Skin-to-Skin Contact

My main focus with this platform is to inform and educate new parents about important practices regarding pregnancy, birth, breastfeeding and parenting. I believe if they have easy access to the important information, they can make informed decisions about their care. So, today I'd like to focus on a very important practice that for years was not very common. Recently, there has been an increased awareness on this simple practice that benefits both mothers and babies immensely. And that practice is skin-to-skin contact (SSC)!

What is Skin-to-Skin Contact?

It's very simple, keep your baby close to you, without any barriers! No clothes or blankets covering your chest. Your baby needs to be naked and placed on your chest. Keep a diaper on to avoid a mess. To keep baby warm cover up with a light blanket over top of both of you. Skin-to-skin contact should happen as soon as possible after birth. It's fascinating to me that a natural thing like this even needs to be explained. We've come so far from nature, that we need to be taught how to do things that should come naturally to us! My hope is that slowly we will start trusting our instincts more, especially when it's backed up by scientific evidence.

The Cochrane Database

This is an awesome database that collects evidence for all sorts of medical topics. Their goal is to make health care better by using evidence without bias to inform practices. This is a quote from their website:

"Cochrane contributors - 37,000 from more than 130 countries - work together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Many of our contributors are world leaders in their fields - medicine, health policy, research methodology, or consumer advocacy - and our groups are situated in some of the world's most respected academic and medical institutions. Contact us for more information."

The researchers at Cochrane want evidence from credible research to inform practices in health care. They do so by writing systematic reviews that objectively look at the research that has been done in that field. Only the highest quality studies are chosen for their reviews. So, it's a great database to use when trying to change current health care practices.

What Are They Trying to Change?

For the longest time, babies and moms were separated after birth, babies were washed, dressed, wrapped up and kept away from their mothers. Remember the nurseries with all the babies in bassinets behind the big window? Babies were not given much time to bond with their parents, apart from during scheduled feeds. At the time, mothers were encouraged to rest after birth and it was considered best for them to have their babies somewhere else so they could sleep and recuperate after the delivery. It's because of research collected by The Cochrane Database into a systematic review that those types of practices have almost completely gone by the wayside in our society and babies and moms are now kept together after birth. I will be using evidence from one such review from Cochrane in this blog post. But don't worry! The science nerd in me will temporarily go on break and I'll keep this easy to read and informative for you guys and gals.

Skin-to-Skin to Support Breastfeeding

According to the report, skin-to-skin contact (SSC - this is the same abbreviation the writers of the report use) should start as soon as possible after birth and last until after the first feed at the breast. This means you should probably tell your visitors to come after this time, which could be an hour or more after delivery! Technically, it's probably best that no one other than the parents hold the baby for the first little while, maybe even the first couple of days. Unfortunately, I see it all to often in my work as a nurse. Parents want their baby weighed, measured and bundled first so they can be passed around to various family members. I really hope the evidence starts to change this practice sooner rather than later!

How Skin-to-Skin Effects Breastfeeding

After reviewing the evidence, the researchers concluded that early or immediate SSC promotes breastfeeding. It helps women be more successful in the beginning and potentially increases the length of time that women breastfeed. When you hold your baby SSC, you're able to read his or her cues to feed and you start to learn how to understand their needs better. They will latch earlier and the feed will last longer, and long feeds typically help your supply to come in faster and you'll have more milk once it does.

Also from Babytalk: The Magical Way to Increase Breast Milk Supply

They found that more women were breastfeeding 1-4 months postpartum if they initiated SSC early on after birth. In addition, women who started SSC early had a more successful first feed!

Advocate for Yourself and Your Baby

In many ways this seems obvious. But now we also know that it is scientifically proven. So, please include in your birth plan your desire to do SSC as soon as possible after birth. Yes, sometimes babies have difficulty transitioning and need to be taken to the baby warmer for resuscitative measures. As soon as your nurse says that the baby is good, is when SSC should begin! Your partner, parents and friends can hold your baby later, skin-to-skin with you is WAY more important in the first minutes and hours after birth. Sometimes the mother is unwell after delivery and cannot do SSC. This is when it can be good for the husband or partner to start SSC. If the mother is well she should always be the first choice for SSC.

Baby's Transition Outside the Womb

Skin-to-skin care helps to stabilize the baby's blood sugar after birth. It also helps stabilize their transition to life outside the womb by stabilizing the cardio-respiratory system. I have seen this often in my practice when babies are intermittently grunting (they make a kind of sing-song sound when they breathe). When placed in SSC, it almost always resolves this issue! Obviously, you will do this in consult with your team at the hospital. Unfortunately, not all caregivers are aware of how much SSC can help babies during their transition to life on the outside. Although it's been proven that SSC can be better than an isolette or baby warmer, they often still gravitate to that solution. It is totally acceptable for you to ask to try to do SSC for a little while to see if the grunting resolves. Nurses and doctors can do all the tests they need to do on baby while he or she is lying on your chest.

Check out this amazing post about the Golden Hour on The Habibi House blog: The Golden Hour After Birth

Skin-to-skin in The Operating Room

A  hot topic in the field of skin-to-skin is incorporating it into operating room (OR) practices. As you might know, the OR is a sterile and organized place. Typically it's a place for very sick people. Birth is a totally different ball game because realistically, women giving birth are healthy and birth is a natural process. Unfortunately, anesthetists and other health care providers can be very set in their ways. They are used to having easy access to the patient. Also, they are not used to having family members and babies in their way. So you can see how this would be an adjustment for them. And fair enough, if things go badly in the OR, you want the doctor to be able to do what has to be done as quickly as possible. Fortunately, things usually go pretty smoothly during a c-section. The patient is almost always awake, they get a spinal or epidural, and are very rarely put to sleep under general anesthetic, except in extreme circumstances.

Also from Babytalk: Everything You Ever Wanted to Know about C-Sections

Changing Practices in The Operating Room

So, can we incorporate SSC in the OR? Almost always is the answer. As long as we have buy-in from the anaesthetists, doctors and nurses. They need to know the importance of SSC and have support in the form of staffing to support mother and baby. It's a matter of changing health care practices! This can take a long time, but I believe the more patients requesting SSC in the OR, the more common it will become.

What does SSC in the OR look like?

The baby is born and taken to the warmer to be checked and then SSC is initiated with either you (the patient) or your partner. The health care team does not need to do all their checks, if baby is doing well, he or she can come immediately to your chest. Make sure that baby is unbundled and tucked in under your gown. Sometimes this requires extra staff in the OR, so please request SSC early on so that nurses can organize their staffing.

Skin-To-Skin With a Natural C-Section

The other way to do skin-to-skin in OR is by "natural c-section". This is becoming more and more popular, but requires a bit more skill, equipment and personnel to be possible. A natural c-section is when the baby is born and goes immediately onto the mother's skin from underneath the sterile drapes. As long as mom and baby are well, SSC can continue for as long as they want. The video below is from a hospital in Toronto, Ontario. They started doing natural c-sections a few years back. There you can see a natural c-section in action! https://www.youtube.com/watch?v=0jCjk73Xpn8 The Cochrane report actually encourages SSC in the OR and found evidence to support it. According to the report, SSC in the OR helps c-section moms to be more successful at breastfeeding. It helps initiate the first feed earlier than without SSC. These moms were able to breastfeed longer than those that didn't initiate skin-to-skin in the OR.

A Shift Towards Real Change

All the evidence points to early and immediate SSC being beneficial to moms and babies. Now we just need to change hospital practices! If SSC is something you are interested in as a patient, speak up. Try as much as you can to advocate for yourself. It can be hard, especially if you get push back from your doctors and nurses. But don't forget, this is YOUR experience and you and your baby deserve the best evidence based care available.   References: http://www.cochrane.org/CD003519/PREG_early-skin-skin-contact-mothers-and-their-healthy-newborn-infants