Early skin‐to‐skin contact for mothers and their healthy newborn infants.

Abstract

Early skin-to-skin contact for mothers and their healthy newborn infants. Moore E.R., Anderson G.C. & Bergman N. (2007) Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Systematic Review Issue 3, Art. No: CD003519. DOI: 10.1002/14651858.CD003519.pub2. Date of most recent substantive amendment: 03 April 2007. The full review report, including references, can be accessed using the digital object identifier, DOI: 10.1002/14651858.CD003519.pub2. What are the effects of early skin-to-skin contact (SSC) on breastfeeding, behaviour and physiological adaptation in healthy mothers and their newborn infants? Cochrane review containing a meta-analysis of trials. Separation of mothers from their babies at birth has become standard practice, despite mounting evidence that this may have harmful effects. Early skin-to-skin contact begins at birth and is defined as placing the naked baby, covered across the back with a warm blanket, prone on the mother’s bare chest. Thirty randomized or quasi-randomized clinical trials involving 1925 mothers and their infants were included in the review. The methodological quality of the included studies was described by the authors as ‘marginally adequate’. In 22 of the included reports the method of randomization was not adequately described, and in all 30 studies there was potential for provider performance bias. Meta-analysis was performed when possible. Outcomes related to breastfeeding were measured in 16 studies and it was found that early SSC resulted in statistically significant and better overall performance on all measures of breastfeeding status at 1- to 4-months postbirth and in improved breastfeeding duration. In two studies, infants held with SSC were more than twice as likely to breastfeed successfully during their first feeding following birth than those who were held swaddled in blankets. 86% of mothers who held their infants with SSC strongly indicated that they would prefer the same type of postdelivery care in the future. However, only 30% of mothers who held their newborn swaddled in blankets said they felt the same way about their postdelivery care. Six trials showed that early SSC increased maternal attachment behaviour and the results of four trials indicated that there was increased affection from the mother during breastfeeding. In one study, infants who received early SSC cried for a shorter period of time. No adverse effects of early SSC were reported. Early SSC between mothers and their newborn infants improves both maternal and infant outcomes, with no reported short- or long-term adverse effects. The timing of SSC can be important; in the first 2 hours following birth most infants are very alert. If they receive SSC immediately after birth and remain undisturbed and unmedicated, infants will often self-attach to the nipple at approximately 1 hour following birth. To ensure that the infant’s temperature remains within a safe range, SSC should be uninterrupted and the infant should be dried well and covered across the back with a warmed blanket. The baby’s head needs to be covered with a dry cap and this should be replaced if it becomes damp. The report recommends: Further high-quality studies are needed in this area and future researchers should report clearly on all aspects of the trial, including ‘the method and timing of random assignment, allocation concealment scheme, measures used to control for selection bias, context, timing, and modality of outcome measurements, and means and standard deviations for the interval or ratio level outcome variables examined’. In studies investigating the benefits of breastfeeding confounding factors in successful, long-term breastfeeding, such as the mother’s prenatal breastfeeding intention and the assistance of an experienced nurse for the first breastfeeding, should be controlled for. Improvement is also needed in the evaluation of maternal attachment behaviours, as there is inconsistency in the way in which this variable is defined and measured. Keywords: breastfeeding, Cochrane review, newborns CARUANA E. (2008) Review Summaries: Moore E.R., Anderson G.C. & Bergman N. (2007) Early skin-to-skin contact for mothers and their healthy newborn infants. Journal of Advanced Nursing62(4), 439–440.