The importance of immediate/early skin-to-skin after caesarean

small__282363031“Immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress” (Stevens et al 2014).

This was the conclusion of Stevens et al (2014), who published a review of the literature on this topic earlier this year in an article which is freely available online.  In another paper due out in the August 2014 issue of the Journal of Human Lactation, de Alba-Romero et al (2014) discuss how they developed and implemented a multidisciplinary strategy for all health care professionals involved in caesarean births which aimed to facilitate the initiation of immediate skin-to-skin contact (regardless of chosen feeding method) and recognise the importance of the woman having a companion present for support during the cesarean section.

It is great to see this area getting attention, along with recognition that investment in some areas can lead to significant gains in others.  As Stevens et al (2014) noted; “More staff may be needed to facilitate SSC in the operating room and in recovery (Dabrowski 2007); however, one medical centre discovered that when they implemented immediate SSC, it reduced staff workload because of mothers having fewer breastfeeding challenges during their hospital stay (McKeever & Fleur 2012).”

I found a couple of elements of these papers really interesting in relation to recent discussions on this site and my facebook page.  One was the question of positioning, which I wrote about in this post sharing Suzanne Colson’s recent paper, and the other relates to the use of baby hats in the birth room, which is something that is increasingly being challenged.

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Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature.

The World Health Organization and the United Nations International Children’s Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.

Stevens J, Schmied V, Burns E et al (2014).  Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. Maternal and Child Nutrition, 10 April 2014. Online version published ahead of print.

Postcesarean Section Skin-to-Skin Contact of Mother and Child

The first hour postpartum is critical for long-term, healthy development. At 12 de Octubre Hospital, Madrid, Spain, we developed and implemented a multidisciplinary strategy based on a consensual, participatory protocol for all health care professionals involved in cesarean deliveries. Our aims were 2-fold: the initiation of skin-to-skin (StS) contact with the newborn immediately after birth, regardless of the feeding method chosen, and the recognition of the importance of a companion present for support during the cesarean section (father or other designated by the mother). The objective of this article is to describe a policy developed to ensure timely postcesarean StS contact. Our protocol for neonatal StS contact with the mother is based on reported benefits found in literature, the World Health Organization’s international recommendations, and deep respect for a process that is both natural and instinctive. We call it “humanizing the cesarean.”

de Alba-Romero C, Camaño-Gutiérrez I, López-Hernánde P et al (2014).  Postcesarean Section Skin-to-Skin Contact of Mother and Child.  Published online before print May 20, 2014, doi: J Hum Lact, August 2014, 30(3): 283-286

photo credit: Mwesigwa via photopin cc

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