The Power of Skin to Skin April 13, 2014 18:30
Written By Michelle Roth, BA, LCCE, IBCLC
What if there were an intervention that could improve how many moms breastfeed their babies, and could help those babies nurse more months than other babies? And what if this intervention was completely FREE? It wouldn’t take any additional investment of money, time or energy on the part of the parents or the birth facility, but it can be started as soon as the baby is delivered. Would you try it?
In reading a recent journal article, I was reminded that we already have tons of research to support just such an intervention – uninterrupted mother-baby skin-to-skin contact. In their survey of 413 mothers, Augustin and colleagues found 59% of mother baby pairs were still breastfeeding at 6 months. Of these dyads, 62% had spent time skin to skin and 49% breastfed in the first hour after birth. Earlier contact means breastfeeding sooner, which may mean a stronger milk supply and a longer overall duration of breastfeeding.
Nils Bergman, one of the world’s foremost experts on skin-to-skin contact and kangaroo mother care, says that for newborns, birth is a habitat transition. I heard him speak at the 2007 La Leche League International Conference in Chicago, and his comment that “the mother is the baby’s habitat” has stuck with me ever since. On a practical level, if we can help mothers and babies stay together – in their natural habitat – we can improve the postpartum adaptation, including breastfeeding success.
Amazingly, babies come into this world hardwired to expect to stay with mom after birth, and if left undisturbed and in contact with mom, they will find the breast and begin feeding, usually within that first hour after birth. Researchers have described a distinct “behavioral sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep” if baby is placed skin to skin with mom and left undisturbed. In their study, Widström et. al. found that babies have a brief “birth cry,” then progress slowly through relaxation, awakening and active phases, each with distinct characteristics. They will then make crawling motions interspersed with rest periods, and when they reach the breast they will familiarize with it then begin suckling and finally will sleep when a feeding is completed. They key to these behaviors? Being left skin to skin with mom, without interruption for hospital routines. The authors conclude that these innate behaviors are adaptive. They help baby to self-regulate from birth, which in turn leads to better developmental outcomes.
Some birth interventions do get in the way of this natural sequence. For instance, the Augustin et. al. survey mentioned above found that 71% of women who had a cesarean birth did not have a chance to spend time skin to skin in the hour after birth, and had a longer span of time before the first breastfeeding was able to take place. On a physiologic level, pain medications for labor and delivery interfere with the baby’s innate reflexes and behaviors after the birth. Righard and Alade found that when mothers use certain pain medications in labor, their baby’s just don’t show the same behaviors at the breast. The babies who fared the worst in their study? The ones whose mothers had narcotic pain medication and who were NOT placed skin to skin with their mothers. The babies placed skin to skin and not exposed to pain medication were all able to suckle successfully within the first two hours after birth.
Another researcher, Suzanne Colson, writes that human infants, like other mammals, are abdominal feeders. Colson and colleagues describe 20 feeding-related newborn reflexes, and, more significantly describe how maternal and infant positioning can impact the expression of these reflexes. When mothers assumed full “Biological Nurturing” positions, babies were more likely to use their reflexes to feed effectively. What components make up this optimal positioning? A semi-reclining position for mom, with baby prone on her body. Colson’s book and website illustrate how laid-back nurturing - a non-structured approach to feeding and latch - can facilitate better breastfeeding. While Colson’s work doesn’t rely on skin to skin contact necessarily, it does inform how moms and babies can best work together to use baby’s inborn traits to facilitate breastfeeding success.
Anytime you are able to spend time skin-to-skin with your baby – from birth onwards - is a good thing. Bergman and Bergman recommend at least 2 hours of uninterrupted skin to skin time after birth, and then remaining skin to skin for the first 24 hours. This challenges the model we have created for hospital birth, with a swaddled baby, frequent separation for routine newborn care, and the inevitable barrage of visitors most moms receive in those first couple of days after baby’s birth.
It’s never too late for skin to skin time, especially if you missed it in the first few hours after birth. Skin to skin can be used to continue your baby’s adaptation to the outside world even after you get home from the hospital. Imagine the baby’s first three months as the 4th trimester, and continue to create a womb-like environment. Carry your baby, sleep with your baby, respond immediately to your infant’s needs, and breastfeed often.
If you’ve never seen a baby crawl to the breast, several resources can be eye-opening. The video Delivery Self-Attachment is short and sweet. Health Education Associates has developed two DVDs – one for parents and one for professionals – to illustrate the newborn breastfeeding reflexes described above. The website www.breastcrawl.org has a wonderful video and extensive resources to learn more about this important aspect of early care. (I have no financial interest in any of these resources, just a passion for helping moms and babies make the most of their nature through a nurturing approach to birth and parenting.)
Albright L. (2001). Kangaroo Mother Care: Restoring the original paradigm for infant care and breastfeeding. Leaven 37(5), 106-107.
Augustin AL, Donovan K, Lozano EA, Massucci DJ, Wohlgemuth F. (2014). Still nursing at 6 months: a survey of breastfeeding mothers. MCN AM J Matern Child Nurs 39(1), 50-5.
Bergman J, Bergman N. (2013). Whose choice? Advocating birthing practices according to baby’s biological needs. J Perinatal Edu, 22(1), 8.
Colson SD, Meek JH, Hawdon JM. (2008). Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development, 84(7), 441-449.
Moore ER, Anderson GC, Bergman N, Dowswell T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5.
Righard L, Alade MO. (1990). Effect of delivery room routines on success of first breast-feed. The Lancet, 336(8723), 1105-1107.
Widström AM, Lilja G, Aaltomaa‐Michalias P, Dahllöf A, Lintula M, Nissen E. (2011). Newborn behaviour to locate the breast when skin‐to‐skin: a possible method for enabling early self‐regulation. Acta paediatrica, 100(1), 79-85.