Immediate skin-to-skin contact between newborns and their mothers offers a better start in life, improving a number of key health metrics, according to a newly-updated Cochrane review.
The review found that babies who have skin-to-skin contact with their mother within the first hour of birth are more likely to see a variety of benefits, including exclusive breastfeeding, optimal body temperatures and blood sugar levels. While possible benefits for the mother were also studied, such as effects on blood loss and timing of placental delivery, the evidence was less certain.
Skin-to-skin involves placing the naked newborn on the mother's uncovered chest immediately after birth. This simple practice helps babies adapt to life outside the womb, keeping them warm, reducing stress and crying, and supporting vital functions such as breathing and heart rate.
The evidence in favour of immediate skin-to-skin contact is such that the authors now advise against further randomized trials where skin-to-skin contact is not offered in the control arm.
Clear benefits for babies
This review builds on a 2016 update that informed 20 international guidelines, including a World Health Organization (WHO) recommendation. The latest update adds 26 new studies, bringing the total to 69 trials with over 7,000 mother–infant pairs, most conducted in high-income countries.
The findings show that mothers who have skin-to-skin contact with their babies in the first hour after birth are more likely to exclusively breastfeed for the first six months of the baby's life. Exclusive breastfeeding brings many health benefits for mothers, babies and health systems.
The review found that about 75% of babies receiving early skin-to-skin contact were breast feeding exclusively at 1 month compared with 55% of babies in the groups that did not receive skin-to-skin contact. Newborns also benefit from more optimal sugar levels, body temperature, breathing and heart rate.
Despite guideline recommendations to initiate immediate, uninterrupted skin-to-skin contact until after the first breastfeeding, many health systems still separate mothers and infants during this period.
"Historically, babies have been separated from their mothers immediately after birth for routine procedures such as physical examination, weighing and bathing, preventing immediate skin-to-skin contact," says lead author Elizabeth Moore, who is retired from the School of Nursing, Vanderbilt University. "Even in countries where there is a lot of high-quality care, this free and easy to implement intervention is not common practice."
Separating mother and baby no longer ethical
Importantly, the review highlights that further randomized controlled trials comparing skin-to-skin contact with 'usual care' are no longer ethical.
The findings show there is now enough evidence to make immediate skin-to-skin contact after birth the global standard of care. As WHO already recommends skin-to-skin the standard of care, the authors argue that randomizing to separation of mother and newborn may no longer be justifiable.
"Withholding skin-to-skin contact would now be considered unethical, as there is enough evidence to show that the practice improves newborn health and survival," says Karin Cadwell, senior author and Executive Director and Lead Faculty of Healthy Children Project's Center for Breastfeeding. "While the studies eligible for our review did not focus on survival, other research in low-resource settings has shown that skin-to-skin contact can be the difference between life and death in low birth weight infants. Recruitment for a large trial across Indian and African hospitals was halted after preliminary data showed that skin-to-skin contact significantly improved survival ."
While the studies included in this review came from high- and middle-income countries across multiple continents, none were conducted in low-income countries. The authors note that future research should now prioritize improving study quality and focusing on implementation, rather than testing the intervention itself.
