3.0 Understanding the importance of skin-to-skin

Skin-to-skin contact between the birthing parent and infant at birth is internationally recognized as best practice based on rigorous research. In the words of Dr. Louise Dumas, "Skin-to-skin is not just something nice to do, it is something we must do!" Research shows that a minimum of 1 to 2 hours of uninterrupted birthing parent-infant skin-to-skin contact, has a positive impact on the physiological and psychosocial aspects of the dyad, while also facilitating breastfeeding.^{1, 2, 3}

The recommendation for immediate, uninterrupted, skin-to-skin for the first 1 - 2 hours after birth is best practice. The key elements include:

• No drying, place the infant widely on the mother/birthing parent's chest, with the infant's head free to move and maintain the airway, and cover with a dry light blanket.
• Observation of the mother/birthing parent and infant is key to safe skin-to-skin contact!

Take the opportunity to read the following procedural document example on safe skin-to-skin contact.

What does skin-to-skin look like?

• Mother/birthing parent is lying semi-upright - neither flat nor fully sitting and is awake and responsive
• Infant is prone ("belly down") on the mother/parent's chest, where the baby's face is easily visible to make contact and also to ensure that the nose and mouth are free from obstruction
• Infant is covered loosely with a dry, clean blanket that does not prevent movement down to the breast or obstruct visual assessment

The BFHI practices such as immediate skin-to-skin and performing all initial checks while the infant is on the mother/birthing parent's body, support delayed cord clamping.

Waiting at least 1-3 minutes after the baby's birth or until the cord itself stops pulsating has multiple benefits both in the immediate postpartum and neonatal period, in particular improving the iron status of both full- and preterm infants⁴ as they are able to receive the full complement of placental blood.

• Blood glucose at 90 minutes is significantly higher in skin-to-skin care newborns.⁵
• Newborn preterm infants in skin-to-skin care achieve thermo-cardio-respiratory stability within 6 hours, compared to babies in traditional incubator care who mostly do not.⁶
• Newborn, full-term babies who spent more than 50 minutes in skin-to-skin care are 8 times more likely to breastfeed spontaneously than infants not in skin-to-skin care.⁷
• Exclusive breastfeeding at 48 hours and 6 weeks postpartum⁸ and incidence of any breastfeeding at 1 and 4 months⁵ was significantly greater for infants in the skin-to-skin care groups.