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ELIZABETH SMITH, MPH, ICCE, IBCLC, RLC COORDINATOR, PATIENT SERVICES
UNIVERSITY OF UTAH HOSPITAL
Skin to Skin Care Baby’s First Touch
Objectives
� Attendees will be able to define skin-to-skin � Attendees will be able to identify three positive
outcomes for skin-to-skin � Attendees will be able to verbalize how to implement
skin-to-skin with the mother and / or father � Attendees will be able to understand how skin to skin
can be incorporated into the whole postpartum period
Infant Crying
Crying in the Newborn
� Increases right atrial pressure – the foramen ovale opens, venous blood mixes with oxygenated blood, cynanosis results
� Increases intra-cranial pressure � Initiates a cascade of stress reactions � Depletes energy reserves
Interferes with the infant’s ability to adapt to extra-uterine life
Separation of Mother and Baby
Separation of Mother and Baby
� The infant develops the ability to better cope with stresses when he is with his mother
� Connection allows the infant to expand his or her responses to cope more effectively with different stressors
� “Stresses” are physical and psychological � The separation causes a dis-regulation and impacts
the structural organization of the brain
� Attachment = Regulation = Well-being
New Research
� A healthy gut is critical to a lifetime of health � Colonization of the gut begins immediately after
birth
� Optimal Health ¡ Vaginal birth and immediate skin to skin contact
� What to do if ideal doesn’t happen?
So Much Better!
Benefits of Rooming In
� Moms and Babies sleep an average of ½- 1 hr longer in a 24 hour period.
� Mom learns early feeding cues � Babies put skin to skin adapt better
¡ Higher glucose ¡ Better HR and Respiratory Rates ¡ Less crying ¡ Feeling of security
� 2nd Night!!!!
History of Skin-to-Skin
� Dr’s Rey and Martinez ¡ Bogota & Cali, Colombia, South America
� Gene Cranston Anderson, R.N., Ph.D., F.A.A.N.
� Dr. Nils Bergman ¡ Introduced KMK in South Africa in 1995
Terms for Skin-to-Skin
� KMC = Kangaroo Mother Care � KC = Kangaroo Care � STS = Skin-to-skin � SSC = Skin-to-skin Contact
Definition of skin-to-skin
� Place the baby naked or with only a diaper prone on the mother’s / father’s bare chest
� Usually takes place at birth or soon after � Cover the baby with a warmed blanket � Place a hat on the baby’s head
Visual of skin-to-skin
Skin to Skin in the OR
Skin to Skin in Recovery
Skin to Skin with Preemies
Dads and Skin to Skin
Infant Brain
� By 20 weeks gestation all structures are formed ¡ Billions of neurons will form
� At birth the highest number synapses will occur � From there it’s the environment that determines
outcomes ¡ Wiring and firing ¡ Neurons that aren’t used will die off
� Body will deal with underuse, eustress and distress ¡ Both underuse and distress can have detrimental impacts ¡ The usual place to learn adaptation is with the mother
÷ Another person can be substituted but mom is ideal
Preterm Brain
� Significant brain growth occurs between 36 and 40 weeks of gestation ¡ One of the reasons the March of Dimes pushed for “no early
delivery unless medically indicated” � For early babies, skin to skin is even more critical
¡ In order to adapt and obtain regulation ¡ Organization of the brain occurs skin to skin
÷ Complex and subtle neurological/biological cues and behaviors
Baby Friendly USA
Baby Friendly Hospital Initiative
Step 4: Help mothers initiate breastfeeding
within an hour of birth.
Uninterrupted Skin to Skin in the first hour is the critical piece
The W.H.O. Evidence for Skin-to-Skin
� Takes advantage of the “alert” 1-2 hours after birth � “Contact” and “suckling” are interrelated
¡ Suckling movements start at a peak of 45 minutes � Increase in breastfeeding rates at 2 to 3 months � Promotes maternal behavior � Newborn skin temperatures were higher, higher
blood glucose levels, and plasma base-excess returned to normal faster
� The newborn cried less
Impact on breastfeeding duration of early infant-mother contact
Adapted from: DeChateau P, Wiberg B. Long term effect on mother-infant behavior of extra contact during the first hour postpartum. Acta Peadiatr, 1977, 66:145-151.
58%
26%
0%
10%
20%
30%
40%
50%
60%
70%
Early contact (n=21) Control (n=19)
Perc
ent s
till b
reas
tfeed
ing
at 3
mon
ths Early contact: 15-20 min suckling and
skin-to-skin contact within first hour after delivery
Control: No contact within first hour
World Health Organization - Evidence for the 10 Steps
The Cochrane Criteria for Studies of Skin-to-Skin
� Looked at all randomized or quasi-randomized studies that encouraged skin-to-skin and was “compared to usual hospital care” (Cochrane, p.7).
� Looked only at studies with a control group, and that were of high quality, looked for bias.
� With inclusion criteria – 30 studies, 29 were randomized control and one was quasi-randomized.
The Cochrane Evidence for Skin-to-Skin
� Breastfeeding outcomes � Maternal feelings � The Infant
The Cochrane Evidence for Skin-to-Skin
• Breastfeeding outcomes
• More likely to breastfeed successfully during the first feed post
birth than those babies who were swaddled in blankets • Infants held STS had more mouthing movements than those
who were not.
• Statistically significant and better overall performance on all measures of breastfeeding status: duration (2-4 months)
The Cochrane Evidence for Skin-to-Skin
• Maternal feelings
• Had less anxiety at 3 days post birth • No difference in milk supply, number of breastfeeding
problems, or parenting confidence
• Those who held their infant STS had a strong desire to do it for future deliveries
• Maternal attachment behavior
The Cochrane Evidence for Skin-to-Skin
• Maternal attachment behavior
• STS increased the amount of maternal affectionate behaviors – kissing, smiling, en-face (face-to-face contact)
• Bias and questionable validity of multiple studies were noted
• Hard to differentiate a mother’s perception of bonding/connection
• One study from Vietnam, when Baby Friendly was implemented as a nation, showed a decrease in the abandonment rate and incidence of child abuse
The Cochrane Evidence for Skin-to-Skin
� Infant temperatures ¡ Mom warms and cools ¡ Others can warm a baby
� Infant physiological
outcomes
The Cochrane Evidence for Skin-to-Skin
• Infant temperatures
• STS infants had more skin temperatures in the neutral range than baby under the radiant warmer
• Mean temperature for STS infants was higher than in control
group
The Cochrane Evidence for Skin-to-Skin
• Infant Physiological outcomes
• STS infant had lower mean ht rate, respiratory rate
• Blood glucose was statistically higher in one study (10.56 mg/dl higher)
• Better stabilization using SCRIP scores (measures infant cardio-respiratory stability that uses ht rate, respiratory rate, and o2 sat)
• No difference in the length of stay for late preterm infant
• Multiple studies have shown that STS infants cry less
The Cochrane Discussion for Skin-to-Skin
� Success of first breastfeed � Breastfeeding success at day three postpartum � Breastfeeding duration at one to four months � Maternal breast engorgement pain � State anxiety � Infant recognition of their mother's milk odor � Maintenance of infant’s temperature � Infant crying, blood glucose, SCRIP scores,
physiological parameters
What about the father?
� Father’s many times feel like outsiders � Gives the father an opportunity to be a care-giver
from the time of birth � Showed that when the father did skin-to-skin –
¡ Infant temperatures were within normal range ¡ Blood glucose levels were up ¡ Catecholamine levels were within normal range
References
� Baby Friendly Hospital Initiative (n.d.). Retrieved from the World Health Organization web page on February 23, 2008 at site: http://www.who.int/nutrition/topics/bfhi/en/
� Bergman, N. (2009), Breastfeeding and Skin-to-Skin, SWAG Conference, Berkeley, CA.
� Christensson, k. (1996). Fathers can effectively achieve heat conservation in healthy newborn infants. Acta Paediatics. 85, p 1354-60.
� Ferber, S.G. & Makhoul, I.R., (2004). The effect of skin-to-skin contact shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial. Pediatrics, 113(4), p. 858-865.
� Gill, N.E., White, M.A., & Anderson, G.C. (1984), Transitional newborn infants in a hospital nursery: from first oral cue to first sustained cry, Nursing Research, 33(4).
� Moore, E.R., Anderson, G.C., Bergman, N., (2008). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Collaboration.
� Schore, A.N. (2001), Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health, Infant Mental Health Journal, 22(1-2), 7-66.
� Vallenas, C. & Savage, F. (1998) Evidence for the ten steps to successful breastfeeding . World Health Organization, Geneva.
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