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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 needs
for oxygen, and keeps them more stable in
other ways as well.
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, Handout #1 Breastfeeding—Starting
out Right, a baby who latches on well
gets milk more easily than a baby who latches
on less well. 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 not have
a lot of milk (but she has enough!), and
a good latch is important to help the baby
get the milk that is available (yes, the
milk is there even if someone has proved
to you with the big pump that there isn’t
any). 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 has the following positive
effects on the baby:
- Are more likely to latch on
- Are more likely to latch on well
- Have more stable and normal skin temperatures
- Have more stable and normal heart rates
and blood pressures
- Have higher blood sugars
- Are less likely to cry
- Are more likely to breastfeed exclusively
longer
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 mother, of course,
may make some attempts to help the baby,
and this should not be discouraged. 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 eyedrops 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. The need for an
intravenous infusion, oxygen therapy or
a nasogastric tube, for example, or all
the preceding, does not preclude skin to
skin contact. 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 still good and 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 because three hours have passed.
The baby not interested yet in feeding may
object strenuously, and thus is pushed even
more, resulting, in many cases, in babies
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 handout #26 When
a Baby Refuses to Latch On).
Handout #1a. The importance
of skin to skin contact. Revised January
2005
Written by Jack Newman, MD, FRCPC. ©
2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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