ELIZABETH SMITH, MPH, ICCE, IBCLC, RLC COORDINATOR, PATIENT SERVICES UNIVERSITY OF UTAH HOSPITAL Skin to Skin Care Baby’s First Touch
ELIZABETH SMITH, MPH, ICCE, IBCLC, RLC COORDINATOR, PATIENT SERVICES
UNIVERSITY OF UTAH HOSPITAL
Skin to Skin Care Baby’s First Touch
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
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.
58%
26%
0%
10%
20%
30%
40%
50%
60%
70%
Early contact (n=21) Control (n=19)
Perc
ent s
till b
reas
tfeed
ing
at 3
mon
ths Early contact: 15-20 min suckling and
skin-to-skin contact within first hour after delivery
Control: No contact within first hour
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 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.