Contact with mother immediately after birth reduces risks to newborns

Immediate skin-to-skin contact between mother and newborn should become the global standard of care, according to a new Cochrane review published in the Cochrane Database of Systematic Reviews.

According to an analysis of 69 studies involving more than 7,000 mother-infant pairs, babies who are placed on their mother's breast immediately after birth have significant physical and physiological advantages. They are more likely to feed exclusively on breast milk, retain heat better, are less likely to suffer from hypoglycaemia and adapt more easily to life outside the womb.

Skin-to-skin contact involves placing a naked infant on the mother's exposed breast immediately after delivery. This simple and free practice helps the baby to:

• maintain an optimal body temperature,

• regulate breathing and heart rate,

• reduces stress and crying,

• promotes successful breastfeeding initiation.

According to a review, 75 per cent of babies who received such contact within the first hour after birth were exclusively breastfed one month later. In the no contact group, the rate was only 55 per cent.

The authors emphasise: further randomised trials with groups without skin-to-skin contact can no longer be conducted.
"We have reached a level of evidence where it is no longer ethical to abandon the practice," states Karin Cadwell, co-author of the review and director of the Healthy Children Project Breastfeeding Centre.

Although most of the studies reviewed were conducted in high- and middle-income countries, it is in resource-limited settings where skin-to-skin contact can be lifesaving. For example, an international study in India and Africa had to stop enrolling participants early when it was found that the practice significantly improved survival of premature babies.

In many clinics, even in high-care settings, mothers and babies are still separated immediately after birth for measurements, examinations or other procedures. This prevents contact, contrary to WHO recommendations.

As the review's lead author Elizabeth Moore explains, in a number of health systems, "skin-to-skin contact is still not perceived as a priority practice, despite its proven effectiveness."

The authors call for a shift in the focus of future research: instead of new clinical trials, focus on implementation, staff training and quality monitoring of the implementation of this simple but highly effective practice.

Skin-to-skin contact is not just a "recommended measure" but a potentially life-saving and health-promoting standard that should be part of the routine in every labour ward in the world.