WHAT IS SKIN-TO-SKIN?

Skin-to-skin Contact (SSC) means holding your newborn on yourself, bare chest against bare chest, baby positioned vertically between breasts.

It can be done at the hospital from birth or at home thereafter, throughout the 4th trimester, usually in a sitting or semi-laying position - but also with mobility (stand up).

This gesture, which is quite natural and instinctive for all primates and other mammals - as well as breastfeeding - is very often underestimated and sometimes brings small miracles ...

It is suggested to practice several times a day, at least 60 minutes each time, decreasing slowly until about 3 months - for full term baby, more for premature baby.

It's often called " KANGAROO CARE " (in a more therapeutic way) by medical staff.

The caring skin to skin contact can be done by Mom or Dad.  

IMPORTANT: the contact must be bare chest mom against bare chest baby (in diaper), BABYWEARING WITH CLOTHING ON CHEST IS NOT SKIN to SKIN.

 

BENEFITS OF SKIN TO SKIN ON FULL TERM BABY

- ESTABLISHES CONTACT, CONFIDENCE AND BONDING WITH PARENTS mainly with touch, hearing and smell throughout the 4th quarter.

-STABILIZES BABY'S TEMPERATURE. Newborns can easily lose too much heat from their bodies, putting them at risk of low blood sugars and / or hypothermia and / or fat loss that can affects their growth. Baby's body temperature stabilizes when held skin to skin. Mother's body can change chest surface temperature by several degrees in just few seconds to naturally warm or cool baby as needed. NOTE: Dad can warm baby but does not stabilize his/her temperature, so may need to uncover baby's head to ensure no overheat.

-STIMULATES AND RELEASES INNATE REFLEXES, SUCH AS CRAWLING AND BREAST SEARCH. When babies are held in skin to skin contact in the first hour after they are born they will root and suckle at the breast initiating their first feed, they are twice as likely to breastfeed in this time than babies who are swaddled.  The familiar scent from the mother's breast triggers feeding behaviours in the baby and contact with their mother's skin helps them locate and attach to the breast.  Rates of breastfeeding are higher in babies given regular skin to skin and they are more likely to breastfeed for longer.

- IMPROVES THE DEVELOPMENT AND MATURATION OF CEREBRAL FUNCTIONS (essential neuronal pathways) and provides a better quality of sleep cycle. Baby falls asleep more easily in SSC and reaches the "QUIET SLEEP" (QS) which contributes to improve organizational patterns of brain. Synaptic responses to stress and early trauma can shape how a child responds to emotional stress later in life. Skin-to-skin contact (SSC) reduces the impact of early stress.

-STRENGHTENS IMMUNE SYSTEM. By increasing breastfeeding, mother's body can respond to baby's saliva pathogens and produce antibodies in her breast milk. Also, when SSC, baby's skin assimilates the natural bacterial flora of mother and increases his skin hydration (better protective barrier against harmful bacteria). Exposure to the mother's colonised skin bacteria stimulates the baby's immune system, this helps prepare the baby's body to fight off other pathogens from their wider environment. At medical level, there are generally fewer infections and also a higher / more stable blood sugar in babies who have been SSC.

-REDUCES CRYING AND INCREASES SMILES. SSC gives babies crucial feelings of security and belonging. Babies with 20 to 30 minutes of skin-to-skin contact have lower levels of stress hormones (cortisol and adrenaline) and increased levels of oxytocin - which promotes relaxation and well-being. Stress can affect baby's ability to fight infection, digest nutrients and sleep well. Skin-to-skin sessions improve the quality of sleep, soothe baby, who cries less and is less agitated. Response to pain sensation is also reduced.

-IMPROVES DIGESTION AND WEIGHT GAIN: The reduction of cortisol in babies during SSC allows better absorption and digestion of nutrients while reducing gastro-intestinal problems. Thermoregulation during skin to skin contact means the baby can more easily maintain the natural layer of fat they are born with which can help them maintain birth weight and ensures better weight gain. Vagal nerve stimulation during skin to skin contact and suckling promotes the healthy maturation of the baby's gut.  After just one hour of skin to skin the child's digestive system is restored and balanced for optimum performance.


BENEFITS OF SKIN TO SKIN CONTACT FOR A PREEMIE, LOW WEIGHT OR WEAKENED BABY
-HELPS TO REGULATE HEART BEAT AND BREATHING. Babies can synchronise their breathing and heart rate with their parent when held in skin to skin contact. This helps their developing systems learn to self regulate resulting in a more regular and stable pattern of heart beat rate and breathing. Babies, particularly those born prematurely can suffer episodes of sporadic breathing or slow heart rate problems.  These are reduced by up to 75% through skin to skin contact.

By stabilizing temperature, heart rate and respiration and reducing the risk of infections, mortality in weakened newborns is reduced, especially where medical help is deficient or absent **.

 

 

BENEFITS OF SKIN TO SKIN CONTACT FOR MOMS

-REDUCES DOUBTS ABOUT PARENTAL SKILLS, and also reduces the parent's separation anxiety and helplessness during interventions.

-IMPROVES MILK PRODUCTION and supports breastfeeding behaviours. Mothers who get SSC to start are more likely to continue exclusive breastfeeding when they come back home. The increase of oxytocin and maternal prolactin in the first hours after birth seems to have long-term effects to increase milk production. Moms who have breastfeeding difficulties are likely to see almost immediate improvement practicing skin to skin for a period of at least 1 hour, 1-2 times a day.

-REDUCES POSTNATAL RECOVERY TIME: The release of oxytocin reduces blood pressure, lowers cortisol levels (stress hormone) and reduces postnatal bleeding, promoting faster recovery.

- PROMOTES PSYCHOLOGICAL WELL-BEING and reinforces BONDING in a healthy and long-term way. Prolonged contact with the body has positive effects on the adult brain. Increasing oxytocin levels REDUCES THE RISK OF POST-PARTUM DEPRESSIONS, creates a feeling of confidence, affection and well-being. Moms - and dads - who have skin-to-skin contact will become more sensitive and more aware of their baby's needs.

-FACILITATES INITIATION AND TRANSITION TO "REGULAR" BABYWEARING. SSC is the first step to babywearing. Accustomed to being held and carried, baby will be quieter when learning to tie woven wraps or others. Baby will naturally seek this contact and this proximity when he/she feels insecure.

For SCIENTIFIC REFERENCES & studies, click here.  

** Even where medical technologies are available, Kangaroo Care does miracles. Click here to read the testimony of Leigh Dumighan (our distributor in the United Kingdoms), mother of a premature baby saved by Kangaroo Care.

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YOU HAVE THE RIGHT TO ASK TO HAVE A SKIN-TO-SKIN CONTACT WITH YOUR NEWBORN BABY RIGHT AT BIRTH and keep baby your arms the time it suits you.

For more details regarding this Right, see "The WOMEN'S RIGHTS - Pregnancy & Delivery" leaflet from the ASPQ (Association pour la Santé Publique du Québec)

For more information on all Skin to skin benefits, please read the leaflet "The importance of skin-to-skin contact" by Dr. Jack Newman, MD, FRCPC, at the bottom of this page.

ALSO TO CONSULT:

Family-centred maternity and newborn care in Canada:

3. Early parent–infant attachment is critical for newborn and child development and the growth of healthy families

"Promoting attachment is central to family-centred care and is facilitated by encouraging early parent–infant interaction, initiating skin-to-skin contact at birth and breastfeeding. Supporting early attachment will have immediate and lasting effects on the health of mothers, infants and families."

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POSITION OF THE NEWBORN FOR SKIN-TO-SKIN 

Skin-to-skin will be mostly done in semi-lying or sitting position. At the Hospital, it is often proposed to wear baby inside your garment or under a small cover. In such a case, it is asked to have another person present to monitor, in case mother falls asleep and drop baby.

To prevent slippage or accident, it is best to put baby inside a specially designed Bandeau (such as the Vija Design ™ Basic Bandeau # VM015P or a Kangaroo Tube). These Bandeau and Tubes also allow easy breastfeeding.

But if Mom/Dad wants to do skin to skin more often, especially when back home, a better mobility is appreciated, so some VIJA DESIGN ™ nursing garments will also allow skin to skin babywearing with mobility while parent is standing and/or moving. This will be for small babies until about 15lbs (7 kg). Note: when doing a fast moves or bending, always keep a hand on baby.

In terms of physiological ergonomic position of the newborn baby in hands-free babywearing (parent standing), make sure baby is in vertical position, in natural position***, chest to chest,  and make sure the weight is well distributed, without pressure points.

***Newborn can be in feotal position (if it's his natural position), legs curled on himself, knees raised on his belly, face should be visible, airways (nose & mouth) clear, shoulders must be flat against mother. Neck should be straight, not bend, in spine axis. Subsequently, the physiological "M - frog" position (sitting-squatting) is recommended for older / heavier baby: slightly rounded back (but not too much!), legs curled up (knees higher than the buttocks, about the height of the baby's belly button) and make sure the lower back / buttocks are well supported to avoid crooked "C" back.

Keep in mind the natural position for the baby when snuggle him against us.



Inside the garment: The garment should fit snugly to provide good support. You should feel that the baby's weight is evenly distributed without pressure points. The fabric should support back, shoulders, buttocks and legs up under the knees. The head should also be supported if you get up. Airways must be clear and visible at all times, the chin should not touch his chest (chin up). The ideal height: up to kiss.

 

 

IMPORTANT NOTE: Some pictures circulating on the Internet showing our clothes with bad positioning. Poor positioning can be harmful to the normal growth of the baby, can be bad for proper breathing and can also damage the garment.

 

Example: In this picture,  baby's spine is bent backwards, which is not a natural position for a baby. In addition, the garment has been overly stretched to move the baby's arms outside, which could break it.

 

 

 

 

 

 

 

VIJA DESIGN SKIN-TO-SKIN GARMENTS

Until very recently (before we created easy hands-free skin-to-skin clothes!), it was difficult to practice skin-to-skin often and in public ... Most of the time, it couldn't be "mobile"... Vija Design™ offers several types of clothing, beautiful, comfortable and also facilitate breastfeeding. And also offers easy Skin-to-skin T-shirts for Dad!

They have been tested and patented.

There are two categories:

1) GARMENTS THAT HOLDS HAND-FREE SKIN TO SKIN WITH BABY, WITH MOBILITY (sitting or upright standing parent, can walk - keep a hand on baby when doing sudden movements or when bending)

2) GARMENTS THAT HOLDS HAND-FREE SKIN TO SKIN WITH BABY, WHEN SITTING OR HALF-LYING (never completely lying! ... Must support the baby with one hand if you get up ...)

4 way stretch cotton / spandex high density jersey without chemical contamination and/or heavy metals (Oeko-Tex certified) is mostly used for these garments. Cotton is hypoallergenic, breathable, non-slip, absorbs moisture and is easy to sterilize, if necessary.When exposed to high temperatures or flames, it does not melt.

Labels are also Oeko-Tex certified without heavy metals or phtalates. Top quality sewing (14 points per inch) for durability. A stretch facing supports neck and / or baby's head without compressing.

HOW TO WEAR THEM?

Clothing allow different ways to practice skin-to-skin. Discover how they can allow you to fully enjoy these precious moments!

1) THE "FULL" SKIN TO SKIN: bare skin against bare skin, no bra, best when sitting or lying down in 45 degree (so you can enjoy it!). Perfect contact, very important & very efficient for the first week of life of your baby but a bit difficult to keep up for a long time! Also perfect for premature baby ...

 

(Kangaroo Tube #VA003) wear as is...

 

(Prema-wrap™ with shoulder straps, unisex #VA070NV2-M) wear under a garment

Prema-wrap™ for twins #VA077B

 

2) THE "ALMOST FULL" SKIN TO SKIN: baby in diaper, mom with a bra (lightweight, without lace or underwire, very open on chest).  More "practical", which allows practice skin-to-skin contact more often and over a longer period of time! Effective and simple for bonding and relief of minor health problems (as colics) when back home...

 

 

The Kangaroo Wrap Cami #VA005W as is, with a bra

 

 

 

 

 

 

 

 

 

 

 

 

 The Kangaroo Wrap Cami #VA005BE (with shoulder straps) wear over a garment which is opened on torso to provide skin to skin contact.

 

 

 

 

 

 

 

 

 

 

 

 

The Skin to skin T-shirt™ with long sleeves (#VC002) wear as is at home (with bra)

 

 

 

 

 

 

 

 

 

 

 

 

Here, a baby inside a regular garment (cross-over t-shirt), with a SKin to skin Basic Cummerbund (#VM015P) over it to support.

 

THE "ALMOST SKIN TO SKIN" BABYWEARING": can be done occasionally, especially during transition with "regular" babywearing (to a wrap or a baby carrier). Baby wears light clothing, directly stuck on mom (or dad) skin ... Convenient (without having to undress completely the baby) with older baby at friends or sitting at the restaurant. However, baby's head should be directly on the chest skin of the parent to smell and hear the heartbeat. Effective to stop crying, relieve small colic, etc ... But not advisable for a newborn baby... Be careful! Make sure baby is not too warm!

 

The Skin to skin Cami for twins (#VA078), so practical! Can be worn with dressed babies.

 

   The Skin to skin Cami (#VA031) worn with a pretty cardigan, with a dressed baby.

 

Caution you must take when wearing the baby in a garment:

-Make sure the baby is well supported, no possibility of slipping down. Make sure the garment is properly adjusted (inner band) to prevent drops.

-Make sure the baby is in vertical upright position, not too "relaxed" (too rounded back), head at kissable height, visible face, and check if support is well spread from below the knee to the other. Fabric must cover back & shoulders of baby.

-Always make sure the baby is breathing normally, the airway must never be obstructed.

-Avoid heat stroke. Be on the lookout for signs of discomfort, especially if it is a very warm day. Heat rash, wet hair, are the signs. NOTE: The mother's body will adjust to stabilize baby's temperature (cooler or warmer), not dad.

-Pay attention to your new dimension, you must not get caught in the door frame with the baby!

-Don't sleep, don't do sports, don't be the driver or passenger of a motor vehicule, avoid being close to chemicals or cigarettes, don't take hot drinks or cooking with baby inside the garment. Avoid any situation where a fall could occur.

-Make sure the garment is always clean (wash before first wear) and in good condition. If a seam is about to open, discontinue the use of carrier or garment.

Note: The care of premies, low-weight babies or with health problems should always be under the supervision of a qualified health professional. Make sure you have consulted prior to use skin-to-skin garments.

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Always use new garment, non-threadbare and non-broken only. Garments are designed for single user. A garment more than two years old, or which have worn small tears should not be used to support a baby.

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The Importance of Skin to Skin Contact - by Jack Newman, MD, FRCPC
There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and more normal, and the baby’s blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their need for extra oxygen, and keeps them more stable in other ways as well (See www.kangaroomothercare.com)

To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat: in close contact with the mother (or father). When a baby or any mammal is taken out of this natural habitat, it shows all the physiologic signs of being under significant stress. A baby not in close contact with his mother (or father) by distance (under a heat lamp or in an incubator) or swaddled in a blanket, may become too sleepy or lethargic or becomes disassociated altogether or cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended. With skin to skin contact, the mother and the baby exchange sensory information that stimulates and elicits “baby” behaviour: rooting and searching the breast, staying calm, breathing more naturally, staying warm, maintaining his body temperature and maintaining his blood sugar.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in the information sheet Breastfeeding—Starting out Right, a baby who latches on well gets milk more easily than a baby who latches on less well. See the video clips of young babies (less than 48 hours old) breastfeeding at the website nbci.ca. When a baby latches on well, the mother is less likely to be sore. When a mother’s milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does have enough milk, but because it is not abundant, as nature intended, the baby needs a good latch in order to get that milk. Yes, the milk is there even if someone has proved to you with the big pump that there isn’t any.

How much does or does not come out in the pump proves nothing—it is irrelevant. Many mothers with abundant milk supplies have difficulty expressing or pumping more than a small amount of milk. Also note, you can’t tell by squeezing the breast whether there is enough milk in there or not. And a good latch is important to help the baby get the milk that is available. If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour (and should continue for as many hours as possible throughout the day and night for the first number of weeks) has the following positive effects. The baby:
Is more likely to latch on
Is more likely to latch on well
Maintains his body temperature normal better even than in an incubator
Maintains his heart rate, respiratory rate and blood pressure normal
Has higher blood sugar
Is less likely to cry
Is more likely to breastfeed exclusively and breastfeed longer
Will indicate to his mother when he is ready to feed
There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The baby may be placed vertically on the mother’s abdomen and chest and be left to find his way to the breast, while mother supports him if necessary. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. This is baby’s first journey in the outside world and the mother and baby should just be left in peace to enjoy each other’s company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother’s partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there “just in case”). The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast simply because three hours have passed. The baby who is not yet interested in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in baby refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the “obvious next step” is to give a supplement. And it is obvious where we are headed (see the information sheet When a Baby Has Not Yet Latched).

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

The Importance of Skin to Skin Contact, 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC and Edith Kernerman, IBCLC, 2008, 2009©

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