Babies are often separated from their mothers at birth. In standard hospital care, newborn infants can be held wrapped or dressed in their mother’s arms, placed in open cribs or under warmers. In skin-to-skin contact (SSC), the newborn infant is placed naked on the mother's bare chest at birth or soon afterwards. Immediate SSC means within 10 minutes of birth while early SSC means between 10 minutes and 24 hours after birth. We wanted to know if immediate or early SSC improved breastfeeding for mothers and babies, and improved the transition to the outside world for babies.
Why is this important?
There are well-known benefits to breastfeeding for women and their babies. We wanted to know if immediate or early SSC could improve women's chances of successfully breastfeeding. Having early contact may also help keep babies warm and calm and improve other aspects of a baby's transition to life outside the womb.
What evidence did we find?
We searched for randomized controlled studies of immediate and early SSC on 17 December 2015. We found thirty-eight studies with 3472 women that provided data for analysis. Most studies compared early SSC with standard hospital care for women with healthy full-term babies. In eight studies women gave birth by cesarean, and in six studies the babies were healthy but born preterm at 35 weeks or more. More women who had SSC with their babies were still breastfeeding at one to four months after giving birth (14 studies, 887 women, moderate-quality evidence). Mothers who had SSC breast fed their infants longer, too, on average over 60 days longer (six studies, 264 women, low-quality evidence). Babies held in SSC were more likely to have breast fed successfully during their first breast feed (five studies, 575 women). Babies held in SSC had higher blood glucose levels (three studies, 144 women, low-quality evidence), but similar temperature to babies with standard care (six studies, 558 women, low-quality evidence). We had too few babies in our included studies and the quality of the evidence was too low for us to be very confident in the results for infants.
Women giving birth by cesarean may benefit from early SSC, with more women breastfeeding successfully and still breastfeeding at one to four months (fourteen studies, 887 women, moderate-quality evidence), but there were not enough women studied for us to be confident in this result.
We found no clear benefit to immediate SSC rather than SSC after the baby had been washed and examined. Neither did we find any clear advantage of a longer duration of SSC (more than one hour) compared with less than one hour. Future trials with more women and infants may help us answer these questions with confidence.
SSC was defined in various ways and different scales and times were used to measure different outcomes. Women and staff knew they were being studied, and women in the standard care groups had varying levels of breastfeeding support. These differences lead to wide variation in the findings and a lower quality evidence. Many studies were small with less than 100 women participating.
What does this mean?
The evidence from this updated review supports using immediate or early SSC to promote breastfeeding. This is important because we know breastfeeding helps babies avoid illness and stay healthy. Women giving birth by cesarean may benefit from early SSC but we need more studies to confirm this. We still do not know whether early SSC for healthy infants helps them make the transition to the outside world more smoothly after birth, but future good quality studies may improve our understanding. Despite our concerns about the quality of the studies, and since we found no evidence of harm in any included studies, we conclude the evidence supports that early SSC should be normal practice for healthy newborns including those born by cesarean and babies born early at 35 weeks or more.
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04 December 2016