Exploring the Benefits of Skin to Skin
With its common usage, “skin to skin” has been heard by many of us, and if not, you can
intuit from the name what is referenced. Skin to skin is defined as having your baby lay naked
except for a diaper across your unclothed chest, offering closeness and physical connection
that lay the groundwork for a myriad of positive effects. Skin to skin has grown in popularity
due in part to a growing number of hospitals in the United States acquiring the “Baby Friendly
Hospital” designation as a way to support mothers in breastfeeding. One requirement in
becoming a Baby Friendly Hospital is to institute the “10 Steps to Successful Breastfeeding,”
of which Step 4 of 10 requires healthcare settings to “Facilitate immediate and uninterrupted
skin-to-skin contact” between mother and infant [1]. Skin to skin within the first 2 hours after
birth has increased in frequency after both vaginal and cesarean births. 80% of vaginal and
70% of cesarean delivery couplets now enjoy skin to skin, more than doubling the rates
compared to 15 years ago [2]. The increase of skin to skin frequency is also likely linked to
the abundant proof of the huge benefits it conveys to both birthing parent and child.
ORIGINS
Skin to skin, originally known as “Kangaroo Care,” was first developed and coined in Bogota,
Columbia, where in 1978, Dr. Edgar Rey Sanabria showed that skin to skin was an alternate
treatment to incubators. Kangaroo Care was defined as the mother remaining skin to skin
with the infant for 8 of every 24 hours. Kangaroo Care solved several challenges
simultaneously: infants would stay warm, and the mother would stay together with the
infant, which was important as abandonment was a common reality at this time. If more
babies received Kangaroo Care, it is estimated that the lives of 450,000 babies could be saved
every year [2]. When utilized, Kangaroo Care decreased infant mortality by 36% and
decreased the risks of sepsis, hypoglycemia, and hospital readmission [2]. Infants who
participated in Kangaroo Care had more stable respiratory rates, better oxygenation of the
blood, greater growth in head circumference, and were more likely to exclusively breastfeed
[2]. Long term positive effects of decreased aggression and hyperactivity were found years
after Kangaroo Care [2].
In 1990, “Kangaroo Mother Care” was developed by Nils Bergman in Zimbabwe. In this model,
the mother kept the baby skin to skin for 23 of every 24 hours. Mothers could be active during
the day and could sleep with the infant wrapped on their chest by raising their bed to a 30
degree angle to keep the infant safe. Studies showed a 400% increase in survival in premature
infants that participated in Kangaroo Mother Care versus those who did not [2].
In Western society, skin to skin is touted as a measure to bond with your baby and is loosely
defined as any time spent with your baby on your bare chest. In contrast, in settings with few
resources available, skin to skin, and specifically the Kangaroo Care method, provides
potentially the greatest impact. This impact may be most pronounced in the premature infant
population with better survival and overall health. Using Kangaroo Care has been proven to
provide shorter hospital stays and lower rates of illness and death to the couplets it serves (2)
BENEFITS
Regardless of setting or health status, there are numerous benefits of utilizing skin to skin in
both the birthing parent and infant. For example, skin to skin is strongly associated with
initiation of breastfeeding, a successful first feeding, and exclusively breastfeeding both at
discharge and longer term (beyond 6 months postpartum) [2].
TO THE PARENT
In the birthing parent, decreased stress and lower blood pressure has been observed after skin
to skin. Fathers noted decreased levels of stress and anxiety after skin to skin [2]. Other
benefits imparted include increased confidence in caregiving, earlier discharge, and a less
expensive hospital stay [3].
TO THE INFANT
Infants experience innumerable benefits from receiving skin to skin with either the birthing
parent or partner. For example, they have 70% decreased blood levels of stress hormones (like
cortisol), active digestion, stabilized heart and respiration rates, and improved temperature
regulation [3]. Additionally, infants have better oxygen saturation, longer stretches of sleep,
better weight gain, decreased crying and therefore less wasted calories, increased brain
development, increased frequency of nursing episodes, and a shorter hospital stay [3]. An
increase of blood sugar levels of 10 mg/dL higher was noted in the infant after skin to skin
[2]. Two hours of skin to skin after birth decreased the chance of hypoglycemia by 50%, likely
due in part to the infant crying less and having lower stress hormones circulating, resulting in
higher blood sugar levels. With better physiologic stability, there were lower rates of
admission to the newborn intensive care unit. Initiation of the infant feeding reflexes
developed more rapidly in skin to skin, allowing the infant to perform the breast crawl, which
instinctually occurs if infant is in skin to skin with the birthing parent and helps the infant to
latch onto the breast [2].
BOTH PARENT AND INFANT
An infant is 10 times less likely to cry if in skin to skin versus not held, which naturally
decreases the stress, anxiety, and discomfort in both the infant and the parent. In both the
birthing parent and infant, positive psychological effects are seen, including increased
nurturing and bonding. Breastfeeding is more successful in the early hours after birth, which
is associated with longer breastfeeding success. The close access to the breast in skin to skin
lends itself to easier initiation of breastfeeding; interruption of skin to skin can disrupt this
process [2]. The smells of amniotic fluid and breastmilk on the mother’s chest and the
sensation of skin to skin together can trigger the rooting reflex, helping to encourage latch
[4]. Four sessions of skin to skin not only decrease the chance of breastfeeding difficulties
from the outset, but also increase the likelihood of overcoming any initial struggles [2]. The
closeness and touch of an infant directly on a nursing parent’s skin releases oxytocin, a
hormone that triggers milk release. Only 1 hour a day of skin to skin showed increased overall
milk volume in the mother [2].
Practicing safe skin to skin is as simple as ensuring the nursing parent is awake and
undistracted in a semi-reclined position, the baby is tummy to tummy with the nursing
parent, the infant’s face is visible and nose and mouth are uncovered, and the baby’s neck is
straight and the chin is slightly lifted [2]. The only exceptions to offering skin to skin would
be in infants born at less than 28 weeks or 750 grams, if they are clinically unstable, or if they
require mechanical ventilation, vasopressor drugs, catheters in large arteries or veins, chest
or abdomen drains, surgery in the last week, or a major procedure in last 12 hours [2].
Skin to skin is of incredible value to the parent and infant to smooth the transition from birth
to a stable extrauterine life.
References
[1] 2022, August 20. 10 S, April 10. Ten Steps to Successful Breastfeeding. Baby Friendly USA.
https://www.babyfriendlyusa.org/for-facilities/practice-guidelines/10-steps-andinternationalcode/
[2] Mohrbacher. Breastfeeding Answers. 2nd ed. Arlington Heights, IL: Nancy Mohrbacher
Solutions; 2020.
[3] Mannel, Martens, Walker. Core Curriculum for Lactation Consultant Practice. 3rd ed.
Burlington, MA: Jones & Barlett Learning; 2013.
[4] Marasco, West. Making More Milk. 2nd ed. United States of America; 2020.
Contributed by Danielle Chu, RN, BSN, IBCLC