Skin-to-skin contact

Skin-to-skin contact is a key part of the Unicef UK Baby Friendly Initiative standards. It helps the baby to adjust to life outside the womb and is highly important for supporting mothers to initiate breastfeeding and to develop a close, loving relationship with their baby.

What is skin-to-skin contact?

Skin-to-skin contact is usually referred to as the practice where a baby is dried and laid directly on their mother’s bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and to help boost a mother’s milk supply. Skin-to-skin contact is also vital in neonatal units, where it is often known as ‘kangaroo care’, helping parents to bond with their baby, as well as supporting better physical and developmental outcomes for the baby.

Why is skin-to-skin contact important?

There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers in many ways.

  • Calms and relaxes both mother and baby
  • Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
  • Stimulates digestion and an interest in feeding
  • Regulates temperature
  • Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection
  • Stimulates the release of hormones to support breastfeeding and mothering.

Additional benefits for babies in the neonatal unit

  • Improves oxygen saturation
  • Reduces cortisol (stress) levels particularly following painful procedures
  • Encourages pre-feeding behaviour
  • Assists with growth
  • May reduce hospital stay
  • If the mother expresses following a period of skin-to-skin contact, her milk volume will improve and the milk expressed will contain the most up-to-date antibodies

What happens during skin-to-skin contact?

When a mother holds her baby in skin to skin contact after birth it initiates strong instinctive behaviours in both. The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies’ instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother’s breast and achieve self attachment it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

After birth, babies who are placed skin-to-skin on their mother’s chest will:

  • initially cry briefly – a very distinctive birth cry;
  • enter a stage of relaxation, where they display very little movement as they recover from the birth;
  • start to wake up, opening their eyes and showing some response to their mother’s voice;
  • begin to move, initially little movements, perhaps of the arms, shoulders and head;
  • as these movements increase the baby will draw up their knees and appear to move or crawl towards the breast;
  • once they have found the breast, they will tend to rest for a little while (often this can be mistaken as the baby being not hungry or not wanting to feed);
  • after a period of rest the baby will start to familiarise with the breast, perhaps by nuzzling, smelling and licking around the area. This familiarisation period can last for some time and is important so should not be rushed. Sometimes it is tempting to help baby to attach at this time but try to remain patient to allow them to work out how best to attach themselves.
  • finally baby will self-attach and begin to feed. It may be that mother and baby need a little help with positioning at this stage.
  • once baby has suckled for a period of time, they will come off the breast and often both mother and baby will fall asleep.

Most term healthy babies will follow this process, providing it is not interrupted by anything, for example taking the baby away to weigh, or the mother going for a shower. Interrupting the process before the baby has completed this sequence, or trying to hurry them through the stages may lead to problems at subsequent breastfeeds. If mother has been given a lot of analgesia during labour baby may be drowsy and this process can take longer.

Skin-to-skin contact in the Baby Friendly standards

The Baby Friendly standards require that skin-to-skin contact is valued and supported in hospitals.

Maternity units are required to ensure that:

  • All mothers have skin-to-skin contact with their baby after birth, at least until after the first feed and for as long as they wish.
  • All mothers are encouraged to offer the first feed in skin contact when the baby shows signs of readiness to feed.
  • Mothers and babies who are unable to have skin contact immediately after birth are encouraged to commence skin contact as soon as they are able, whenever or wherever that may be.

Neonatal units are required to ensure that:

  • Parents have a conversation with an appropriate member of staff as soon as possible about the importance of touch, comfort and communication for their baby’s health and development.
  • Parents are actively encouraged to provide comfort and emotional support for their baby including prolonged skin contact, comforting touch and responsiveness to their baby’s behavioural cues.
  • Mothers receive care that supports the transition to breastfeeding, including the use of skin-to-skin contact to encourage instinctive feeding behaviour.

Safety considerations

Vigilance of the baby’s well-being is a fundamental part of postnatal care immediately following and in the first few hours after birth. For this reason, normal observations of the baby’s temperature, breathing, colour and tone should continue throughout the period of skin to skin contact in the same way as would occur if the baby were in a cot (this includes calculation of the Apgar score at 1, 5 and 10 minutes following birth). Care should always be taken to ensure that the baby is kept warm. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern.

Staff should have a conversation with the mother and her companion about the importance of recognising changes in the baby’s colour or tone and the need to alert staff immediately if they are concerned.

It is important to ensure that the baby cannot fall on to the floor or become trapped in bedding or by the mother’s body. Mothers should be encouraged to be in a semi-recumbent position to hold and feed their baby. Particular care should be taken with the position of the baby, ensuring the head is supported so the infant’s airway does not become obstructed

Notes – Mothers

  • Observations of the mother’s vital signs and level of consciousness should be continued throughout the period of skin to skin contact. Mothers may be very tired following birth and so may need constant support and supervision to observe changes in their baby’s condition or to reposition their baby when needed
  • Many mothers can continue to hold their baby in skin to skin contact during perineal suturing, providing they have adequate pain relief. However, a mother who is in pain may not be able to hold her baby safely. Babies should not be in skin to skin contact with their mothers when they are receiving Entonox or other analgesics that impact consciousness.

Notes – Babies

All babies should be routinely monitored whilst in skin to skin contact with mother or father. Observation to include:

  • Checking that the baby’s position is such that a clear airway is maintained– observe respiratory rate and chest movement. Listen for unusual breathing sounds or absence of noise from the baby
  • Colour – the baby should be assessed by looking at the whole of the baby’s body as the limbs can often be discoloured first. Subtle changes to colour indicate changes in the baby’s condition
  • Tone – the baby should have a good tone and not be limp or unresponsive
  • Temperature – ensure the baby is kept warm during skin contact.

Always listen to parents and respond immediately to any concerns raised

This video covers both the theory and practice of skin to skin, but most importantly, what it can mean to mothers and babies meeting each other for the first time.

Find out more