Access KeysSkip to MenuSkip to ContentSkip to Footer

4.1 The first hours

Promotional poster - from Baby Friendly UK

Promotional poster - from Baby Friendly UK

The benefits to the mother of immediate breastfeeding are innumerable, not the least of which, after the weariness of labour and birth, is the emotional gratification, the feeling of strength, composure, and the sense of fulfillment that comes with the handling and suckling of the baby.1

Ashley Montague, 1978

Baby Friendly Step 4

Step 4 of the Ten Steps to Successful Breastfeeding states:

"Help mothers to initiate breastfeeding within a half-hour of birth."

This step is now interpreted as:

Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed. 2

Immediately following birth

At the time of birth 90% of newborns do not need assistance to begin breathing and will benefit from being placed in skin-to-skin contact on the mother. 3

  • Immediately dry newborn and move him/her onto mother's abdomen in skin-to-skin contact.
  • In this position:
    • Baby can be covered with dry linen to maintain temperature,
    • upper airway can be cleared by wiping the mouth and nose, and
    • respiration and heart rate can be assessed and monitored.

The first breastfeed

Read this great article!

What happens now is truly a miracle to watch! Click on the icon on the left to read this paper, then file it in your Workbook. If you are in contact with colleagues who are with birthing mothers, share it with them too.

Several researchers have described this species-specific set of innate behaviors when baby is placed in skin-to-skin contact with the mother immediately following birth. It is clear that newborn babies are born with the instinct to breastfeed.4,5,6,7


© R.Cantrill, IBCLC

Research findings

  • Blood glucose at 90 minutes is significantly higher in the skin-to-skin care newborns. 8
  • Newborn preterm infants in skin-to-skin care achieve thermo-cardio-respiratory stability within 6 hours, compared to babies in traditional incubator care who mostly do not. 9
  • Newborn, full-term babies who spent more than 50 minutes in skin-to-skin care are 8 times more likely to breastfeed spontaneously than infants not in skin-to-skin care. 10
  • Exclusive breastfeeding at 48 hours and 6 weeks postpartum 11 and incidence of any breastfeeding at 1 and 4 months 8 was significantly greater for infants in the skin-to-skin care groups.

The role of the birth attendants

This critical period in the relationship between mother and baby is, in some birthing units, a high-intervention time when it should be exactly the opposite. Recall that the AAP Neonatal Resuscitation Guidelines 3 state that all observations can take place with infant in skin-to-skin contact with his mother. The role of the birth attendants at this time is to support the mother to provide the ideal environment for her baby to adapt to extrauterine life, orientate to the breast and coordinate suckling.

Appropriate support is given by discussing with the mother, and others present, the importance of uninterrupted skin-to-skin contact. Some birth attendants tell of the mother and her support people being enthralled as they watch the baby move through this sequential pre-feeding behavior, not wishing to interrupt it. A little education can go a long way!

Just the thing for busy staff!

Supporting the mother to care for her baby with skin-to-skin contact will significantly reduce the workload of the health care staff looking after her.
  • The infant will adapt to extrauterine life more quickly, reducing any risk of hypothermia or cardio-respiratory instability.
  • Glucose homeostasis is achieved quickly, reducing risk of hypoglycemia.
  • Breastfeeding will be initiated early and successfully, with minimal input from others.
  • Breastfeeding will stimulate the release of oxytocin, reducing the risk of maternal hemorrhage.
  • Skin-to-skin care will colonize the baby with the mother's normal flora, which, when combined with breastfeeding, significantly reduces the risk of nosocomial infections.
  • Maternal self-confidence and independence will rise.

Addressing barriers to skin-to-skin

Concern that the baby will get cold.

  • Dry the baby and place in skin-to-skin contact on mother's chest.
  • Put a dry cloth or blanket over both the mother and the baby.
  • If the room is cold cover the baby's head with a bonnet to reduce heat loss.
  • Babies in skin-to-skin contact have higher temperature than those dressed and better temperature regulation than those under a heater or in incubator care. 12 13

Baby needs to be examined.

  • Most examinations can be conducted with baby on mother's chest.
  • There is no need to move the baby to monitor vital signs.
  • Weighing can be delayed.

Mother needs suturing.

  • Baby can stay on mother's abdomen while an episiotomy is sutured.
  • Baby can stay on mother's chest while suturing a cesarean section wound.14

Baby needs to be bathed.

  • Delaying the first bath provides better thermoregulation and allows the vernix to remain on the skin.
    • Gently wipe the baby dry after birth, preserving the vernix.
    • Vernix retention is associated with significantly higher skin hydration, a lower skin pH and significantly less erythema. 15
    • Early bathing is associated with a significant fall in temperature. 16

Delivery room is busy.

  • Mother and baby can be transferred to the postnatal ward while in skin-to-skin contact.

Insufficient staff to remain with the mother.

  • A responsible family member can stay with the mother and baby.
  • Discuss routine precautions with the family member to ensure their safety.
  • Monitoring of maternal and infant vital signs by staff should continue as per hospital standards.

Baby is not alert.

  • If a baby is sleepy due to maternal medications it is even more important that the baby has contact as he/she needs extra support to bond and feed.

Mother is tired.

  • A mother is rarely so tired that she does not want to hold her baby.
  • Contact with her baby can help the mother 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 mother is in a semi-reclined position; a good position for resting.

Lack of knowledge in the health professional wishing to move the baby

  • This first step following birthing has far-reaching effects on mother, baby 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.

Workbook Activity 4.2

Complete Activity 4.2 in your workbook.

Maternal-infant bonding

This is the beginning of a loving relationship between the parents and their newborn. The infant appears to play his part in the establishment of these bonds by actively interacting with his parents. Following an initial cry at birth the infant becomes quietly alert and seeks visual contact, massages the mother's chest and breasts and latches and breastfeeds. The high blood levels of beta endorphins, oxytocin and prolactin in both mother and infant facilitate falling in love.17

For this to occur the following factors have to be in place and considered. These are all influenced by the birth attendants.

  • the availability of the infant to his/her parents,
  • an environment conducive to parent and child interaction, and
  • the attitude of those present at the delivery to the appearance of the infant17

What about a baby to be artificially fed?

Skin-to-skin time with mother is equally important for EVERY baby. In Topic 4.3 Postnatal interventions, you will read the effects of separating mothers and newborns - facilitating breastfeeding is only one of many, many benefits of skin-to-skin contact.

What should I remember?

  • the interpretation of Step 4 of the Ten Steps
  • the immediate care of the newborn following birth AND where it should take place
  • the many important functions that skin-to-skin contact on the mother's chest has for both her and her infant
  • how you could address the barriers to skin-to-skin care should your colleagues be concerned

Self-test quiz

Notes

  1. # Montague A (1978) Touching: The Human Significance of the Skin
  2. # World Health Organization (2006) Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Intergrated Care
  3. # Kattwinkel J et al. (2010) Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
  4. # Righard L et al. (1990) Effect of delivery room routines on success of first breast-feed
  5. # Widstrom AM et al. (1990) Short-term effects of early suckling and touch of the nipple on maternal behaviour
  6. # Varendi H et al. (1998) Soothing effect of amniotic fluid smell in newborns
  7. # Mattos-Graner RO et al. (2001) Relation of oral yeast infection in Brazilian infants and use of a pacifier
  8. # Moore ER et al. (2012) Early skin-to-skin contact for mothers and their healthy newborn infants.
  9. # Bergman NJ et al. (2004) Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns
  10. # Gomez Papi A et al. (1998) Kangaroo method in the delivery room for full-term babies
  11. # Thukral A et al. (2012) Early skin-to-skin contact and breast-feeding behavior in term neonates: a randomized controlled trial.
  12. # Carfoot S et al. (2005) A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding.
  13. # Fransson AL et al. (2005) Temperature variation in newborn babies: importance of physical contact with the mother.
  14. # Smith J et al. (2008) The natural caesarean: a woman-centred technique.
  15. # Visscher MO et al. (2005) Vernix caseosa in neonatal adaptation.
  16. # Bergstrom A et al. (2005) The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial.
  17. # Attrill B (2002) The assumption of the maternal role: a developmental process