The importance of skin to skin with baby

Baby Ryan struggled with breastfeeding from the time he was born. “He would latch on for a minute, then pull his head back and cry, and at times I couldn’t get him to latch on at all,” says his mom, Renee Farquhar. She ended up pumping and feeding her milk to her son in a bottle, and was beginning to despair that breastfeeding would ever work.

Then, one chilly winter night, Farquhar decided to have a bath with Ryan in hopes of warming them both up. “I held him in my arms in the warm water. On his own, he decided that he wanted to nurse right there in the tub.” Ryan snuggled against her, latched on beautifully and, Farquhar says, “filled his belly.” While day-to-day feedings were still sometimes challenging, Farquhar found that Ryan would always nurse well when they were skin to skin in the bathtub. “I am not sure who enjoyed it more—me or him,” she says.

Babies love to be cuddled and held, as every parent knows. But new evidence suggests that being in skin-to-skin contact with a parent does more than just make the baby happy. It can help to solve breastfeeding problems, prevent hypoglycemia and other newborn difficulties, reduce pain, stabilize premature babies and set the stage for optimal brain development. That’s pretty impressive for something so low-tech!

The interest in skin-to-skin contact for the littlest of babies started in 1979, when neotatologists Edgar Rey and Hector Martinez, in Bogotá, Colombia, found themselves without enough incubators to care for all the premature babies in their hospital. Instead, they put the tiny babies on their mothers’ bodies and wrapped them in cloth carriers to keep them warm. The babies thrived, and the doctors named their technique, which also included breastfeeding and early discharge, the Kangaroo Mother Method. Later the term was changed to kangaroo mother care.

Nils Bergman, a physician and researcher now working in South Africa, has shown kangaroo mother care to be beneficial in stabilizing and promoting the health of premature babies. He also pulls together work by other researchers to demonstrate its value for all babies. Bergman explains: “A newborn’s brain development depends on positive sensory stimulation. At birth, the sensations that tell the brain ‘I am safe’ are the mother’s smell, her movements and skin-to-skin contact. Also her voice, but that is not always there. When the brain does not get those sensations, it says, ‘I am not safe,’ and then it goes into a self-defence program. Yes, it keeps breathing and eating and digesting, but brain development is on hold.”

When the baby is in skin-to-skin contact with his mother, Bergman says, a natural process unfolds. “It stimulates a specific part of the newborn brain, so that two things happen. The baby will move to the breast, self-attach and feed; and secondly, the baby will open his eyes and gaze at his mother,” he says. The first step (getting milk) allows the baby to continue developing physically, while the second step ensures emotional and social development. “The mother’s body is the baby’s natural habitat, the place where development happens,” he adds.

Boosting breastfeeding with skin t0 skin contact

While kangaroo mother care is simply routine in the hospitals where Bergman has worked, it’s not nearly as common in North American hospitals, where babies tend to be offered to their mothers bundled in several layers of clothes and blankets. As well, mothers don’t feel much like stripping down when staff and visitors can walk in at any moment. The nursing staff may even discourage it.

That may change if Nikki Lee, a lactation consultant (LC), nurse and speaker from the Philadelphia area is able to convey her message to more hospital staff. She says: “When nurses understand about skin to skin, they realize that it saves them work. I was the LC in two hospitals, and I’d go down the hall, putting each baby skin to skin with his mother. Then I’d go back into each room to check on them. Each time, more than half of the babies would have started breastfeeding by the time I came back.”

Bergman says that without skin-to-skin contact, getting breastfeeding underway is more challenging. “Only when the baby feels safe will the baby breastfeed.” The “pressure contact” of the baby’s skin against the mother’s telegraphs this sense of safety to the baby, he explains; without it, breastfeeding may be more difficult than it should be.

“If the baby isn’t skin to skin, it’s like being in a long-distance relationship as far as the baby is concerned,” says Lee. “It’s no help to a newborn to hear ‘I love you’ from across the room.”

Skin-to-skin contact seems to help calm a stressed baby and prepare him to feed. In a 2004 article, Donna Karl explains that a baby who appears to be sleeping, for example, may actually be “closed down” because of too much stress; and attempts to wake him up only add more stress. Even if his eyes open and he starts to cry, he’s unlikely to breastfeed well. Putting that baby in skin-to-skin contact with his mother, though, will prepare him for feeding. Karl writes: “Skin-to-skin contact...can both alert a sleepy baby and calm one who is over-aroused.”

Beyond breastfeeding

But what if you’re not breastfeeding? Is there any value to having skin-to-skin contact in that case? Lee describes helping a father who was bottle-feeding his baby. She encouraged him to have skin-to-skin time with his son, and noticed his approach to bottle-feeding changed. “He was more sensitive to the baby, talked to him more, and picked up on his signals when he wanted to stop,” she recalls.

When is a baby too old for skin-to-skin time? Bergman says, “I don’t give a limit! Once a baby has learned that his mother is there, perhaps being clothed is not a hindrance. How long this takes we do not know, but the ideal would be for the baby to have skin-to-skin contact until he makes it clear that he doesn’t need it anymore. Even when he’s much older, if the baby has a bad day, being skin to skin will help.”

Alicia Dybdal would certainly agree. Dybdal adopted her daughter Sofia from Ethiopia when she was 12 months old. She says: “My husband and I came across the idea of skin-to-skin contact in some of the literature we read as preparation for bringing Sofia home. It really struck us as a good idea. In the first week we had her, we were living in a hotel room in Addis Ababa, and we spent most of our alone time with Sofia wearing her diaper, and my husband and I just in shorts. Everything was so new to Sofia and her whole world had been taken away from her, but she found comfort in us and in the closeness. From my perspective, skin to skin helped me understand that Sofia is my child. It broke down the barriers and made us a family.”

All this makes skin-to-skin contact sound almost magical, but to Bergman it’s simply normal. This is what babies expect when they are born: the feel and smell of their mothers’ bodies. The real test, he adds, is to ask parents who haven’t had this kind of contact with one baby but then experience it with the next. Bergman says: “They will tell you that they want to have their next baby with them, skin to skin.”

Natural, simple, yet surprisingly powerful. Maybe it’s time to make skin-to-skin contact part of every newborn’s care.

The research on skin to skin

Skin-to-skin contact:

• stabilizes premature babies more quickly and reliably than being in an incubator
• maintains the baby’s temperature better than an incubator (One study of twins made one too warm and the other too cold, and then placed both on the mother’s chest at the same time. The result: The too-cold baby warmed up while the other simultaneously cooled. Dads can’t do quite as well, but they will warm a baby who is too chilly.)
• stabilizes a premature baby’s heart rate and breathing
• helps prevent babies’ blood sugar from dropping too low
• relieves pain when babies need to have blood tests or other procedures done
• helps premature babies gain weight better
• encourages increased milk production in breastfeeding mothers
• helps non-latching babies or those with a range of breastfeeding problems breastfeed more effectively
• reduces the amount babies cry
• promotes stronger bonds between mothers and babies — and probably fathers too, but the research has been done on mothers (In one study, fewer babies were later abused or abandoned if they’d been cared for skin to skin in hospital.)

Getting skin to skin in a cold country

While having your baby skin to skin sounds good in theory, it may not seem very practical. Here are some tips that have worked for mothers:

• In hospital, you may be able to shut the door and pull the curtains around your bed to get some privacy with your baby.
• Bring a large bathrobe from home that you can wrap around both you and baby to cover up.
• A large button-front shirt can also be a quick cover-up.
• In your first days at home, spend as much time as you can in bed, semi-reclining with baby on your chest.
• If you’ve needed to be up and dressed for much of the day (because of visitors), try taking a relaxing warm bath with your baby at the end of the day.
• Try a wrap baby carrier to hold your diaper-only baby against your bare chest, then put a button-front shirt over both of you.
• Skin-to-skin time with Dad is also very valuable, and more socially acceptable if you have company.

Read more:
Your postpartum body: What to expect
55 things nobody told me about my baby's first year
3 tips for surviving the first three months with baby