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The Benefits of Skin to Skin, and How to Do It

The practice has been popping up on birth plans everywhere, and science is on its side.

A bare skin newborn resting on your bare chest, isn’t just sharing affection. The warm contact between baby and parent skin releases oxytocin, the love hormone, and transfers body heat and bacteria that can help your baby (and you!) be healthier and happier. But there are even more studied skin to skin benefits: It helps newborns adjust to life outside the womb, improves bonds long after birth, lowers stress levels (for both babies and parents), promotes breastfeeding, and even lessens crying. Still, how do you go about? How often? It depends. Here’s what the science says.

The Benefits of Skin to Skin

In the womb, the mother’s body regulates her fetuses vitals. However, at birth, infants are on their own, breathing for the first time and suddenly managing their own heart rate and temperature. It’s quite the transition period, according to Dr. Deborah E. Campbell, Director of the Division of Neonatology at the Children’s Hospital at Montefiore. But staying close to mom or dad via skin to skin can have remarkable benefits to ease that transition.

In fact, the American Academy of Pediatrics (AAP) recommends skin to skin occur between mom and baby as soon after birth as mom is awake and stable, and that it continue for an hour, with urgent procedures, tests, and check-ins (like the APGAR tests) being performed in this position, and any procedures that require separating mom and baby delayed until an hour of skin to skin and the first breastfeed has taken place. 

A 2012 literature review of 34 randomized controlled trials of skin-to-skin reveals why the recommendation makes so much sense. Researchers found that the contact of flesh helped establish and sustain breastfeeding, maintain the baby’s body temperature,  stabilize their blood sugar, shorten the time they spent crying, and in the case of premature babies, helped stabilize their heart rate, all with no other negative side effects. Newer research shows skin-to-skin may promote healthy brain development in babies and reduce the risk of postpartum depression in parents.

There are a couple of key reasons skin to skin contact is considered so effective in boosting outcomes for new families.

Temperature Regulation

One of the most immediate effects of skin-to-skin is helping babies stabilize their body temperature. At birth, when babies are exposed to air for the first time, often in a cold environment like a delivery room, their temperature drops an average of 2-4 degrees celsius. But “Mom’s body has a unique ability, when an infant is placed on the mom’s chest, to regulate her body temperature to keep her baby warm,” Campbell says.

In fact, one randomized controlled trial of 100 babies found that those who did skin-to-skin immediately after birth were eight times less likely to develop hypothermia than infants who were cleaned and clothed in a warming area. And even for babies who do become hypothermic, skin-to-skin has been shown to be as effective in warming them as an incubator.

Breastfeeding

Skin to skin is correlated with higher breastfeeding rates for up to four months after birth, according to a literature review of 13 studies on the subject. On average, new moms who did skin-to-skin soon after birth breastfed for almost six weeks longer than those who didn’t. 

Researchers believe this has to do with the heightened alertness and sense of smell newborns have when they’re born. They’re hardwired to find their mother’s nipple, and when there are no clothes between them the mother’s skin to her body temperature and the smell of her nipple, prompts infants to seek out the nipple and establish feeding routines.

Researchers think that the hormone oxytocin is the driver. Since oxytocin reduces stress and anxiety, researchers suspect it helps mothers feel a calm sense of bonding and mastery which leads to confidence, increasing breastfeeding duration. Basically, when mom feels good about breastfeeding, she’s more likely to keep doing it.  

Crying 

Unsurprisingly, babies who are snuggled against a parent’s chest also tend to be calmer. A small (30 infant) 1995 randomized controlled trial found that when babies were held skin-to-skin soon after birth, only 14% of them spent more than one of their first 90 minutes of life crying. But when babies were cared for in cots, 93% cried for more than a minute. Researchers theorized that infants, much like other mammals, instinctually recognize separation from their mother and that crying is a “genetically encoded reaction to separation” that serves as a way to “restore proximity to the mother.” 

The ability of skin to skin to bring comfort to infants even holds true long after birth. Babies held skin-to-skin during heel pricks, blood draws, and shots have been shown to cry less. They also have lower heart rates and levels of stress hormones, and maintain more neutral facial expressions, suggesting less pain.  

Skin to Skin After a C-Section

When it comes to routine cesarean sections, “A baby can certainly still do skin to skin,” Campbell says. This may happen in the operating room, or shortly after in a recovery room. Research on skin-to-skin after c-sections has shown that it lowers moms’ pain levels and makes them feel more satisfied and less anxious, and is even associated with the use of less medication. However, when a parent undergoing a c-section is unable to do skin-to-skin due to nausea or rare general anesthetic, some hospitals will let the other parent have skin-to-skin time, Campbell says. 

While most research focuses on skin-to-skin done between babies and their mothers, there’s evidence that babies reap similar benefits from skin to skin with dad. One study of infants born via a cesarean found that those who did skin to skin with their dads shortly after birth had more stable heart rates and body temperatures, cried less, and ate sooner. Plus, the dads scored lower for anxiety and depression and bonded with their babies more quickly. 

If an infant is premature, skin-to-skin will operate on a case-to-case basis. “It’s a matter of how much support that baby is on… There is greater emphasis in recent years in terms of trying to help parents provide skin-to-skin care when a baby is physiologically ready, as early as possible,” Campbell says. There’s good evidence that skin-to-skin can improve the health of premature infants, and even help parents feel less helpless when their baby has to stay in the NICU, according to the AAP

When Can’t Skin to Skin Be Done?

  • Babies with very low APGAR scores or other complications may need to be more closely monitored than skin to skin would allow for (aap)
  • In the rare case that a c-section is done under general anesthesia, skin to skin with mom will be delayed until she’s awake and alert 
  • If a baby is healthy, Campbell says there are very few situations when skin-to-skin with a parent wouldn’t be advisable, barring an active infection on the parent’s chest or an active respiratory infection like the flu. Even parents with COVID-19 can do skin to skin as long as they wear a mask and wash their hands regularly. HIV positive parents can do skin to skin too with extra precautions, like not letting the baby latch onto the breast. 

A Year of Skin to Skin

Well after a baby is born, skin to skin continues to bring benefits to both parents and baby. Doing skin-to-skin on either parent exposes baby to the good bacteria on their parents chest, helping to build their immune system. In the case of a breastfeeding parent, this exposure helps customize breastmilk, as the body produces antibodies in response to what bacteria the baby has. 

There are plenty of benefits for parents too. Researchers suspect that the hit of oxytocin that skin-to-skin triggers makes it a powerful tool for warding off depression and making parents feel less stressed. One 2017 randomized controlled trial found that dads who did skin-to-skin for at least 15 minutes on the day of their baby’s birth and the following three days had stronger attachments to their babies than dads who held their babies while clothed.

Researchers measured attachment with a well-known tool called The Father-Child Attachment Scale, a survey where dads reported how often they talked to, touched, cared for, and explored their child. Researchers suggested that holding their infants skin to skin helped dads understand their baby’s needs. They also theorized that the release of oxytocin (sometimes referred to as the love hormone/neurotransmitter) associated with skin to skin helps relax parents and reduce their stress levels, which further promotes bonding. The authors cite a study that found that skin to skin not only lead to increased oxytocin levels in both mother and fathers but also increased cortisol levels. This is notable because a 2018 study of almost 300 father-infant pairs found that dads whose cortisol levels rose when they first held their baby were more involved with their baby’s care months later. 

How to Do Skin to Skin Kangaroo Care

  • Make sure you’re alert enough to stay awake. If you start to fall asleep, place the baby in their own bed. 
  • Take your top off, strip your baby down to their diaper, and hold them chest to chest
  • Make sure their head is turned to the side so that their nose and mouth are uncovered 
  • Make sure their neck isn’t kinked