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Skin to skin

Tuesday, December 12, 2017

Skin-to-skin is a technique of newborn care where babies are kept in intimate skin contact, with a parent, typically their mother. Doesn’t have to be the mother. Any family member can do skin-to-skin. In our current private medical care system, with its mandated mother child separation after a caesarian section, it is the father who usually has the luck of holding the newborn first.

Skin-to-skin basically started in Bogota, Colombia in 1978. I remember the shock I got at the idea that premature babies could be nursed outside of an incubator. Trained in what was then cutting edge technology in Baltimore, the idea that a mother’s body could warm a baby better than an incubator was initially distasteful to me. It was an inauspicious start to a life long attraction with psychoneuroimmunology or the interaction between psychological processes and the nervous and immune systems of the human body.

What happened in a Bogota public hospital was that there was overcrowding and understaffing in the nursery and high levels of premature mortality due to nosocomial infection (hospital acquired, baby to baby or doctor to baby or nurse to baby). The paediatrician in charge of the premature unit, Dr. Edgar Rey Sanabria, decided mothers should be given their babies to take care of them. This freed up overcrowded incubator space and nurses. Once this decision was taken he realised that the only way to maintain their temperature, was to keep them in intimate contact with their mothers, i.e. have continuous skin-to-skin contact. The immediate result was a decrease in mortality.
More advantages followed. Prematures not only maintained their temperatures better, their oxygen levels went up, their heart rates and blood pressures went down, they fed better, gained weight faster than their counterparts hidden inside incubators and they went home quicker. It also increased breast feeding practices and improved maternal satisfaction and confidence. This last turned out to be as important as any of the previous mentioned advantages. Babies taken care this way consistently turn out to do better, educationally, socially and economically than their incubator nursed peers.
This form of newborn care was called “kangaroo mother care”. Kangaroos have no placenta so their joeys are born prematurely, migrate into their mother’s pouch and attach to the breast there until they have matured.
Skin-to-skin rapidly became common in full term babies with similar results. It’s easy to do. As soon as the baby is born, it is placed on the mother’s naked chest, covered with a blanket and allowed to do its own thing which basically means rooting around for a while and then crawling up the chest to the breast and latching on some time later.
In fact, there is a fairly distinctive process that such babies follow. After the initial cry, which everyone in the birth room loves to hear, the babies enter a stage of relaxation, recovering from the birth. After a variable period, they begin to make little movements of their arms and legs and head which gradually increase until they actually crawl up or over to the breast. Once they have found the breast, they stop moving and rest. Unwary nurses often take this to mean that the baby is not interested and remove the baby just as it is about to get more familiar by nuzzling, smelling, licking before latching on to the breast.
Trying to rush this process or interruptions such as removing the baby to weigh or measure is counter-productive, and may lead to bonding or breastfeeding problems.
A superficial examination of the baby can be done rapidly by whatever caregiver is present, it’s more important for both mother and baby to rest and get to know each other after the birth efforts. Weighing, cleaning and taking pictures for auntie in Toronto, can wait.
What’s important is the psychological process of bonding that skin-to-skin triggers, releasing comforting hormones that shape brain architecture and future adult behaviour.


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