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Skin To Skin Contact: A Powerful Therapy

Written by Mandy Daly
8 mins
father-holding-newborn

Overview

Touch is the first of the senses to develop in the human being and it remains perhaps the most emotionally central to our lives. For preterm infants, positive human touch is not always what they experience due to the medical intervention they require, yet we know that touch is often essential for a new-born's survival. So how can we ensure that this is what these vulnerable premature babies are still able to experience?

What is skin to skin contact (SSC) and why does it matter?

Skin to skin care (SSC) is prolonged & continuous skin to skin contact between a parent & their new-born, low birth weight infant both in hospital & after early discharge, with (ideally) exclusive breastfeeding, & proper follow up post-discharge1.

Who can benefit from skin to skin care?

While most babies can benefit from the many positive effects of skin to skin, it’s particularly powerful for premature babies. Please note, that certain premature babies will not be suitable for skin-to-skin care.

When can preterm babies start Skin to skin contact?

There’s no ‘one size fits all’ here. Skin to skin contact generally depends on baby’s medical stability. Currently, the recommendations are for infants born less than 27 weeks, it is based on individual medical assessment. For infants born 28-31 weeks gestation, then is it usually okay to trial immediately after initial assessment/stabilisation, as long as the baby doesn’t have any other underlying conditions that may preclude the ability to do skin to skin contact. For those babies born at greater than 32 weeks gestation, then it can begin, following initial infant assessment, in the delivery room. Those on ventilation can also try SSC following stabilization and with monitoring and observation2.

Skin to skin contact with a baby has been shown to be beneficial until the infant is 15lb weight (6.8kg) but can be continued after that if wanted.

How to do skin to skin with a baby

Currently, The World Health Organisation recommends approximately 90 minutes per session. Parents are recommended to sit comfortably in a reclining chair for the duration of the session.

  • Plan with parents – provide SSC information booklet, assess parental readiness, front opening clothes.

  • Plan a time – suitable quiet time in the unit, allow 1 hour at least, consider the infants day and planned HCP interventions.

  • Prepare parents with food, drink, toilet, clothes, expressing.

  • Prepare baby – appropriate positioning for easy transfer, nest or wrap to transfer, avoid after a feed, consider advisability of undressing.

  • Prepare environment – seating, light, noise, draughts, privacy

Baby is placed on the parent’s chest in upright position with their head turned to one side and slightly extended. Baby’s hips should be flexed and abducted in a frog position with arms flexed. Their tummy should sit just below where the parent’s ribs meet with their bottom supported3. See example below (WHO 2003 Guidance).

Skin-to-skin contact mother illustration

WHO code Guidance (2003) Kangaroo mother care, a practical guide. Geneva; Department. of Reproductive health and Research, World Health Organisation.

Why is skin to skin contact important?

Through skin to skin contact, parents act as an incubator, helping to regulate baby while providing nutrition and appropriate stimulation. It also serves to humanize the NICU experience, promoting bonding through the release of feel-good maternal hormones.

A variety of physiological parameters and clinical outcomes have been extensively researched and benefits of skin to skin include:

  • Reducing mortality 4

  • Reducing rates of infection 5

  • Promoting sleep and self-regulation 6

  • Thermal regulation 7

  • Stimulating mother’s digestive system 8

  • Promoting breastfeeding 4, 8

  • Improving weight gain 4

  • Regulating heart and respiration rates 4, 8

  • Enhancing bonding and attachment 9

  • Shortening hospital stay 10

  • Improving immune function 5

  • Improving neurodevelopmental outcome 11

  • Releasing maternal oxytocin through sensory stimulation i.e. touch, warmth, smell 12

  • Lowering maternal and paternal stress levels 12

  • Improving mothers sense of confidence and sense of their role as a mother 13

  • Improving parental sensitivity to infant cues 14

  • Improving social behavior in early adulthood 15

  • As a powerful pain management tool 16-18

  • Reducing prematurity related morbidity in adulthood 19

What to do if a baby is not ready for skin to skin contact

Minimise separation through gentle containing touch, presenting face where infant can see it/have face-to-face visual contact & talking softly. Work with parents on the safest way for them to touch their baby.

Is it safe?

There have been a variety of studies assessing the physiological parameters of skin to skin contact especially around body temperature and apnoeic episodes20, 21. This has shown skin to skin contact to be safe for premature babies. Parents should continue to monitor their infant during skin to skin contact and should consult a HCP if they have any concerns during skin to skin contact.

Mandy’s Personal Experience

After four very long emotionally and physically draining weeks, during which I witnessed several resuscitations, lost count of the number of times I said goodbye to her, I finally got the opportunity to hold Amelia. Was I overcome with emotion? YES, but not the emotions I had anticipated. My brain said YES but my body was gripped with fear and anxiety as Amelia was placed upon my chest. My heart was beating so hard it hurt, adrenaline coursed through my veins, I struggled to breath and what ought to have been a special time for both of us - descended into a stress fest with neither of us benefiting from that first encounter. Babies speak to the world through their behaviours and gestures and an awareness on my part of Amelia’s stress cues would have guided that first skin-to-skin contact between us in a very different direction. Had I been aware of the far-reaching benefits of SSC for both Amelia and I, I would have advocated for it much earlier.

Concluding Paragraph

Skin to skin contact with a baby is just one of the many family-centered and developmentally supportive interventions that can make a real and lasting difference to the lives of the premature babies and families who spend time in the neonatal unit. For more on skin-to-skin care, the WHO have published a fantastic and thorough practical guide to Skin to Skin Care, which you can access by clicking here. A revised edition of this publication is due for release in late 2022.

The writer of this article, Mandy Daly, is a medical and disability underwriter and a parent of a preterm infant born in 2006. She has extensive experiential and deep sectoral knowledge and has many and varied achievements in the field of preterm.

Since the birth of her own preterm infant she has been advocating in the neonatal space and in 2013 she founded the collaborative multi-stakeholder platform, The Irish Neonatal Health Alliance (www.inha.ie).

Among many other achievements, she is a chair committee member of the group that developed the European Standards of Care For Newborn health, is a public reviewer for the Health Research Board and the British Medical Journal Open Pediatrics, is a member of the National Office of Research Ethics Clinical Trials Committee, works with the National Clinical Trials Office Stakeholder and Management Committee and the Health Products Regulatory Authority and European Medicines Agency and has published papers in several journals including the British Medical Journal, The Lancet, The Journal of Obstetrics and Gynaecology and Trials. She serves on the advisory board of the PPI Ignite Network, the European Foundation For The Care Of Newborn Infants and the NIDCAP Federation International Board and working as patient collaborator and embedded patient researcher on several national and international research studies.

References

  1. N, Ruiz-Peláez JG, De Calume Figueroa Z. Current knowledge of kangaroo mother intervention. Curr Opin Pediatr. 1996;8(2):108–12.

  2. Vívian Mara Gonçalves de Oliveira Azevedo, César Coelho Xavier, Fernanda de Oliveira Gontijo, Safety of Kangaroo Mother Care in Intubated Neonates Under 1500 g, Journal of Tropical Pediatrics, Volume 58, Issue 1, February 2012, Pages 38–42, https://doi.org/10.1093/tropej/fmr033

  3. WHO (2003) Kangaroo mother care A practical guide. Geneva: Dept. of Reproductive Health and Research, World Health Organization.

  4. Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD002771.

  5. Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. “Kangaroo mother care” to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010 Apr;39 Suppl 1:i144-154.

  6. Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson PD, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics 2006; 117: e909–23

  7. Thermal control of the newborn: A practical guide. Maternal Health and Safe Motherhood Programme. Geneva, World Health Organization, 1993 (WHO/FHE/MSM/93.2). 11 Shiau SH, Anderson GC.

  8. Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012 May 16;(5):CD003519.

  9. Tessier R, Charpak N, Giron M, Cristo M, de Calume ZF, Ruiz-Pelaez JG. Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr 2009; 98: 1444–50.

  10. Mokhachane M, Saloojee H, Cooper PA. Earlier discharge of very low birthweight infants from an under-resourced African hospital: a randomised trial. Ann Trop Paediatr 2006; 26: 43–51.

  11. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014 Jan 1;75(1):56–64.

  12. Atzil S, Hendler T, Feldman R. Specifying the neurobiological basis of human attachment: brain, hormones, and behavior in synchronous and intrusive mothers. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2011 Dec;36(13):2603–15.

  13. Aghdas K, Talat K, Sepideh B. Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: a randomised control trial. Women Birth J Aust Coll Midwives. 2014 Mar;27(1):37–40.

  14. Bigelow AE, Littlejohn M, Bergman N, McDonald C. The relation between early mother-infant skin-to-skin contact and later maternal sensitivity in South African mothers of low birth weight infants. Infant Ment Health J. 2010 May;31(3):358–77

  15. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, et al. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. 2017 Jan;139(1).

  16. Neu M, Laudenslager ML, Robinson J. Coregulation in salivary cortisol during maternal holding of premature infants. Biol Res Nurs 2009; 10: 226–40

  17. Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med 2003; 157: 1084–8.

  18. Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatr 2008; 8:

  19. Hochberg Z, Feil R, Constancia M, Fraga M, Junien C, Carel J-C, et al. Child health, developmental plasticity, and epigenetic programming. Endocr Rev. 2011 Apr;32(2):159–224.

  20. Mori R, Khanna R, Pledge D, Nakayama T.Meta-analysis of physiological effects of skin-to-skin contact for newborns & mothers. Pediatr Int 2010:52(2):161-70.

  21. Heimann K, Caessen P, Peschgens T, Stanzel S, Wenzl TG, Orlilowsky T. Impact of skin-to-skin care, prone & supine positioning on cardiorespiratory parameters & thermoregulation in premature infants. Neonatology 2010:97(4):311-7

IMPORTANT NOTICE: 

We believe that breastfeeding is the ideal nutritional start for babies, and we fully support the World Health Organization’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age. We also recognise that breastfeeding is not always an option for parents. We recommend that healthcare professionals inform parents about the advantages of breastfeeding. If parents choose not to breastfeed, healthcare professionals should inform parents that such a decision can be difficult to reverse and that the introduction of partial bottle-feeding will reduce the supply of breast milk. Parents should consider the social and financial implications of the use of infant formula. As babies grow at different rates, healthcare professionals should advise on the appropriate time for a baby to begin eating complementary foods. Infant formula and complementary foods should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.

 

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