Research on skin-to-skin contact

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Below is a selection of studies exploring the impact of skin-to-skin contact on infant and maternal health. Find out more about how skin-to-skin works.

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case–control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I² = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25–1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.

Lord, L., harding, J., Crowther, C. and Lin, L. (2023) ‘Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis’, BMC Pregnancy and Birth, 23(744), pp.1–21. Available at: doi:https://doi.org/10.1186/s12884-023-06057-8.

Daily skin-to-skin contact alters microbiota development in healthy full-term infants

In this randomized controlled trial, the gut microbiota was obtained as a secondary outcome measure in a study on the effects of one hour of daily skin-to-skin contact (SSC) for five weeks in healthy full-term infants. Specifically, it studied the effects on alpha/beta diversity, volatility, microbiota maturation, and bacterial and gut-brain-axis-related functional abundances in microbiota assessed thrice in the first year. Findings provide evidence that postpartum SSC may influence microbiota development. Replication is necessary to validate and generalize these results.

Eckermann H, Meijer J, Cooijmnas K et al (2023) Daily skin to skin alters microbiota development in health full term infants. Gut Microbes. Vol 16. Issue 1. Available at: https://www.tandfonline.com/doi/full/10.1080/19490976.2023.2295403

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Mother-infant contact after birth can reduce postpartum post-traumatic stress symptoms through a reduction in birth-related fear and guilt

Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, this study proposes and examines a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births.

Rotem Kahalon, et al. 2022. Mother-infant contact after birth can reduce postpartum post-traumatic stress symptoms through a reduction in birth-related fear and guilt, Journal of Psychosomatic Research, Volume 154, 2022, 110716, ISSN 0022-3999, doi.org/10.1016/j.jpsychores.2022.110716.

Daily skin-to-skin contact in full-term infants and breastfeeding: Secondary outcomes from a randomized controlled trial

This randomized controlled trial evaluated the effect of a 5-week daily skin-to-skin contact (SSC) intervention between mothers and their full-term infants, compared with care-as-usual, on exclusive and continued breastfeeding duration during the first post-natal year. Findings demonstrate that for the total group, the 5-week daily SSC intervention did not extend exclusive and continued breastfeeding duration. However, for mothers performing a regular daily hour of SSC, this simple and accessible intervention may extend exclusive and continued breastfeeding duration by months. Future studies are required to confirm these promising findings.

Cooijmans K, Beijers R, Brett B et al (2021) Daily skin to skin contact in full term infants and breastfeeding: secondary outcomes from a randomizes controlled trial. Maternal and child nutrition. Jan 18 (1): e13241 Available at: https://pubmed.ncbi.nlm.nih.gov/34236131/

This longitudinal study from Israel aimed to further research on the negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC) by examining the protective factors for PTSS-FC. Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. Results emphasise the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative.

Immediate skin-to-skin contact may have beneficial effects on the cardiorespiratory stabilisation in very preterm infants

This randomised clinical trial aimed to investigate the effect immediate skin-to-skin contact with a parent had on the cardiorespiratory stabilisation of very preterm infants. A total of 91 infants in Norway and Sweden received either skin-to-skin contact or incubator care, with findings indicating that immediate skin-to-skin contact for the first six postnatal hours had beneficial effects on the cardiorespiratory stabilisation of very preterm infants.

Linnér, A., Lode-Kolz, K., Klemming, S., Bergman, N., Lilliesköld, S., Markhus Pike, H., Westrup, B., Rettedal, S. and Jonas, W. (2022), Immediate skin-to-skin contact may have beneficial effects on the cardiorespiratory stabilisation in very preterm infants. Acta Paediatr. https://doi.org/10.1111/apa.16371

Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study

Women’s lived experience of an elective caesarean birth often includes separation from their newborn following transfer to a postnatal ward. This quasi-experimental design study explored the outcomes for women and newborns engaging in skin-to-skin contact within the first five minutes of elective caesarean births compared to those who did not have skin-to-skin contact. Findings provided evidence of the benefits of skin-to-skin contact, with results indicating that women proceeded to have their first feed and breastfeed faster than those who did not engage in skin-to-skin contact. Findings also showed these women exhibited higher breastfeeding rates on discharge and had a positive experience with improved bonding and reported less anxiety and depression than their previous caesarean birth.

Gina M. Sheedy, Virginia M. Stulz, Jeni Stevens, Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study, Women and Birth, 2022, ISSN 1871-5192, https://doi.org/10.1016/j.wombi.2022.01.008.

Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates

This study examines the interactive effects of maternal depression and breastfeeding on mother and infant affectionate touch, as well as infant temperament and cortical maturation patterns across early development. A total of 113 mothers and their infants aged between 1 and 3 months were assessed to determine levels of maternal depressive symptoms, feeding, and temperament. Tonic EEG patterns (asymmetry and left and right activity) were collected, with data analysis showing that EEG activity and mother-infant affectionate touch differed as a function of mood and feeding method. Notably, only infants of depressed mothers that bottle-fed showed right frontal EEG asymmetry and attenuated change in the left frontal region across 3 months. Breastfeeding positively impacted affectionate touch behaviors and was associated with increased left and decreased right frontal EEG activation even for depressed groups, suggesting that breastfeeding and the infant’s positive temperament influence mother-infant affectionate touch patterns and result in neuroprotective outcomes for infants, even those exposed to maternal depression within early development.

Hardin, JS. et al. 2021. Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates. Neuropsychobiology 2021;80:158–175. https://doi.org/10.1159/000511604

Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight

Findings from a new study coordinated by the World Health Organization (WHO) demonstrate that initiation of kangaroo mother care (KMC) alongside skin-to-skin contact and exclusive breastfeeding dramatically improves survival outcomes for preterm or low-weight babies when started immediately after birth. Outcomes suggest that early initiation of KMC could save up to 150,000 more lives each year.

The WHO is currently in the process of reviewing its 2015 recommendations on initiating KMC upon stabilisation of the infant in light of the new evidence that has become available. You can read more on this study on the Baby Friendly blog.

Effect of Community-Initiated Kangaroo Mother Care on Postpartum Depressive Symptoms and Stress Among Mothers of Low-Birth-Weight Infants

Approximately 1 in 5 women in low- and middle-income countries experience postpartum depression, and the risk is higher among mothers of low-birth-weight (LBW) infants. Kangaroo mother care (KMC) is effective in improving survival among LBW infants, but the benefits of KMC for mothers are not well described. This randomised clinical trial explores whether the practice of community-initiated kangaroo mother care (ciKMC), an intervention encompassing skin-to-skin-contact and exclusive breastfeeding, during the neonatal period reduces the risk of moderate-to-severe postpartum depressive symptoms among mothers of low-birth-weight (LBW) infants. The trial included 1950 mothers of stable LBW infants from low-income areas in India, with findings suggesting that ciKMC practice may substantially reduce the risk of moderate-to-severe maternal postpartum depressive symptoms. This evidence supports KMC as an intervention to be incorporated in essential newborn care programs in low- and middle-income settings.

Bireshwar, S., et al. 2021. JAMA Netw Open. 2021;4(4):e216040. doi:10.1001/jamanetworkopen.2021.6040

Synchronous caregiving from birth to adulthood tunes humans’ social brain

This birth-to-adulthood study tested the effects of maternal–newborn contact and synchronous caregiving on the social processing brain in human adults. Authors observed mother-child social synchrony of preterm and full-term neonates who received or lacked initial maternal bodily contact for two decades, with findings demonstrating the long-term effects of maternal care giving in humans, similar to their role in other mammals and particularly in tuning core regions implicated in salience detection, simulation, and interoception that sustain empathy and human attachment.

Yanviv. A. et al. 2021. Synchronous caregiving from birth to adulthood tunes humans’ social brain. Proceedings of the National Academy of Sciences Apr 2021, 118 (14) e2012900118; DOI: 10.1073/pnas.201290018

Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth and Neurodevelopment in Preterm Infants

This study investigates the impact of kangaroo mother care (KMC) on breastfeeding and health outcomes in preterm infants and concludes that KMC effects are significant in promoting a higher proportion of mothers’ milk used during hospitalisation, less feeding intolerance at discharge, higher rates of exclusive breastfeeding at 6 months, improved growth and neurodevelopment.

Wang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med. 2021 Feb 2. doi: 10.1089/bfm.2020.0358. Epub ahead of print. PMID: 33533688.

The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies

This review of studies found that preterm and low birthweight infants receiving a kangaroo mother care intervention initiated breastfeeding 2 days 14 h 24 min earlier than infants who received the “conventional” care of the radiant warmer/incubator method.

Mekonnen, A, Yehualashet, S and Bayleyegn, D, (2019). The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and low birthweight infants: a meta-analysis of published studies. International Breastfeeding Journal, doi.org/10.1186/s13006-019-0206-0

Effects of paternal skin-to-skin contact in newborns and fathers after cesarean delivery

This study of neonates born via elective cesarean delivery and their fathers investigated the effects of paternal skin-to-skin contact (SSC) on newborns and fathers after cesarean delivery. Newborns who received SSC shortly after delivery had a more stable heart rate and forehead temperature, less duration of crying, and started feeding behavior earlier. The duration of breastfeeding after SSC in the treatment group was longer as well, with statistical significance, than the control group. In addition, fathers in the treatment group had lower scores of anxiety and depression and better role attainment than those in the control group, with statistical significance.

Xiaoli Huang, Liling Chen, & Li Zhang, (2019). Effects of paternal skin-to-skin contact in newborns and fathers after cesarean delivery. Journal of Perinatal & Neonatal Nursing 2019, 33 (1): 68-73

Hospital breastfeeding support and exclusive breastfeeding by maternal pre‐pregnancy BMI

This US study explored the impact of the Ten Steps to Successful Breastfeeding on supporting breastfeeding amongst mothers with obesity, who have disproportionately lower rates of exclusive breastfeeding than mothers who are not obese. Researchers found that holding babies in skin-to-skin contact for the first time and being encouraged to feed on demand were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin‐to‐skin significantly less often than other mothers. They concluded that interventions aimed at helping mothers with obesity to hold their babies skin‐to‐skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.

Kair, L, Nickel, N, Jones, K, et al, (2019). Hospital breastfeeding support and exclusive breastfeeding by maternal pre‐pregnancy BMI. Maternal & Child Nutrition, doi.org/10.1111/mcn.12783

Older research

Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section

Stevens, J, Schmied, V, et al (2018). Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section. Women and Birth, doi.org/10.1016/j.wombi.2018.02.005

Mapping, measuring, and analyzing the process of skin-to-skin contact and early breastfeeding in the first hour after birth

Cadwell, K, Brimdyr, K, et al (2018). Mapping, measuring, and analyzing the process of skin-to-skin contact and early breastfeeding in the first hour after birth. Breastfeeding Medicine, doi.org/10.1089/bfm.2018.0048

An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth

Brimdyr, K, Cadwell, K, et al, (2017). An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth. Maternal & Child Nutrition, doi.org/10.1111/mcn.12571

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation

Lau, Y, et al (2017), An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation, Maternal & Child Nutrition, DOI: 10.1111/mcn.12492

Early skin-to-skin contact for mothers and their healthy newborn infants

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003519.pub4/full

Kangaroo mother care for preterm infants

Charpak, N (2016), Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 139(1):e20162063

Healthy Birth Practice #6: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

Crenshaw, JT, (2014). Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby, and Breastfeeding, Journal of Perinatal Education, doi: 10.1891/1058-1243.23.4.211

Below is a selection of studies exploring the impact of skin-to-skin contact on infant and maternal health. Find out more about how skin-to-skin works.

Older research

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