The Effects of Early Skin-to-Skin Contact on Newborn Health

The Effects of Early Skin-to-Skin Contact on Newborn Health

 Skin to skin (STS) contact involves placing the newborn on the mother’s bare chest after birth. Despite recent evidence of the benefits of STS contact, it is a practice inconsistently used within the medical field. Current practice after delivery is to dry the infant under a warmer to provide routine care and to regulate body temperature (Safari, Saeed, Hasan, & Moghaddam-Banaem, 2018). However, this practice is not evidence based. To address this gap in knowledge, literature was reviewed to analyze the outcomes of early STS on neonatal mortality, thermoregulation, and breastfeeding initiation.

PICO(T) Question

How does early skin to skin contact (I) of a healthy newborn with the mother (P) in the first hour of life (T) compare to no skin to skin contact (C) impact on neonatal mortality, hypothermia, and initation of breastfeeding (O)?

Search Strategy

Keywords: skin-to-skin, breastfeeding, effects of early skin-to-skin, newborn, bonding, thermoregulation, immediate skin-to-skin contact, temperature, kangaroo care, breastfeeding

Databases: PubMed, CINAHL, Academic Search Complete

Search modifiers: and, or, quotation marks, articles written within the last five years

Number and type of records found: Research articles, literature reviews, and academic journals that mentioned the effects on the newborn from early skin-to-skin contact were found. PubMed 62 articles found, CINAHL 253 articles found, and 20 articles found on Academic Search Complete database.

Summary of Findings

Early initiation of skin-to-skin (STS) contact has shown to be beneficial for newborns and mothers. It is a safe and therapeutic intervention that can be performed after vaginal and cesarean section deliveries (Cleveland et al., 2017). It is a cost-effective modality that is worth exploring that is found to have several benefits for the infant-mother dyad.

STS care has been shown to improve physiologic stability and overall health of the infant. Thermoregulation, growth and development, and inittiation of breastfeeding are positive outcomes when performed within the first hour of birth (Cleveland et al., 2017; Safari et al., 2018; Stevens, Schmied, Burns, & Dahlen, 2014). Prolonged STS contact after birth is reported to decrease levels of neurosteroids and improve neurodevelopment of the infant (McCallie et al., 2017). Therapeutic touch, a consequence of STS, is found to decrease stress levels for the newborn and mother, (Cleveland et al., 2017). Furthermore, there is also a significant decrease in the number of transfers to the neonatal intensive care unit (NICU) with a consequent drop in mortality rates (Schneider, Crenshaw & Gilder, 2017).

STS plays a role in the early initiation of breastfeeding (Safari et al., 2018). Safari et al. (2018), reports a link of easier breastfeeding to the increase in catecholamines at birth which improve the olfactory senses of the newborn to find the nipple. However, Lau et al. (2017) found that STS is only beneficial if performed within the first thirty minutes. As an intervention it is also found to foster breastfeeding in the short-term and in the long term (Vila-Candel, Duke, Soriano-Vidal, & Castro-Sanchez, 2018). STS, as a precursor to breastfeeding, has shown to decrease mortality and morbidity rates in lower-middle-class areas (Potgieter & Adams, 2019). Besides the benefits of physiological development and fostering of breastfeeding, it is a natural and easy intervention that is cost-effective (Safari et al., 2018).

The John Hopkins Evidence-based Practice Model was utilized in this study to present the evidence. The three phases of this model consist of 1) identifying a practice question, 2) reviewing and rating evidence, and 3) making recommendations to translate the findings to practice. The studies that were used in the literature review consisted primarily of level II and Level V evidence.

Recommendation for Practice Change

Based on the literature review, early STS contact should be implemented with all delivery types (cesarean and vaginal).  STS contact is an easy and feasible intervention that can be performed in any hospital setting, including the operating room. OBGYNs, pediatricians, neonatal team, and other relevant staff  should be presented with the practice of STS to secure support. Nurses can educate medical staff on the methods of immediate STS contact through educational material, on-demand training, and workshops to aid in the promotion of this intervention. Additionally nurses can engage in client centered care  and educate new mothers and their families at prenatal visits and at the bedside on the benefits of STS contact to enhance understanding of the practice at the time of delivery.

Nurses should implement STS contact within the first 30 minutes of delivery and perform routine care during this time. Vital signs, head-to-toe assessment, APGAR, vaccinations, blood glucose, and documentation can be performed while the infant participates in STS. The effectiveness of the intervention should be measured using satisfaction surveys, health records, and observation by the nursing team. The results of the data collected should further be analyzed to make adjustments and modifications of the practice. The team of nurses, OBGYNs, pediatricians, and relevant staff should engage in ongoing evaluation and reviews of the outcomes of the intervention at the three-month, six-month, and nine-month marks. By the nine-month mark, this phase should be complete.

Conclusion and Recommendation for Further Research

The focus of our research was to look at the effects of early skin-to-skin contact on a newborn’s physiologic processes. Our question pertains specifically to outcomes of infant mortality, thermoregulation, and initiation of breastfeeding. It was found that the early introduction of skin-to-skin contact benefited both newborn and mother. Skin-to-skin care shows many benefits, including significant breastfeeding initiation, earlier infant thermoregulation, decreased newborn stress and cortisol levels, and reduction in neonatal pain response (Cleveland et al., 2017). McCallie et al. (2017) report that skin-to-skin improves neurodevelopmental outcomes, as well. It is also found to have a positive effect on infants’ immunological and later motor and cognitive development outcomes (Potgieter & Adams, 2019). Infant mortality is a concern for many, especially for countries with significantly high rates. Initiation of skin-to-skin after delivery can be just the answer to this epidemic. Much of this can be accomplished through the education of both the medical staff and the patients themselves. Implementing protocols for skin-to-skin contact directly after delivery, whether vaginally or cesarean, can significantly improve infant outcomes (Lau et al., 2018). The procedures customarily performed on the infant can be done while the infant is in contact with the mother. Routine care includes warming, suctioning, and painful procedures such as vaccinations and heel lancets. This early initiation of the mother with the newborn promotes immediate breastfeeding, as well. It is recommended that nurses and lactation consultants be trained to support this initiation early and know proper techniques (Lau et al., 2018).

Within the research, this review has addressed and highlighted several gaps in knowledge. Stevens et al. (2014) noted that there are no known adverse effects of skin-to-skin contact. The authors proceeded to list suggestions on how to safely conduct skin-to-skin, that include to ensure the newborn’s nares are visible and educating the mother on the importance of letting the nursing staff know of any changes in the newborn’s status. Yet, there seems to be a need for more research on the possibilities of adverse side effects of skin-to-skin. These findings would further enhance the training and use of skin-to-skin contact after birth, particularly cesarean section. This leads to another gap in knowledge: skin-to-skin post-cesarean section. Data regarding this topic is limited. Although most women and newborns are alert and responsive at the time of cesarean births and the literature shows positive results, few hospitals implement skin-to-skin contact within hours of delivery (Schneider et al., 2017). Further research and actionable steps to support post-cesarean skin-to-skin care will assist with the implementation process.

In contrast to the research around not enough skin-to-skin contact used, further research needs to define too much touch and stimulation of a newborn. Potgieter and Adams (2019) pointed out that excessive or intrusive caregiving, not in line with the infant’s needs, is associated with insecure attachment. The research could further look into how too much skin-to-skin can affect the newborn physiologically. Critically ill and preterm newborns also need to be explored for future research and the benefits for this specific group, particularly to reduce admission to the NICU (Schneider et al., 2017).

While further research is needed, there is astounding evidence that supports newborn skin-to-skin contact with the mother immediately after birth. The evidence shows decreased rates of neonatal mortality and hypothermia as well as increased rates of successful initiation of breastfeeding.

Evidence Table

References

Cleveland, L., Hill, C., Pulse, W., DiCioccio, H., Field, T., & White-Traut, R. (2017). Systematic review of skin-to-skin care of full term, healthy newborns. Journal of Obstetric,          Gynecologic, & Neonatal Nursing, 46(6), 857-869. Doi:   https://doi.org/10.1016/j.jogn.2017.08.005

Lau, Y., Tha, P. H., Shorey, S., Ho-Lim, S. S. T., Wong, L. Y., Lim, P. I., & Citra Nurfarah, B.    Z.M. (2018). An analysis of the effects of intrapartum factors, neonatal characteristics,   and skin-to-skin contact on early breastfeeding initiation. Maternal & Child Nutrition,             14(1), n/a-1. https://doi-org.concordia.idm.oclc.org/10.1111/mcn.12492

McCallie, K. R., Gaikwad, N. W., Castillo Cuadrado, M. E., Aleman, M., Madigan, J. E.,                         Stevenson, D. K., & Bhutani, V. K. (2017). Skin-to-skin contact after birth and the                       natural course of neurosteroid levels in healthy term newborns. Journal Of Perinatology:   Official Journal Of The California Perinatal Association, 37(5), 591–595. https://doi-            org.concordia.idm.oclc.org/10.1038/jp.2016.268

Potgieter, K. L., & Adams, F. (2019). The influence of mother-infant skin-to-skin contact on                    bonding and touch. South African Journal of Occupational Therapy, 49(2), 11–17.             https://doi-org.concordia.idm.oclc.org/10.17159/2310-3833/2019/vol49n2a3

Safari, K., Saeed, A. A., Hasan, S. S., & Moghaddam-Banaem, L. (2018). The effect of mother               and newborn early skin-to-skin contact on initiation of breastfeeding, newborn                         temperature and duration of third stage of labor. International Breastfeeding Journal,           13(1), N.PAG. https://doi-org.concordia.idm.oclc.org/10.1186/s13006-018-0174-9

Schneider, L. W., Crenshaw, J. T., Gilder, R. E. (2017). Influence of immediate skin-to-skin contact during cesarean surgery on rate of transfer of newborns to NICU for observation. Nursing for Women’s Health, 21(1), 28-33. https://doi.org/10.1016/j.nwh.2016.12.008

Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin-to-skin             contact after a caesarean section: a review of the literature. Maternal & Child Nutrition, 10(4), 456–473. https://doi-org.concordia.idm.oclc.org/10.1111/mcn.12128

Vila-Candel, R., Duke K., Soriano-Vidal, F. J., & Castro-Sanchez, E. (2018). Affect of early                    skin-to-skin mother-infant contact in the maintenance of exclusive breastfeeding:                                  Experience in health department in Spain. Journal of Human Lactation, 34(2), 304-312.                       Doi: 10.1177/0890334416676469