“The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.”
An article by Healthy Children Project faculty and colleagues just published in Acta Paediatrica is the first to define the who, what, when, why and how of skin-to-skin contact.Twenty subject matter experts participated in the development of the guideline. In a comprehensive review starting with 56,029 articles on skin-to-skin, the authors found that the definitions of skin-to-skin contact and ideas of how, when, and for whom it should be implemented were vastly inconsistent, so they set out to provide a clear guideline based on high-level evidence.
After the narrowing the article list down to 369 relevant and distinct articles, a group of 20 subject matter experts on the topic of skin-to-skin contact after birth reviewed and evaluated the evidence.
They developed the following guideline for skin-to-skin contact after birth:
Guideline recommendation | Rating |
|---|---|
| All mothers Skin-to-skin contact at birth is appropriate for all mothers throughout the world (Table S1 in Appendix S2). | A |
| All babies Skin-to-skin contact at birth is appropriate for all babies throughout the world (Table S2 in Appendix S2). | A |
| Immediately after birth Immediately after birth, the baby should be placed directly onto the mother’s bare chest/abdomen, before the cord is clamped (Table S3 in Appendix S2). | A |
| Skin-to-skin contact The naked newborn baby should be placed prone on the mother’s naked chest/abdomen (Table S4 in Appendix S2). | A |
| All births Skin-to-skin contact is appropriate after all modes of birth (Table S5 in Appendix S2). | A |
| Postpone routine care Routine care such as weighing, eye care and screenings can be postponed safely for the first hour. Necessary care that can be done while on the mother’s body, such as assessment of vital signs and Apgar scoring, should be conducted during skin-to-skin contact (Table S7 in Appendix S2). | A |
| Uninterrupted The baby and mother should be allowed a peaceful time during skin-to-skin contact, observed but undisturbed by family or staff (Table S6 in Appendix S2). | B |
| Continuous The naked baby remains skin-to-skin on the mother’s bare chest/abdomen. The baby should not be removed for routine care or transfer to another bed or ward (Table S8 in Appendix S2). | A |
| Safe Skin-to-skin contact is safe and improves outcomes for mother and baby (Table S9 in Appendix S2). | A |
| Instinctive behaviour Infant should be given the opportunity to progress through their instinctive behavioural stages: the birth cry, relaxation, awakening, activity, rest, crawling, familiarisation, breastfeeding and sleeping (Table S10 in Appendix S2). | B |
The article also includes a Pragmatic Implementation Guide for Skin-to-Skin Contact after Birth which serves as a how-to for staff. preparing them to facilitate skin-to-skin contact before and during the birth. This is available to download as Appendix S1.
The full article is published in Acta Paediatrica and is available with open access here.