due to STS contact enhancing mothers’ mood states,

therefore lessening depressive symptoms (Bigelow et al., 2012). When separation occurs

between a mother and her infant due to the infant being in the NICU, kangaroo care has also

shown to decrease depressive symptoms in the mother correlated with this separation (Bigelow

et al., 2012). As STS contact is also associated with a reduction in a mothers’ physiological

stress (Bigelow et al., 2012), the maternal benefits of STS contact are immense.

Nursing Implication

With the various benefits of STS contact for the newborn, mother and father, it is the

nurses’ responsibility to ensure safe implementation of this practice. Although STS contact is

associated with little to no risks for the infant, proper teaching and observation of mother and

baby during immediate STS contact after birth is necessary. “AWHONN recommends that an

appropriately trained health care professional be in attendance for all immediate skin-to-skin

sessions during the first two hours of life and that the infant and mother be observed frequently

during this time” (AWHONN, 2016, p. 615). It is also the nurses’ responsibility to observe for

proper positing of the baby, maternal and newborn safety measures, and monitor physiologic

indicators that could lead to needed intervention (AWHONN, 2016). Proper observation by the

nurse should be to make sure the infant’s head is positioned so the nares are always visible, and

the baby’s color perfusion and respirations remain stable (Phillips, 2013). Additionally, the nurse

should observe the infant’s activity and tone, and for proper positioning of the neck and mouth
THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 7

(Ludington-Hoe & Morgan, 2014). The nurse is also responsible for educating and supporting

mothers in STS contact to promote a broader public health policy about maternal-child health

(Alex & MacLellan, 2013). When the nurse is able to teach, monitor, and promote proper STS

contact, both infant and mother can reap the benefits of successful implementation.

Nursing Education

Proper nurse education of the importance and benefits of immediate STS contact to both

the mother and family is significant. Timing of this teaching can happen during implementation

of immediate STS contact, however parents can benefit most if teaching occurs before the birth

experience occurs. Additionally, parents should be taught that even if a cesarean section takes

place, as long as it is uncomplicated immediate STS contact can still take place. Schneider,

Crenshaw & Gilder (2017) state, “We urge health professionals to inform women and their

families during the prenatal period about the benefits of immediate skin-to-skin contact during

medically uncomplicated cesareans” (p. 33). Also, if parents and family are taught about what to

expect after the baby is born, they can understand the importance of leaving mom and baby

uninterrupted during this time (Phillips, 2013). Parents should understand that STS contact

involves holding the baby unclothed to mom’s bare chest, but also that the baby should remain

covered with blankets during this time to prevent the infant from becoming cold. Furthermore,

nurses need to educate parents about proper positioning of the baby and how to avoid

distractions during this important period (AWHONN, 2016). Since immediate STS contact is

very beneficial to initiating the first breastfeeding, parents should go into delivery knowing the

importance of this. It was found that not only does immediate STS contact lead to breastfeeding

self-efficacy, but also that breastfeeding self-efficacy is one of the most important components in

maintaining and continuing breastfeeding (Aghdas, Talat & Sepideh, 2014).

THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 8

Conclusion

Immediate STS contact has proven to have immense positive implications on both the

physiological and psychological health of mother and baby. STS contact can be given in both

vaginal and cesarean births and also helps promote and establish successful breastfeeding.

Transfer rates of infants to the NICU have shown to be reduced in families who participate in

immediate STS contact as well. STS contact can reduce and prevent postpartum depression and

can even provide physiological benefits to the baby when given by the father. Since the birthing

experience can be overwhelming for both the mother and infant, immediate STS contact can be a

beneficial method to reduce this stress and maximize a positive postpartum event.
THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT 9

References

Aghdas, K., Talat, K., & Sepideh, B. (2014). Effect of immediate and continuous mother–infant

skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised

control trial. Women and Birth,27(1), 37-40. doi:10.1016/j.wombi.2013.09.004

Alex, M., & MacLellan-Peters, J. (2013). The relationship among skin‐to‐skin contact,

breastfeeding, and mother–infant interaction: Implications for nursing. Journal of

Obstetric, Gynecologic & Neonatal Nursing,42(1), S88-S89.

doi:https://doi.org/10.1111/1552-6909.12181

Bigelow, A., Power, M., Maclellan‐Peters, J., Alex, M., & Mcdonald, C. (2012). Effect of

mother/infant skin‐to‐skin contact on postpartum depressive symptoms and maternal

physiological stress. Journal of Obstetric, Gynecologic & Neonatal Nursing,41(3), 369-

382. doi:10.1111/j.1552-6909.2012.01350.x

Early initiation of breastfeeding to promote exclusive breastfeeding. (2017). Retrieved June 11,

2017, from http://www.who.int/elena/titles/early_breastfeeding/en/

Immediate and sustained skin-to-skin contact for the healthy term newborn after birth:

AWHONN practice brief number 5. (2016). Nursing for Womens Health,20(6), 614-616.

doi:10.1016/s1751-4851(16)30331-2

Ludington-Hoe, S. M., & Morgan, K. (2014). Infant assessment and reduction of sudden

unexpected postnatal collapse risk during skin-to-skin contact. Newborn and Infant

Nursing Reviews,14(1), 28-33. doi:10.1053/j.nainr.2013.12.009

THE BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CONTACT
10
Moore, H. (2015). Improving kangaroo care policy and implementation in the neonatal intensive

care. Journal of Neonatal Nursing,21(4), 157-160. doi:10.1016/j.jnn.2014.11.001

Phillips, R. (2013). The sacred hour: Uninterrupted skin-to-skin contact immediately after

birth. Newborn and Infant Nursing Reviews,13(2), 67-72.

doi:10.1053/j.nainr.2013.04.001

Schneider, L. W., Crenshaw, J. T., & Gilder, R. E. (2017). Influence of immediate skin-to-skin

contact during cesarean surgery on rate of transfer of newborns to NICU for

observation. Nursing for Womens Health,21(1), 28-33. doi:10.1016/j.nwh.2016.12.008

Shorey, S., He, H., & Morelius, E. (2016). Skin-to-skin contact by fathers and the impact on

infant and paternal outcomes: an integrative review. Midwifery,40, 207-217.

doi:10.1016/j.midw.2016.07.007