Skin-to-Skin Contact and Its Effect on Breastfeeding

Introduction to Skin-to-Skin Contact and Breastfeeding

In earlier times, when babies were born at home, they were kept close to the mother immediately following birth. As society evolved and deliveries began occurring in nursing homes and hospitals, the norm of skin-to-skin contact (SSC) began to fade. SSC refers to the practice of placing the naked newborn on the mother's bare chest immediately after birth. Interventions conducted on mammals revealed how separation of baby and mother affects the newborn (Moore, Anderson, Bergman, & Dowswell, 2012).

The idea of promoting closeness for breastfeeding emerged partly from observations of animal behavior. In mammals, the interactions between mother and offspring immediately after delivery are essential: they encourage the newborn to obtain milk from the mother, which is critical for survival. When an animal is separated from its mother during this period, distress cries signal the negative impact of that separation. Similar behavior has been observed in humans. Babies placed in separate cots, rather than next to their mothers, made more noise and were more unsettled than infants kept close to their mothers (Moore et al., 2012).

This research is important because of the growing trend of separating mothers from babies after birth — a trend that persists despite well-documented evidence of the benefits of postpartum SSC. Standard hospital delivery-room procedures often create obstacles to close bonding between mothers and neonates. Breastfeeding is one of the key bonds that can develop immediately after birth. It has been noted that newborns experience an adrenaline surge right after birth, during which they are primed to breastfeed. Because separation of mother and child after birth may cause difficulties that persist throughout life, this issue warrants careful attention (Moore et al., 2012).

An additional motivating factor for this body of research is the growing number of women who are moving away from breastfeeding. Breastfeeding has well-established advantages: it supports the emotional and intellectual development of the baby, provides crucial immunological benefits, and fosters the mother-child bond. Data collected by the U.S. Food and Drug Administration between 2005 and 2007 revealed that 83% of women initiated breastfeeding, yet only 43% continued during their hospital stay (Moore et al., 2012). The central question across the studies reviewed is whether skin-to-skin contact promotes breastfeeding. Breastfeeding is not as straightforward as it may appear: the baby must develop a bond with the mother, while the mother needs to feel sufficiently confident to breastfeed successfully (Moore et al., 2012).

Study Populations

The participants across the reviewed studies were mothers and their newborn babies, including both full-term and premature infants. In one study, SSC was initiated within 24 hours of birth. The mothers represented varied racial backgrounds and age groups. The data reviewed is cumulative across multiple independent studies, and no correlational linkages were drawn between them. The outcomes in each review depended solely on whether the babies received skin-to-skin contact or not.

For the study examining infant suckling competency, participants were recruited from childbirth preparation classes and the study took place at a university medical center's labor and delivery unit (Moore & Anderson, 2010). The women were over 18 years of age, had no prior chronic illnesses, and reported no history of drug abuse. They intended to deliver vaginally and were committed to breastfeeding for at least one month postpartum. This was a significant criterion, as many women in industrialized countries now prefer bottle-feeding from birth; reluctance to breastfeed could introduce limitations and skew results. All babies in this group were full-term and weighed more than five pounds. Additionally, all participating women were first-time mothers, since prior breastfeeding experience or other children at home could have introduced confounding variables.

A separate study reviewed forty-eight studies funded by the National Institutes of Health. This study was heterogeneous, encompassing low-birth-weight infants, premature infants, and babies on respiratory support (Renfrew, Dyson, McCormick, Misso, Stenhouse, King, & Williams, 2009).

The study examining the effects of Kangaroo Mother Care (KMC) was conducted across four NICUs in hospitals in Sweden. This study differed in that it included only preterm infants — specifically, babies born before 37 weeks of gestation. The final sample included 300 babies: 103 born before 32 weeks and 197 born between 32 and 36 weeks of gestation (Flacking, Ewald, & Wallin, 2011).

Interventions

The studies compared standard postpartum procedures with those that encouraged SSC. SSC must be carried out in a specific manner, and three categories were identified. The first was birth SSC, in which the baby was placed on the mother's bare chest or abdomen within one minute of birth. If suctioning was required, it was performed while the baby remained on the mother. To prevent heat loss, the infant's head was covered with a dry cap or a blanket was placed over the back. The second category was very early SSC, in which contact began 30 to 40 minutes after birth, without the requirement for a cap. The third category included SSC initiated at any point between one and twenty-four hours after birth (Moore et al., 2012). In all cases, emphasis was placed on ensuring the baby was undressed and that the contact was ventral-to-ventral — that is, front of infant to front of mother.

Interventions in a related group of studies included simultaneous milk ejection from the breasts in the early weeks after delivery, community and hospital support, Kangaroo skin-to-skin contact, and staff training. Considerable interest was directed at whether effective and supportive staff could meaningfully enhance SSC and lead to better outcomes (Renfrew et al., 2009).

For the KMC study, data were collected from parent-completed reports. Parents recorded the onset and duration of KMC sessions between mother and baby. Nurses followed up by phone at two weeks postpartum to ask about breastfeeding progress. Data were subsequently collected at two-week intervals, at two, four, and six months of age. Questions focused specifically on whether the infant was receiving milk directly from the breast or through other methods (Flacking, Ewald, & Wallin, 2011).

Conclusion

Most of the studies reviewed focused on short-term outcomes, capturing effects immediately or shortly after delivery. As a result, the findings reflect the most immediate impacts of SSC, while long-term effects remain largely unknown. Although the data collected were valid and credible, the absence of long-term follow-up indicates that this area of research requires further investigation (Renfrew et al., 2009).

Across thirty-four sets of studies involving a total of 2,977 mother-infant pairs, all were judged qualitatively viable for inclusion in the review. The overall findings indicated that breastfeeding outcomes improved with SSC (Moore et al., 2012). The combined results demonstrated a meaningful association between SSC and the promotion of breastfeeding immediately after birth (Moore et al., 2012).

In the study examining infant response to SSC, meaningful breastfeeding was achieved twice as quickly in the SSC group compared with the control group. Mothers in the SSC group also reported fewer difficulties initiating breastfeeding. However, at one month postpartum, no significant difference was observed between the two groups in terms of feeding from the breast versus expressing milk. Both groups showed similar averages, indicating that SSC did not alter the infant's ability to accept milk from alternative sources such as a bottle (Moore & Anderson, 2010).

The NIH-funded study also concluded in favor of breastfeeding promotion. SSC, peer support within the hospital, staff expertise, and effective breast milk expression were all found to contribute to higher rates of breastfeeding (Renfrew et al., 2009).

The most significant findings came from studies of very preterm infants. Infants who spent more time in KMC breastfed at higher rates than those who did not. Kangaroo Mother Care was found to be especially beneficial during the hospital stay, with the strongest effects observed in the most vulnerable mother-infant pairs (Flacking, Ewald, & Wallin, 2011). This indicates that very preterm infants stand to gain the most from SSC and KMC, and that the association between KMC and breastfeeding outcomes is particularly pronounced in this group.

Breastfeeding is an established source of nutrition and developmental support for infants. Steps are being taken globally to promote it among new mothers — a necessary effort, since women who are ambivalent about breastfeeding may also be less likely to pursue SSC. Initiatives such as the Ten Steps to Successful Breastfeeding and the Innocenti Declaration represent meaningful efforts to raise awareness (Canahuati & de Suarez, 2001). Nevertheless, social constraints — particularly in Western societies — continue to discourage sustained breastfeeding. A mother who is also a teacher, for instance, faces practical dilemmas about where and when she can feed her child (Canahuati & de Suarez, 2001).

All the studies discussed involved mothers and infants from diverse regions and ethnic backgrounds. Given that the majority of findings consistently indicate that SSC promotes breastfeeding, there is a strong case for incorporating SSC into standard postpartum practice. When an intervention yields clear benefits and no demonstrated harms, it deserves adoption. Hospital staff, communities, and expectant mothers alike should be informed about SSC and encouraged to implement it following birth.