Skin-to-skin care (SSC) is a biologically normal practice. It consists of placing an unclothed or diaper-only newborn baby chest-to-chest with mother immediately after delivery and keeping them together for at least the first hour after birth, whether the mother has had a vaginal or cesarean birth and regardless of the feeding method planned. This practice is supported by the World Health Organization (WHO), Baby Friendly Hospital Initiative (BFHI), the Academy of Breastfeeding Medicine (ABM), and the American Academy of Pediatrics (AAP). This is an important component of family-centered care.
Immediate SSC for a minimum of one hour after birth is one of the most effective methods for promoting exclusive breastfeeding. Babies who have early SSC are more likely to be exclusively breastfed at discharge, exclusively breastfed after discharge, and breastfed for longer durations.
Reasons why SSC is important for baby and mother:
- Keeps mother and baby together.
- Promotes bonding between mother and baby.
- Provides for earlier initiation of the first breastfeeding experience.
- Reduces crying.
- Helps baby maintain body temperature better than a hospital warmer, as your body will alter your own temperature to warm or cool the baby to maintain a normal temperature.
- Helps regulate baby’s breathing and heart rate.
- Helps keep baby’s blood sugar level stable.
- “Normalizes” a difficult or surgical birth.
- Decreases pain for baby from any procedures done while skin-to-skin.
- Reduces postpartum hemorrhage in mother.
- Can reduce maternal stress and postpartum depression.
- Increases the probability of breastfeeding as well as the length of time you will breastfeed your baby beyond the hospital time.
Skin-to-skin right after birth:
- Mother is in a slightly reclined position.
- Baby is placed on mother’s abdomen, dried, and covered with a blanket until the cord is clamped.
- Once the cord is clamped, baby is placed chest-to-chest with mother and remains there uninterrupted for at least one hour and preferably until the first breastfeeding is completed. This provides optimal physiological stability.
- Baby’s face is easily visible and uncovered, neck is straight, knees are bent.
- Baby may be naked or diapered.
- Baby can be dried during process of placing skin-to-skin then baby and mother are covered by a warmed blanket.
- Other tests like Apgar scoring can be done while baby is being held skin-to-skin.
- Most other “standard procedures,” like a Vitamin K shot, can be done while baby is on mother’s chest.
- Baby’s measurements can be delayed for up to six hours – they are not going to change dramatically in that time frame.
- Time in a warmer will not be needed since mother’s body will keep baby warm.
- Baby and mother are monitored by nursing staff during SSC.
- Mother notices baby’s feeding cues, like rooting or sucking on hands, and can guide baby to breast for first feeding.
- SSC can continue as mother and baby are moved from the labor suite to the postpartum setting with proper observation for safety.
- Regardless the birth setting – hospital, birth center or home – SSC can be part of the normal care of the newborn.
- The more that mother and baby are together, the easier it is for mother to recognize baby’s early feeding cues, more frequently baby will breastfeed, and a greater milk volume will be stimulated.
- Mothers who “room-in” in the hospital will tend to practice SSC more frequently.
- Mothers who practice SSC report greater confidence in their ability to feed and care for their baby.
- Babies who “room-in” have more quiet sleep than those who are separated.
Remember that SSC can continue past the birth period and early postpartum. Many mothers have found that snuggling baby skin-to-skin can be soothing at any time and any age.
Mothers often ask:
- How safe is SSC?
- Very safe when mother and baby are positioned properly and observed.
- There is nursing staff there to observe mother and baby to monitor temperature, heart rate, respiration, as well as assessing for any unusual health issues.
- I’m expecting twins. Can I still do SSC?
- Absolutely! Each one is positioned side-to-side, one over each breast.
- Studies have shown that the temperature of each breast will rise or fall to warm to cool each baby independently
- What if I’m not feeling well enough?
- Let staff know if you are not feeling well enough to hold your baby.
- Allow your support person for labor hold the baby skin-to-skin until you are ready.
- How does this work if I have a cesarean?
- Check your hospital’s policy to be sure they are set up for this practice.
- If it is a planned cesarean, you can arrange to have your support person with you to hold the baby skin-to-skin until you are ready.
- Your baby will be placed on your chest, above the drape. Many hospitals are set up to have SSC begin even while your incision is being closed. Your support person can help with positioning as needed.
- What if my baby comes early?
- If the baby will be going to the mother-baby floor with you, you can begin SSC right after birth and any specific medical checks needed due to the early arrival.
- If the baby is premature and going to a neonatal intensive care unit (NICU), you can begin SSC as soon as baby is stable enough to be held outside the isolette. (See “Skin-to-Skin Care in the NICU” create link)
- How do I find out my hospital’s policy for SSC?
- Ask your OB or midwife about their practice with regards to skin-to-skin. They can tell you if there are any limitations at the facility you have chosen for your birth.
- Attend a prepared childbirth class. The instructor will have a good sense of the practices of the hospitals in your area.
- If you are preparing a birth plan, include this request in your plan.
- If the hospital where you plan to deliver does not have SSC as part of their standard of care for childbirth, ask your healthcare team to advocate for you. If you chose another hospital or practice, make sure you let them know why you have made the switch.