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)

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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.