3.3 Addressing barriers to skin-to-skin
Barriers to skin-to-skin
The major barriers to skin-to-skin care (SSC) at birth are lack of personnel, time constraints, and safety concerns. Training, designated health personnel for SSC, and teamwork are the key interventions likely to improve SSC at birth.
Concern that the newborn will get cold.
- Place newborn's abdomen directly on the mother/birthing parent's chest, without drying
- Skin-to-skin is immediate (directly from the mother/birthing parent)
- Newborn is extended as much as possible, so as much skin contact as possible (oxytocin)
- Newborn is dried, especially back and head
- Newborn is then covered with a dry blanket
- Skin-to-skin re-warms cold babies better than in an incubator or warmer (hypothermia = 36.3 C)
Newborn needs to be examined.
- Most examinations can be conducted with a newborn on the mother's/birthing parent's chest.
- There is no need to move the newborn to monitor vital signs.
- Weighing can be delayed.
Mother/birthing parent needs suturing.
- Newborn can stay on the mother's/birthing parent's abdomen while an episiotomy is sutured.
- Newborn can stay on the mother's/birthing parent's chest while suturing a cesarean section wound16.
Newborn needs to be bathed.
- Delaying the first bath provides better thermoregulation and allows the vernix to remain on the skin.
- Gently wipe the newborn dry after birth, preserving the vernix.
- Vernix retention is associated with significantly higher skin hydration, a lower skin pH, and significantly less erythema.
- Early bathing is associated with a significant fall in temperature.
Delivery/birthing room is busy.
- Mother/birthing parent and newborn can be transferred to the postnatal ward while in skin-to-skin contact.
Insufficient staff to remain with the mother/birthing parent.
- A responsible family member can stay with the mother/birthing parent and newborn.
- Discuss routine precautions with the family member to ensure their safety.
- Monitoring of maternal and newborn infant vital signs by staff should continue as per hospital standards.
Newborn is not alert.
- If a newborn is sleepy due to maternal medications it is even more important that the newborn has contact as he/she needs extra support to bond and feed.
Mother/Birthing parent is tired.
- A mother/birthing parent is rarely so tired that they do not want to hold their infant.
- Contact with her infant can help the birthing parent to relax.
- Review labor practices such as withholding fluid and foods, and practices that may increase the length of labor.
- Skin-to-skin care and breastfeeding is best when the birthing parent is in a semi-reclined position; a good position for resting.
Lack of knowledge in the health professional wishing to move the infant
- This first step following birthing has far-reaching effects on the birthing parent, infant, and breastfeeding.
- Train all birthing room staff in the effects of immediate and undisturbed skin-to-skin contact.
- Refer all staff to the hospital policy which they must follow. Hospital breastfeeding policies will reflect the 10 Steps to Successful Breastfeeding, including Step 4.
Resources

Skin-to-skin Contact.
© Developed by Magdalena Whoolery and Carole Dobrich. Illustrations by Angela Eastgate. May (2020)
This poster is available in multiple languages on the LLLI website.