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There
are now a multitude of studies that show that mothers and babies
should be together, skin to skin (baby naked, not wrapped in a
blanket) immediately after birth, as well as later.
The baby is happier, the baby’s temperature is more
stable and more normal, the baby’s heart and breathing rates
are more stable and more normal, and the baby’s blood sugar is
more elevated. Not
only that, skin to skin contact immediately after birth allows
the baby to be colonized by the same bacteria as the mother.
This, plus breastfeeding, are thought to be important in
the prevention of allergic diseases.
When a baby is put into an incubator, his skin and gut
are often colonized by bacteria different from his mother’s.
We now know that this is true not only for the baby born
at term and in good health, but also even for the premature
baby. Skin to skin
contact and Kangaroo Mother Care can contribute much to the care
of the premature baby. Even
babies on oxygen can be cared for skin to skin, and this helps
reduce their needs for oxygen, and keeps them more stable in
other ways as well.
From
the point of view of breastfeeding, babies who are kept skin to
skin with the mother immediately after birth for at least an
hour, are more likely to latch on without any help and they are
more likely to latch on well, especially if the mother
did not receive medication during the labour or birth.
As mentioned in the information sheet, Handout #1 Breastfeeding—Starting
out Right, a baby who latches on well gets milk more easily
than a baby who latches on less well.
When a baby latches on well, the mother is less likely to
be sore. When a
mother’s milk is abundant, the baby can take the breast poorly
and still get lots of milk, though the feedings may then be long
or frequent or both, and the mother is more prone to develop
problems such as blocked ducts and mastitis.
In the first few days, however, the mother does not have
a lot of milk (but she has enough!), and a good latch is
important to help the baby get the milk that is available (yes,
the milk is there even if someone has proved to you with the big
pump that there isn’t any).
If the baby does not latch on well, the mother may be
sore, and if the baby does not get milk well, the baby will want
to be on the breast for long periods of time worsening the
soreness.
To
recap, skin to skin contact immediately after birth, which lasts
for at least an hour has the following positive effects on the
baby:
- Are more likely to latch
on
- Are more likely to latch
on well
- Have more stable and
normal skin temperatures
- Have more stable and
normal heart rates and blood pressures
- Have higher blood
sugars
- Are less likely to cry
- Are more likely to
breastfeed exclusively longer
There
is no reason that the vast majority of babies cannot be skin to
skin with the mother immediately after birth for at least an
hour. Hospital
routines, such as weighing the baby, should not take precedence.
The
baby should be dried off and put on the mother.
Nobody should be pushing the baby to do anything; nobody
should be trying to help the baby latch on during this time.
The mother, of course, may make some attempts to help the
baby, and this should not be discouraged.
The mother and baby should just be left in peace to enjoy
each other’s company. (The mother and baby should not be left
alone, however, especially if the mother has received
medication, and it is important that not only the mother’s
partner, but also a nurse, midwife, doula or physician stay with
them—occasionally, some babies do need medical help and
someone qualified should be there “just in case”). The
eyedrops and the injection of vitamin K can wait a couple of
hours. By the way, immediate skin to skin contact can also be done
after cćsarean section, even while the mother is getting
stitched up, unless there are medical reasons which prevent it.
Studies
have shown that even premature babies, as small as 1200 g (2 lb
10 oz) are more stable metabolically (including the level of
their blood sugars) and breathe better if they are skin to skin
immediately after birth. The
need for an intravenous infusion, oxygen therapy or a
nasogastric tube, for example, or all the preceding, does not
preclude skin to skin contact. Skin to skin contact is quite
compatible with other measures taken to keep the baby healthy.
Of course, if the baby is quite sick, the baby’s health
must not be compromised, but any premature baby who is not
suffering from respiratory distress syndrome can be skin to skin
with the mother immediately after birth.
Indeed, in the premature baby, as in the full term baby,
skin to skin contact may decrease rapid breathing into the
normal range.
Even
if the baby does not latch on during the first hour or two, skin
to skin contact is still good and important for the baby and the
mother for all the other reasons mentioned.
If
the baby does not take the breast right away, do not panic.
There is almost never any rush, especially in the full
term healthy baby. One of the most harmful approaches to feeding the newborn has
been the bizarre notion that babies must feed every three hours.
Babies should feed when they show signs of being ready,
and keeping a baby next to his mother will make it obvious to
her when the baby is ready.
There is actually not a stitch of proof that babies must
feed every three hours or by any schedule, but based on such a
notion, many
babies are being pushed into the breast because three hours have
passed. The
baby not interested yet in feeding may object strenuously, and
thus is pushed even more, resulting, in many cases, in babies
refusing the breast because we want to make sure they take the
breast. And it gets
worse. If the baby
keeps objecting to being pushed into the breast and gets more
and more upset, then the “obvious next step” is to give a
supplement. And it
is obvious where we are headed (see Handout #26 When a Baby
Refuses to Latch On).
Handout
#1a. The importance of
skin to skin contact. Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further
permission,
on the
condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated
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