This is a plain English summary of an original research article
Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth.
This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the baby’s heart and breathing rates and blood sugar levels after birth was based on fewer trials and less strong.
These findings support UK good practice to promote immediate skin-to-skin contact after birth to improve breastfeeding rates. It remains one of the important steps recommended by NICE and UNICEF aimed at improving the low rates of breastfeeding in the UK. Other measures include providing a favourable environment, support and education.
Why was this study needed?
There are many well documented benefits to breastfeeding. For the child, it reduces infections, helps brain development and reduces the risk of obesity and diabetes later in life. For the mother, it reduces the risk of breast and ovarian cancer and diabetes.
Despite the benefits, breastfeeding rates are low in the UK. Only 34% of women do any breastfeeding by six months, with just 1% exclusively breastfeeding as per international recommendations.
Previous studies had shown a link between immediate or early skin-to-skin contact and likelihood of continuing to breastfeed. It is believed to decrease the baby’s distress, reduce maternal anxiety and improve the bond between mother and baby.
This review combined results of other trials to quantify the effect of skin-to-skin contact on breastfeeding and ease of transition of the baby to life outside the womb.
What did this study do?
This systematic review compared skin-to-skin contact in the 24 hours following birth to contact through a layer of clothing or having the baby in a crib. It included 38 trials from 21 countries with different resource levels and a total of 3,472 mother-baby pairs. This is the third update of a review first published in 2003.
The main outcomes were breastfeeding one to four months after birth and physiological stability of the baby in the first hours of life.
This study focussed on healthy full-term babies, and the majority of women had a normal birth. Only eight trials included women who had a caesarean section, so the results may not be as reliable for this type of birth.
The main limitations are small sample sizes and participants and health professionals being aware of the type of mother-baby contact.
What did it find?
- Women who had skin-to-skin contact with their babies were more likely to be breastfeeding one to four months after giving birth. Breastfeeding rates were 67% versus 54% for women without skin-to-skin contact, (risk ratio [RR] 1.24, 95% confidence interval [CI] 1.07 to 1.43. These results came from 14 trials of 887 participants).
- The breastfeeding period was 64 days longer on average in women who had skin-to-skin contact with their babies, though this was based on low quality evidence (95% CI 38 to 89 days).
- Women were more likely to exclusively breastfeed following birth when they had skin-to-skin contact with their babies. From hospital discharge up to one month after birth, 84% of women were exclusively breastfeeding following skin-to-skin contact compared to 64% following standard contact (RR 1.30, 95% CI 1.12 to 1.49). Exclusive breastfeeding rates in trials running for six weeks to six months after birth were 78% following skin-to-skin contact compared to 52% (RR 1.50, 95% CI 1.18 to 1.90).
- Women who underwent a caesarean procedure and had skin-to-skin contact with their babies were also more likely to be breastfeeding one to four months after giving birth (95% CI 1.04 to 1.44). However, the small sample (220 mother-baby pairs) limits confidence in these results.
- The heart and breathing rates were more stable in babies who had skin-to-skin contact. They were also less likely to have low blood sugar levels. These results should be viewed with some caution as they are based on a small number of babies and stability was averaged from multiple time points.
What does current guidance say on this issue?
The NICE clinical guideline on postnatal care up to eight weeks after birth was last updated in 2015. It recommends that hospitals create an environment that helps to promote breastfeeding, and that “women should be encouraged to have skin-to-skin contact with their babies as soon as possible after the birth”. This echoes the UNICEF UK Baby Friendly Initiative which recommends women have skin-to-skin contact after birth and at least until after the first feed. For women who are unable to have immediate contact, the guidelines recommend it occurs as soon as possible.
What are the implications?
Midwives have expressed some concerns that time pressures and lack of resources can prevent skin-to-skin contact from being a priority. However, according to a survey of women's experiences of maternity care by NICE in 2015, 90% of the women interviewed had experienced skin-to-skin contact with their baby after birth. Given the finding that this should have improved breastfeeding rates, the challenge to understand and improve UK rates, which are much lower than those seen in this international review, continues.
It remains unclear if the benefits of skin-to-skin contact are equally seen after caesarean birth, if duration of contact influences the outcome and if physiological stability of babies is improved. Despite these limitations, skin-to-skin contact should remain high up the list of priorities for actions following birth.
Citation and Funding
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519.
No funding information was provided for this study.
NICE. Postnatal care up to 8 weeks after birth. CG37. London: National Institute for Health and Clinical Excellence; 2006.
NICE. Intrapartum care. QS105. London: National Institute for Health and Clinical Excellence; 2015.
UNICEF UK. Guide to the baby friendly initiative standards. London: UNICEF UK; 2012.
UNICEF UK. Breastfeeding rates in the UK. London: UNICEF UK; 2016.
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