What is the role of early skin-to-skin contact in effective breastfeeding initiation?

Early Skin-to-Skin Contact for Effective Breastfeeding

Parents giving birth should be supported to breastfeed through early initiation of skin-to-skin contact immediately after birth (as soon as the mother is medically stable, awake, and able to respond to her newborn) and continuing for at least 1 hour, with skilled lactation support readily available in maternity care facilities. 1

Definition and Technique

Skin-to-skin care (SSC) involves placing the infant in direct ventral contact with the mother's chest (chest-to-chest), with the infant typically naked or wearing only a diaper to maximize surface contact, and covering the dyad with prewarmed blankets while leaving the infant's head exposed. 1

Timing and Implementation

Immediate Postpartum Period

• SSC should begin immediately after birth for all mothers and newborns, regardless of feeding or delivery method, and continue uninterrupted for at least 1 hour. 1

• Routine procedures including weighing, vitamin K administration, and ophthalmic prophylaxis can be safely delayed for at least 1 hour and up to 4 hours after delivery to allow for uninterrupted SSC. 1, 2

• For breastfeeding mothers, these procedures should occur after the first breastfeeding is completed. 1

• The infant should be allowed to root and latch on spontaneously within the first hour of life during SSC. 2

After Cesarean Section

• SSC is feasible and should be initiated in the operating room immediately after cesarean birth for healthy mothers and infants. 3

• Healthy infants born by cesarean who experienced SSC in the operating room had significantly lower rates of formula supplementation in the hospital (33%) compared to those who experienced SSC within 90 minutes but not in the OR (42%), and those who did not experience SSC in the first 90 minutes (74%). 4, 3

• Maternal SSC after cesarean is associated with increased breastfeeding initiation, decreased time to first breastfeeding, reduced formula supplementation, and increased bonding and maternal satisfaction. 1

Breastfeeding Outcomes

Immediate Effects

• SSC immediately after delivery and continued throughout the postpartum period enhances the opportunity for an early first breastfeeding, leading to more readiness to breastfeed, an organized breastfeeding suckling pattern, and more success in exclusive and overall breastfeeding. 1

• SSC helps mothers recognize when their infants are ready to breastfeed, facilitating cue-based feeding. 1

Long-Term Breastfeeding Success

• Maternal SSC in the operating room after cesarean showed statistical association with exclusive breastfeeding rates at discharge, with this effect maintained at three and six months postpartum. 4

• SSC and breastfeeding within 30 minutes of birth have been shown to reduce postpartum hemorrhage. 1

Physiologic Benefits Supporting Breastfeeding

For the Infant

• SSC stabilizes newborn body temperature and prevents hypothermia. 1

• SSC stabilizes blood glucose concentrations, which is critical for maintaining infant energy for effective breastfeeding. 1

• SSC provides cardiorespiratory stability, especially in late preterm newborns. 1

• SSC decreases crying and infant stress, creating optimal conditions for breastfeeding initiation. 1

For the Mother

• SSC decreases maternal stress and improves maternal perception of the mother-infant relationship. 1

• Depression scores and salivary cortisol concentrations are lower over the first month among postpartum mothers providing SSC. 1

• Mother-infant separation causes significant stress with persistent consequences on the hypothalamic-pituitary-adrenal axis. 1

Implementation Barriers and Solutions

Common Pitfalls

• Despite recommendations, only 27.4% of eligible newborns self-attached and suckled in the first hour, and 37% did not receive immediate SSC after vaginal birth even when planned. 5

• Critical institutional barriers include inadequate staffing and insufficient education of clinicians on SSC protocols. 6

• Absence of clear clinical algorithms and unclear definitions for eligible mothers and infants hinder implementation. 6

Facilitating Factors

• Hospitals should implement maternity care practices that improve breastfeeding initiation, duration, and exclusivity, such as those in the WHO Ten Steps to Successful Breastfeeding. 1

• Parental education and motivation are important familial-level factors that facilitate SSC success. 6

• Procedures that can be performed at the bedside should be done while the infant is held skin-to-skin or at least in the room with the mother. 1

Continuation Beyond the First Hour

• SSC should continue throughout the hospital stay while rooming-in, with mothers and infants remaining together 24 hours per day. 1

• For breastfeeding mother-infant dyads, rooming-in supports cue-based feeding, leading to increased frequency of breastfeeding, decreased hyperbilirubinemia, and increased likelihood of continued breastfeeding up to 6 months. 1

Safety Considerations

• A newborn requiring positive-pressure resuscitation should be continuously monitored, and SSC should be postponed until the infant is stabilized. 1

• Low Apgar scores (less than 7 at 5 minutes) or medical complications from birth may require careful observation and monitoring during SSC. 1

• When the mother is medically stable, awake, and able to respond to her newborn, SSC can safely proceed. 1