Skin-to-skin Contact Group Research Articles

The Relationship Among Skin‐to‐Skin Contact, Breastfeeding, and Mother–Infant Interaction: Implications for Nursing

Newborn Care Poster Presentation Objective To investigate the effect of mother–infant skin‐to‐skin contact (SSC) on the maintenance of breastfeeding over the first 3 months and the effect of breastfeeding on mother–infant interaction. Design Longitudinal quasi‐experiment. Setting Home visits in eastern Nova Scotia. Sample Seventy‐seven full‐term infants and their mothers were seen in their homes at 1 week, 1 month, 2 months, and 3 months. Methods Mothers in an SSC group were requested to provide SSC, no request for SSC was made to control group mothers. All mothers kept daily records of the SSC they provided. The SSC group mothers provided approximately 5 hours/day of SSC in the infants' first week and then more than 2 hours/day until the infants were 1 month old. Control group mothers provided little or no SSC. At each home visit, mothers reported whether they provided exclusive breastfeeding, partial breastfeeding, or no breastfeeding. Mother–infant interactions were assessed at each visit using the Nursing Child Assessment Feeding Scale (NSAFS). Results The SSC group mothers provided more SSC than control group mothers (week 1: SSC, M = 4.92 hours/day, control M = 0.48 hours/day; weeks 2‐4 SSC, M = 2.77 hours/day, control M = 0.19 hours/day). At 1 week, the percentage of breastfeeding dyads was similar in both groups (exclusive: SSC=77%, control=69%; exclusive + partial: SSC=81%, control=75%). The percentage of breastfeeding dyads (exclusive + partial) declined in the control group as the infants aged but remained stable in the SSC group. Breastfeeding dyads had significantly higher scores on the NCAFS Caregiver Scale, indicating more positive maternal interactions at 1 week, 2 months, and 3 months. Conclusion/Implications for Nursing Practice Though numerous studies have shown SSC to benefit newborns' physiological adjustment, few studies have investigated the effect of SSC on breastfeeding duration beyond the newborn period. In this study, SSC facilitated the maintenance of breastfeeding during the infants' early months, and breastfeeding was associated with increased positive maternal interactions. The findings imply the importance of the promotion of SSC to help mothers maintain the decision to breastfeed to the benefits of infants, mothers, and the developing mother–infant relationship. As providers of postpartum care, nurses are uniquely positioned to educate and support mothers in SSC and to influence broader public health policy about maternal–child health.

Effect of Mother/Infant Skin‐to‐Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress

To investigate the effect of mother/infant skin-to-skin contact (SSC) on mothers' postpartum depressive symptoms during the first 3 postpartum months and their physiological stress during the first postpartum month. Longitudinal quasi-experiment. Data were collected during home visits. Mothers in the SSC group (n = 30) provided approximately 5 hours per day of SSC with their infants in the infants' first week and then more than 2 hours per day until the infants were age one month. Mothers in the control group (n = 60) provided little or no SSC. All mothers had full-term infants. Mothers completed self-report depression scales when infants were 1 week, 1 month, 2 months, and 3 months of age. Compared to mothers in the control group, mothers in the SSC group had lower scores on the depression scales when the infants were one week and marginally lower scores when the infants were one month; when the infants were age 2 and 3 months, there were no differences between groups in the mothers' depression scores. Over their infants' first month, mothers in the SSC group had a greater reduction in their salivary cortisol than mothers in the control group. Mother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.

Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants

Skin-to-skin contact (SSC) promotes physiological stability and interaction between parents and infants. Analyses of EEG-sleep studies can compare functional brain maturation between SSC and non-SSC cohorts. Sixteen EEG-sleep studies were performed on eight preterm infants who received 8 weeks of SSC, and compared with two non-SSC cohorts at term (N=126), a preterm group corrected to term age and a full-term group. Seven linear and two complexity measures were compared (Mann-Whitney U test comparisons p<.05). Fewer REMs, more quiet sleep, increased respiratory regularity, longer cycles, and less spectral beta were noted for SSC preterm infants compared with both control cohorts. Fewer REMs, greater arousals and more quiet sleep were noted for SSC infants compared with the non-SSC preterms at term. Three right hemispheric regions had greater complexity in the SSC group. Discriminant analysis showed that the SSC cohort was closer to the non-SSC full-term cohort. Skin-to-skin contact accelerates brain maturation in healthy preterm infants compared with two groups without SSC. Combined use of linear and complexity analysis strategies offer complementary information regarding altered neuronal functions after developmental care interventions. Such analyses may be helpful to assess other neuroprotection strategies.

Short duration of skin‐to‐skin contact: Effects on growth and breastfeeding

To compare weight gain and head growth in very-low-birthweight (VLBW, <1501 g) infants with or without exposure to short duration of skin-to-skin contact (STSC) during their stay in a neonatal intensive care unit. Stable VLBW infants were randomised into either STSC or control group. Parents of the STSC group were encouraged to provide STSC for at least 1 h daily. One hundred and forty-six infants were randomised, but only 126 were enrolled (STSC group: n = 64; n = 62). Infants in the STSC group had better mean weekly increase in head circumference (1.0 cm (SD = 0.3) vs. 0.7 cm (SD = 0.3); P < 0.0001) and higher breastfeeding rate at discharge (29.7% vs. 14.5%; P = 0.04). Although the mean duration of maternal education was longer in STSC (13.0 vs. 12.1 years; P = 0.04) than in controls, linear regression analysis showed that the significant predictors associated with weekly head growth were exposure to STSC (unstandardised coefficient: 0.2; 95% confidence intervals (CI): 0.1, 0.3; P < 0.0001) and head circumference of infants at the time of enrollment (unstandardised coefficient: -0.05; 95% CI: -08, -0.03; P < 0.0001); the number of years of maternal education was not a significant predictor. Logistic regression analysis showed that the only significant predictors of successful breastfeeding at discharge were receiving expressed breast milk at enrollment (adjusted OR: 4.1; 95% CI: 1.4, 11.7; P = 0.009) and receiving expressed breast milk during intervention period (adjusted OR: 8.3; 95% CI: 2.8, 24.4; P < 0.0001); exposure to STSC and maternal education were not significant predictors. Exposure to short duration of STSC may promote head growth in VLBW infants.

Neurophysiologic Assessment of Neonatal Sleep Organization: Preliminary Results of a Randomized, Controlled Trial of Skin Contact With Preterm Infants

Sleep is important to brain organization, but few strategies to promote sleep among premature infants have been tested. Behaviorally based measures of sleep have shown increased quiet sleep (QS) and decreased active sleep (AS) during skin-to-skin contact (SSC) with the mother, but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization. Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state. Data for the first 28 relatively healthy, preterm subjects of an ongoing randomized trial of one 2- to 3-hour session of SSC or incubator care between feedings are reported here. Infants were positioned prone, inclined, and nested in an incubator during the 2- to 3-hour pretest period, were fed, and then went into the test period of SSC or incubator care. Infants were left largely undisturbed throughout testing. A mixed-model regression analysis compared the test-pretest differences in outcome measures within and between groups. Results showed that arousals were significantly lower in the SSC group, compared with the control group, for the entire study period and for test-pretest matched segments of QS and AS. Rapid eye movement was significantly lower for the SSC group for the study period and AS segments. Indeterminate sleep was significantly lower for the SSC group when confounding environmental variables were included in the regression analysis. When 4 subjects who experienced excessive ambient light levels during SSC were removed from analysis, QS increased during SSC. The patterns demonstrated by the SSC group are analogous to more-mature sleep organization. SSC may be used as an intervention to improve sleep organization in this population of preterm infants.