Early skin-to-skin contact for mothers and their healthy newborn infants

• Published in: Cochrane database of systematic reviews 2016-11, Vol.11 (11), p.CD003519
• Main Authors: Moore, Elizabeth R, Bergman, Nils, Anderson, Gene C, Medley, Nancy
• Format: Article
• Language: English
• Subjects: Breast Feeding - statistics & numerical data; Care after childbirth; Child health; Complementary & alternative medicine; Female; Humans; Infant; Infant, Newborn; Kangaroo-Mother Care Method - methods; Mother-Child Relations; Mothers; Object Attachment; Pregnancy & childbirth; Randomized Controlled Trials as Topic; Skin Physiological Phenomena; Touch - physiology
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD003519.pub4

Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior. To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies. Randomized controlled trials that compared immediate or early SSC with usual hospital care. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach. We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07