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Case study: Skin-to-skin contact to encourage breastfeeding

Encouraging breastfeeding from the start

Traditionally, when a baby was born, they were quickly wrapped up or dressed before being passed to their mother. In recent years, skin-to-skin contact has become common practice with the baby being placed on the new mother’s chest immediately or soon after birth and covered with a blanket.

Skin-to-skin soon after birth helps a babies’ instinct to feed kick in at the earliest point and contact should continue until the baby has achieved their first breastfeed. Skin-to-skin is beneficial beyond birth too as it helps babies to be calm, regulate their heart and breathing rates, and increases the bond between parent and child.

The benefits of breastfeeding have been well documented. As well as the bond created between the mother and her baby, babies who breastfeed are less likely to become ill, with the benefits of this lasting into adulthood. There are benefits for the mother too, with a reduced risk of developing certain cancers and osteoporosis.

Reviewing the evidence

The widespread decline in breastfeeding has become a major public health concern. Where previous research has focused on the benefits of skin-to-skin contact in terms of health, researchers from the NIHR-funded Cochrane Pregnancy and Childbirth Group aimed to discover if skin-to-skin contact improved breastfeeding rates and helped babies adjust to the outside world.

They looked at the results of 46 studies which included almost 4000 mothers and their babies. The majority of these studies compared early skin-to-skin contact with standard hospital care for women with healthy full-term babies. Eight studies included women who gave birth by caesarean, and six studies included healthy, preterm babies born at 35 weeks or more.

The research team found that skin-to-skin contact did have an impact on breastfeeding rates. Firstly, babies were more likely to have a successful first breastfeed after birth and have higher blood glucose levels. Secondly, women were 24% more likely to be breastfeeding at one to four months after birth and 50% more likely at three to six months post birth. Women breastfed potentially 60 days longer than women who had not had skin-to-skin contact soon after birth.

The review also suggested that women who give birth by caesarean may also be more likely to maintain breastfeeding following skin-to-skin contact. It found no clear benefit for immediate skin-to-skin rather than waiting until the baby had been washed and examined, and no advantage from longer contact of an hour or more.

Overall, the review supports the use of skin-to-skin to encourage breastfeeding. The evidence suggests that early skin-to-skin should be normal practice for healthy newborns including those born by caesarean and babies born early at 35 weeks or more. Even where skin-to-skin is possible only for a short time, it will still encourage successful breastfeeding one to four months post birth. Importantly, the findings of improved breastfeeding rates were found in diverse countries and among women of low and high socio-economic class. 

Making a difference

The review from the Cochrane Pregnancy and Childbirth Group has informed 20 sets of guidelines around the world, with the World Health Organisation (WHO) referencing the review in their 2017 guidance for promoting and supporting breastfeeding. It has been translated into five languages.

Elizabeth Moore, Associate Professor of Nursing at Vanderbilt University School of Nursing and lead author of the review said:

I have really been amazed at the impact that this Cochrane Review has had around the world. It started as just a gut feeling I had as a breastfeeding consultant over 20 years ago that placing mothers and babies together skin-to-skin right after birth would help them breastfeed more successfully. Since then, this profound, but simple intervention has spread throughout the world based on the evidence in this review.”

In the UK, NICE has used the evidence in their 2006 guidance, and the latest revision in 2015, with the recommendation that women have skin-to-skin contact with their babies after birth. The Royal College of Nursing, UNICEF and Public Health England have all cited the research to promote skin-to-skin contact after birth. As a result, a 2019 survey by the Care Quality Commission reported that 93% of women in England had skin-skin contact after birth.

In June 2020, the WHO stated that skin-to-skin contact and breastfeeding should still be encouraged for new mothers and their babies in cases of suspected or confirmed COVID-19. Early evidence suggests that the benefits of skin-to-skin and breastfeeding far outweigh any risks.

Read the full review for more details.

Further reading

NIHR Alert: Kangaroo mother care may boost the survival of newborn, premature babies