Immediately after birth

Skin to skin baby care is sometimes referred to as kangaroo care.  The idea being that the mother holds the baby immediately after birth in an upright position against her chest with “skin to skin” care.  This has been shown to have some therapeutic benefit for both full-term and low body weight infants.  This form of care is most beneficial immediately after birth when the infant is adjusting to their new environment.

In light of the fact that there is some evidence of benefits of this care of the newborn infant I would recommend this form of care when possible.  There are some research papers that suggest skin-to-skin care makes no difference or that there is not sufficient evidence to advocate skin-to-skin care.  There is no evidence that skin to skin care causes any harm and skin-to-skin care in the first hours after birth is a good experience for both mother and baby in establishing a bond and the benefits that may come from skin to skin care are an added bonus.

Benefits of skin-to-skin baby care

• Helps develop the maternal bond with the baby
• Maintains baby body temperature
• Aids baby in adjusting to new environment
• Beneficial effect on breastfeeding outcomes
• Reduced infant crying
• Decreases time needed in hospital in low birth weight infants

Evidence

Full-term infants who had 90 minutes skin to skin care with their mothers immediately after birth showed some benefits in comparison with those kept in cots.  They showed significantly higher skin and axillary temperatures than the cot babies and their blood glucose was higher.  The skin-to-skin infants also cried less.  The conclusion was that skin-to-skin contact preserves energy and accelerates metabolic adaptation (Ref.1).

A review of studies into skin-to-skin contact concluded that early skin-to-skin contact has some clinical benefit regarding breastfeeding outcomes, and infant crying.  There were no short or long-term negative effects found (2).

In low birth weight infants mothers were encouraged to have skin to skin contact for at least 4 hours per day and compared to mothers who just held there babies.  Mothers who had skin-to-skin contact were shown to lactate for 4 weeks longer and at 6 months the infants cried significantly less than those who were just held (4).

A comparison of low birth weight infants who received 24-hour care skin-to-skin contact with those kept in an incubator showed greater benefits for the skin-to-skin group.  The babies who received skin-to-skin care were in hospital for shorter periods of time, had greater increase in head circumference, less severe infections and a greater number were breast fed for 3 months of corrected age.  Therefore 24-hour skin-to-skin contact in low birth weight babies decreases neonatal hospital stay and promotes breast-feeding without compromising survival, growth or development (5&6).

There have also been studies which have shown no benefit of skin to skin care compared with conventional care.  Many studies conclude that there is insufficient evidence to promote this form of care widely (7, 8, 9, 11, 13 & 14).  There have been no negative outcomes of skin-to-skin care (8, 12 & 15).

References

1. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot.  Christensson K et al Acta Paediatr. 1992 Jun-Jul;81(6-7):488-93.
2. Early skin-to-skin contact for mothers and their healthy newborn infants. Anderson GC, Moore E, Hepworth J, Bergman N. Cochrane Database Syst Rev. 2003;(2):CD003519.
3. Kangaroo mother care and the bonding hypothesis. Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, Charpak Y, Charpak N. Pediatrics. 1998 Aug;102(2):e17
4. Skin-to-skin contact for very low birthweight infants and their mothers. A Whitelaw, G Heisterkamp, K Sleath, D Acolet and M Richards. Archives of Disease in Childhood, Vol 63, 1377-1381,
5. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Charpak N, Ruiz-Pelaez JG, Figueroa de C Z, Charpak Y. Pediatrics. 2001 Nov;108(5):1072-9
6. Kangaroo mother care. Doyle LW. Lancet. 1997 Dec 13;350(9093):1721-2
7. A systematic review of randomised controlled trials evaluating the effect of mother/baby skin-to-skin care on successful breast feeding. Carfoot S, Williamson PR, Dickson R. Midwifery. 2003 Jun;19(2):148-55
8. A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding. Carfoot S, Williamson P, Dickson R. Midwifery. 2005 Mar;21(1):71-9
9. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Conde-Agudelo A, Diaz-Rossello JL, Belizan JM.  Cochrane Database Syst Rev. 2003;(2):CD002771
10. Kangaroo-Mother Care: scientific evidence and impact on breastfeeding Venancio SI, de Almeida H J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S173-80
11. A comparison of kangaroo mother care and conventional cuddling care. Roberts KL, Paynter C, McEwan B. Neonatal Netw. 2000 Jun;19(4):31-5
12. Kangaroo Mother Care: 25 years after  Charpak N et al Acta Paediatr. 2005 May;94(5):514-22
13. Current knowledge of Kangaroo Mother Intervention. Charpak N, Ruiz-Pelaez JG, Figueroa de Calume Z Curr Opin Pediatr. 1996 Apr;8(2):108-12
14. Rey-Martinez Kangaroo Mother Program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Charpak N, Ruiz-Pelaez JG, Charpak Y. Pediatrics. 1994 Dec;94(6 Pt 1):804-10
15. Kangaroo mother versus traditional care for newborn infants </=2000 grams: a randomized, controlled trial. Charpak N, Ruiz-Pelaez JG, Figueroa de C Z, Charpak Y. : Pediatrics. 1997 Oct;100(4):682-8
16. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Charpak N, Ruiz-Pelaez JG, Figueroa de C Z, Charpak Y. Pediatrics. 2001 Nov;108(5):1072-9.