Whyisskintoskincontactafterbirthandbreastfeedingwithinthefirsthouroflifeso important? Ifleftundisturbed,thehealthytermbabytakesanaverageofone(1)hourtoorientate tothebreast,attachandstarttobreastfeed.Babiesaffectedbymedicationsused duringthelabourandbirthmayrequirelongerthanonehour Babydevelopsasequenceofbehaviourcrawling,rooting,suckingandusesthe sensesofsmell,sightandhearingtofindtheflightpathtothebreast Babyadaptsbetterstabilisestemperature,breathing,heartrateandbloodsugar levels Motherandbabyimprintingisfosteredwithbabyusingthestrongestnewborn sensesmell Babyshandandmouthcontactwiththenipplestimulatesmaternaloxytocinto enhanceuterinecontractions,milkletdownandmotherbabyinteractionand bonding.

Inrecentyears,research(seereferencesbelow)hasconfirmedtheimportanceof uninterruptedskintoskinformotherandbabyafterthebirth.Ourpracticeshave hadtochangetomirrorthisevidence. TheBabyFriendlyHospitalInitiative(BFHI)wasconvenedgloballybyUNICEFandthe WorldHealthOrganisation,alongwiththeevidencebased10StepstoSuccessful Breastfeeding.InAustraliaitisadministeredbytheAustralianCollegeof Midwives.Currently,therearegreaterthanfiftyhospitalsaccreditedasBaby FriendlywithinAustralia,withseveninTasmania. BFHIhasrecognisedtheimportanceofskintoskinandthefirstbreastfeedthroughthe implementationofStep4andforyourinterest,wehaveincludedpartofthewritten Stepbelow: 4. Placebabiesinskintoskincontactwiththeirmothersimmediatelyfollowingbirthforatleast anhourandencouragemotherstorecognisewhentheirbabiesarereadytobreastfeed,offering helpifneeded.

Thefacilityhasprocedureswhichkeepmothersandbabiestogetherinskintoskincontact foratleastanhourafteravaginalorcaesareanbirth.Whenthemotherplanstobreastfeed, thefirstbreastfeedisallowedtooccurwhenthebabyisready. Initiatingbreastfeedingafteravaginalbirth Unlessamedicallyindicatedprocedureiisrequired,immediateiiskintoskincontactwiththe motherisfacilitatedandcontinuesundisturbediiiuntilthebabyhashadthefirstbreastfeed, evenifmotherandbabyhavetobetransferred.Thebabyisallowedtofollowthenormal sequenceofinnatefeedingbehavioursandinitiatesbreastfeedingwhenready.Staffprovide assistancebykeepingthemotherandbabytogetherandencouragingthemotherto recogniseandrespondtoherbabysinnatefeedingbehaviours. Initiatingbreastfeedingafteracaesareanbirth Skintoskincontactbetweenmotherandbabyshouldpreferablybeinitiatedintheatresuite.

Wherethisisnotpossible,amotherwhohasnothadageneralanaestheticisinskintoskin contactwithherbabywithin10minutesofthetimeshearrivesinrecovery,unlessa medicallyindicatedprocedure1isrequired.Amotherwhohashadageneralanaestheticis inskintoskincontactwithin10minutesofbeingabletorespondtoherbabyiv.Onceskinto skincontactisfacilitated,itcontinuesundisturbeduntilthebabyhashadthefirstbreastfeed, evenifmotherandbabyhavetobetransferred.Thebabyisleftundisturbedtofollowthe normalsequenceofinnatefeedingbehavioursandinitiatesbreastfeedingwhenready.Staff provideassistancebykeepingmotherandbabytogetherandencouragingthemotherto recogniseandrespondtoherbabysinnatefeedingbehaviours.

A medically indicated procedure includes resuscitation or stabilisation procedures for sick and/or preterm infants. There are only a small percentage of babies who require procedures that cannot be carried out with the baby on the mothers abdomen. [Reference: Textbook of Neonatal Resuscitation, 4th edition, American Academy of Pediatrics, 2000]

Immediate (skin-to-skin contact): Although skin-to-skin contact starting immediately after a vaginal delivery is optimal, for the purposes of Step 4 there may be up to 5 minutes of separation before continuous skin-to-skin contact starts. As a guide to measuring 5 minutes, the baby should be on the mothers chest in skin-to-skin contact before the second Apgar.
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Continues undisturbed: Although this step specifies that skin-to-skin contact should continue for at least an hour, it has been shown that most healthy term babies will follow a sequence of pre-feeding behaviours for more than an hour before they are ready to initiate breastfeeding the median is 80 minutes. If the mothers condition necessitates a toilet break before the baby has breastfed, then the interruption should be as brief as possible, before resuming skin-to-skin contact. References / Resources 1. American College of Obstetrics and Gynecology. (2007). Breastfeeding: Maternal and infant aspects. Special report from ACOG. ACOG Clin Rev, 12(supp), 1s-16s. 2. Bergstrom, A., Okong, P., & Ransjo-Arvidson, A. (2007). Immediate maternal thermal response to skin-to-skin care of newborn. Acta Paediatr, 96(5), 655-658. 3. Dimkin, P., & OHara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(5, Supp), S131-S159. 4. Fransson, A., Karlsson, H., & Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Arch Dis Child Fetal Neonatal Ed, 90, F500-F504. 5. Hanson, L. (2004). Immunobiology of Human Milk: How Breastfeeding Protects Infants. Amarillo, TX: Pharmasoft Publishing. 6. Kramer, M., Chalmers, B., Hodnett, E., & PROBIT Study Group. (2001). Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the republic of Belarus. JAMA, 285, 413-420. 7. Kroeger, M., & Smith, L. (2004). Impact of birthing practices on breastfeeding:Protecting the mother and baby continuum. Boston: Jones and Bartlett. 8. Lauer JA, Betran AP, Barros AJ, de Onis M. (2006). Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment. Public Health Nutr, 9(6):673-85. 9. Matthiesen, A., Ranjo, A., Nissen, E., & Uvnas-Moberg, K. (2001). Postpartum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth, 28, 13-19.

10. Sobhy, S. M., NA. (2004). The effect of earl initiation of breastfeeding on the amount of vaginal blood loss during the fourth stage of labor. Egypt PublicHealth Association, 79(1-2), 1-12. 11. The Academy of Breastfeeding Medicine Protocol Committee. (2003). Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term. Retrieved May 1, 2007, from www.bfmed.org 12. Vaidya, K., Sharma, A., & Dhungel, S. (2005). Effect of early mother-baby close contact over the duration of exclusive breastfeeding. Nepal Medical College Journal, 7(2), 138-140. 13. Widstrom, A., Ransjo-Arvidson, A.-B., Christensson, K., & et al. (1987). Gastric suction in healthy newborn infants: Effects on circulation and developing feeding behaviour. Acta Paediatr, 76, 566-572. 14. Edmond K et al (2006) Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 117:380-386 15. Edmond KM, Bard EC, Kirkwood BA. Meeting the child survival millennium development goal. How many lives can we save by increasing coverage of early initiation of breastfeeding? Poster presentation at the Child Survival Countdown Conference, London UK. December 2005.
By Jill Hanson RN, RM, IBCLC, Grad Dip Adv Nurs Clinical Nurse Specialist: Lactation Consultant Launceston General Hospital