What is the evidence behind skin-to-skin (STS) contact immediately after birth in establishing maternal-infant bonding and promoting a good breastfeeding pattern?

Evidence for Skin-to-Skin Contact After Birth for Bonding and Breastfeeding

Skin-to-skin contact (SSC) immediately after birth is strongly recommended for all mothers and newborns as it establishes maternal-infant bonding, promotes successful breastfeeding patterns, and provides numerous physiological benefits that improve mortality and morbidity outcomes. 1

Definition and Recommendations

Skin-to-skin care involves placing the naked infant (or wearing only a diaper) directly on the mother's bare chest, with the infant's ventral surface facing and touching the mother's skin. The pair is then covered with prewarmed blankets, leaving the infant's head exposed.

• SSC is recommended for all mothers and newborns regardless of:

  • Feeding choice (breast or formula)
  • Delivery method (vaginal or cesarean)
  • As soon as the mother is medically stable and responsive 1

• Duration recommendations:

  • At least 1 hour immediately after birth
  • Continue throughout the hospital stay whenever possible
  • Extended into infancy during routine care 1

Evidence for Physiological Benefits

SSC provides multiple physiological benefits that directly impact infant mortality and morbidity:

• Temperature regulation: Stabilizes newborn body temperature and prevents hypothermia 1
• Metabolic stability: Helps stabilize blood glucose concentrations 1
• Cardiorespiratory function: Provides cardiorespiratory stability, especially beneficial for late preterm newborns 1
• Pain reduction: Decreases pain response during procedures like blood draws 1
• Improved sleep patterns: Promotes more restful sleep and less crying 1
• Neurodevelopment: Results in improved autonomic and neurobehavioral maturation 1

Evidence for Breastfeeding Success

SSC has strong evidence supporting its role in establishing successful breastfeeding:

• Early initiation: Enhances opportunity for first breastfeeding within the critical first hour 1
• Improved technique: Leads to more organized breastfeeding suckling patterns 1
• Increased success rates: Improves exclusive and overall breastfeeding rates, even after cesarean deliveries 1, 2
• Dose-response relationship: Longer duration of SSC correlates with better breastfeeding outcomes 3, 4
• Reduced formula supplementation: Decreases need for formula supplementation in hospital 2
• Improved maternal self-efficacy: Increases maternal breastfeeding confidence 4

A 2022 quasi-experimental study showed that 60 minutes of immediate SSC (versus 20 minutes) significantly improved neonatal breastfeeding ability and maternal breastfeeding self-efficacy in the short term after birth 4.

Evidence for Maternal-Infant Bonding

SSC provides significant bonding benefits:

• Reduced maternal stress: Decreases maternal stress hormones and improves paternal perception of relationship stress 1
• Improved maternal mental health: Lower depression scores and salivary cortisol concentrations over the first month among mothers providing SSC 1
• Increased maternal satisfaction: Particularly noted after cesarean deliveries when SSC is implemented early 2, 5

Safety Considerations

While strongly recommended, SSC requires appropriate safety monitoring:

• Postpone SSC for infants requiring positive-pressure resuscitation until stabilized 1
• Monitor closely infants with low Apgar scores (less than 7 at 5 minutes) 1
• Supervise first-time mothers during SSC, especially in the first hours after delivery 6
• Ensure proper positioning to maintain a free airway, particularly with mothers who have a high BMI 6
• Be aware of SUPC risk (Sudden Unexpected Postnatal Collapse) which, while rare, can occur during unmonitored SSC 3, 6

Implementation After Cesarean Birth

Special considerations for cesarean deliveries:

• Implement SSC as soon as the mother is alert and responsive 2, 5
• Benefits after cesarean section include:
  • Increased breastfeeding initiation
  • Decreased time to first breastfeeding
  • Reduced formula supplementation
  • Increased bonding and maternal satisfaction
  • Maintained newborn temperature
  • Reduced newborn stress 2

Clinical Protocol Recommendations

For optimal implementation of SSC:

1. Begin SSC immediately after birth for stable mother-infant pairs
2. Continue for at least 1 hour uninterrupted
3. Delay routine procedures (vitamin K, eye prophylaxis) until after the first hour or first breastfeeding
4. Provide appropriate monitoring, especially for primiparas and mothers with high BMI
5. Ensure proper positioning to maintain infant airway
6. Continue SSC throughout hospital stay whenever possible
7. Educate parents on safe SSC practices for home

SSC is a cornerstone practice in the WHO's "Ten Steps to Successful Breastfeeding" and serves as a basic tenet for baby-friendly hospital designation 1.