Introduction
Skin-to-skin contact between a mother and a newborn is an effective practice for bonding, breastfeeding, and postpartum comfort. The importance of this practice should be recognized by the newborn’s families, nurses, and other clinical professionals. The involvement of the medical staff and the desire of the mother are necessary for the proper establishment of this practice. However, skin-to-skin contact may not be practiced due to a lack of specialists, the need for medical intervention, or the psychological barrier of the mother. The role of the nurse is to organize this process properly, communicate the importance of the practice to patients, and address any questions of the new mother and her family.
Definition of Skin-to-Skin Contact and Relevance for Nursing Practice
Skin-to-skin contact is a practice in which a newborn baby is placed on the mother’s breast after birth. Such contact can occur at any time, in order to calm the baby or improve the production of the mother’s milk. By attaching the baby to the mother, the heart rate and breathing are regulated, which contributes to better adaptation during the first minutes of life (Widstrom et al., 2019). The first contact with the mother’s skin is a factor for the child to further establish breastfeeding. It is important for nursing practice to recognize the critical importance of skin-to-skin contact in establishing the relationship between a mother and a child. Encouraging this process and explaining its importance to the new mothers is the task of the nurse.
WHO Recommendations
The World Health Organization (WHO) has developed guidelines regarding the importance of skin-to-skin contact in the first hours after childbirth. WHO (2020) emphasizes that newborns with prolonged contact with the mother’s skin are more successful in adapting to breastfeeding. Recommendations emphasize the importance of prolonged contact, lasting more than 90 minutes (WHO, 2020). During this time, the necessary adaptation of the body of the newborn to the dramatically changed living conditions takes place. Breastfeeding through long-term skin contact with the mother is critical to infant survival (WHO, 2020). The recommendations also consider that contact should be made immediately after birth, without an additional period in the incubator (WHO, 2022). Breastfeeding plays an exceptional role in the survival of premature babies, helping the child gain weight more actively in the first days of life (WHO, 2022). Starting breastfeeding immediately after birth is now thought to save lives, reduce the risk of hypothermia, and significantly improve feeding (WHO, 2022). Thus, worldwide practice indicates that skin-to-skin contact is a simple, intuitive, and effective method of maintaining the health of newborns.
Benefits and Recommendations for the Patient
The new mother and her family will naturally face many questions related to the new role of parents that the nurse must address. It must be critically emphasized that skin-to-skin contact is important for both a mother and a child. The first contact with the mother’s skin is psychologically important for relaxing and calming, helping to rest after the difficult process of childbirth. Through skin-to-skin contact, the newborn’s digestion is stimulated, generating interest in feeding (RNAO, 2022). Interacting with the warmth of the mother’s body, the child regulates the temperature. Body contact stimulates the production of hormones for breastfeeding (RNAO, 2022). Factors contributing to the need for skin-to-skin contact also include the baby’s need to adapt to life outside the womb and develop proper respiratory and heart rhythms (Widstrom et al., 2019). Patients should be aware of the importance of this simple and effective procedure for establishing motherhood.
Barriers to Implementation
Skin-to-skin contact is the proven standard of care for newborns. However, the implementation of this practice may face barriers. Although both the staff and the new mother are generally aware of the importance of skin-to-skin contact, it is not always possible to implement it in a hospital setting. Lack of time and staff can be key factors hindering the implementation of skin-to-skin contact practices. Clinicians often describe the 90-minute time required to establish physiological and emotional connections as impractical and time-consuming, interfering with necessary medical procedures (Karimi et al., 2019). When medical staff cannot establish proper care for every new mother and baby, implementing this practice can be life-threatening.
Barriers to the practice of skin-to-skin contact may come from internal conditions and the psychological difficulties of the mother of the newborn. The emotional and psychological distance can be experienced by women after a cesarean section (Hughes et al., 2019). Postoperative effects may interfere with the desire for contact with the newborn. In addition, the mother, as well as the medical staff, is aware of the importance of carrying out all necessary medical procedures in the first place. The process of childbirth can be a psychologically difficult event, and the process of attaching a child becomes a reminder of this, caused by complications in accepting a new role as a mother (Hughes et al., 2019). Resolving barriers to the introduction of skin-to-skin contact practices can be the admission of relatives to the post-delivery unit. Additional education on the importance of skin-to-skin contact for the new mother and her family will help prepare for this practice.
A Misunderstood Concept and Future Research
The mother’s psychological barrier is an understudied concept in skin-to-skin contact. Clinical guidelines mostly talk about the benefits of such a practice and its critical importance, but rarely refer to the reluctance to implement this practice by mothers themselves. Fears for the life of the child and the difficult experience of childbirth can become psychological factors of rejection (Ahmad & Vismara, 2021). The possibility of such a phenomenon should be explained to mothers and their families in order to prevent postpartum depression and establish contact between mother and child. Further research is needed on the relationship between skin-to-skin reluctance and manifestations of depression, post-traumatic stress disorder, and anxiety.
From a layperson’s point of view, the refusal of physical contact may be misunderstood and perceived as unwillingness to care for the child. The family and the new mother need to be explained that such a psychological defense mechanism is normal for a stressful situation. Being unprepared for a new parental role or mismatching expectations and reality does not make them bad mothers. The family of the mother and the newborn should be informed of the importance of care to ensure comfortable conditions. Mothers usually need more time to resolve physical and psychological difficulties.
Conclusion
Skin-to-skin contact has been proven to be important in the first hours of a child’s life. Establishing breastfeeding, creating bonds between a mother and a child, and organizing the physiological process can be improved using this approach. The barrier of maternal psychological denial, which can make skin-to-skin contact impossible is misunderstood and understudied. The assistance of medical personnel, additional education of the mother and her family, and the admission of relatives in the department can improve the situation. Further research into this gap is needed to improve maternal and newborn care.
References
Ahmad, M., & Vismara, L. (2021). The psychological impact of COVID-19 pandemic on women’s mental health during pregnancy: A rapid evidence review. International Journal of Environmental Research and Public Health, 18(13), 1-18. Web.
Hughes, C., Foley, S., Devine, R. T., Ribner, A., Kyriakou, L., & Boddington, L. (2020). Worrying in the wings? Negative emotional birth memories in mothers and fathers show similar associations with perinatal mood disturbance and delivery mode. Archives of Women’s Mental Health, 23(1), 371-377. Web.
Karimi, F. Z., Sadeghi, R., Maleki-Saghooni, N., & Khadivzadeh, T. (2019). The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis. Taiwanese Journal of Obstetrics and Gynecology, 58(1), 1-9. Web.
Registered Nurses’ Association of Ontario (RNAO). (2022). Breastfeeding best practice guidelines for nurses. Practice Recommendations. Web.
World Health Organization (WHO). (2020). Skin-to-skin contact helps newborns breastfeed. Feature Stories. Web.
World Health Organization (WHO). (2022). WHO advises immediate skin to skin care for survival of small and preterm babies. News. Web.
Widstrom, A. M., Brimdyr, K., Svensson, K., Cadwell, K., & Nissen, E. (2019). Skin‐to‐skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatrica, 108(7), 1192-1204. Web.
