Key messages
Mothers who have skin-to-skin contact with their babies in the first hour after birth are probably more likely to breastfeed exclusively up to one month later and from six weeks to six months later.
Skin-to-skin contact between mothers and newborns probably helps newborns adapt to life outside the womb by keeping their body temperature stable and increasing their blood sugar levels. It may also help their breathing and heart rate.
Skin-to-skin contact may result in little to no difference in the time until the delivery of the placenta. The effect on the mother's blood loss after a vaginal birth is unclear.
What is the issue?
Major global health groups like the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) advise that right after birth, a newborn should be placed directly on the mother's bare skin. The baby should be naked and stay there without interruption for at least an hour, ideally until after the first breastfeeding. This is called skin-to-skin contact. However, in many settings, it is common practice to separate newborn infants from their mothers, wrap or dress them, or place them in open cribs or under radiant warmers. Skin-to-skin contact is less common in low-income countries and lower-middle-income countries. Because this practice can help mothers breastfeed successfully, lower rates of skin-to-skin contact may be one reason breastfeeding levels vary between nations with different income levels.
What did we want to find out?
We wanted to expand our understanding of how skin-to-skin contact at birth affects breastfeeding duration and exclusivity and the baby's transition to life outside the womb. Specifically, we wanted to know if skin-to-skin contact is better than standard contact for improving:
exclusive breastfeeding;
infant body temperature;
infant blood sugar levels;
infant breathing and heart rate;
time to delivery of the placenta;
maternal bleeding after vaginal birth.
What did we do?
We searched for randomized studies of immediate skin-to-skin contact (starting less than 10 minutes after birth) and early skin-to-skin contact (between 10 minutes and 24 hours after birth) in major databases. In randomized studies, participants are randomly put into two or more groups to ensure the groups are similar. We summarized the results and evaluated our confidence in their findings based on factors like study size and methods.
What did we find?
We found 69 studies with 7290 mother-infant pairs. Most studies compared immediate skin-to-skin contact (within 10 minutes of birth) with standard hospital care for women with healthy full-term babies. In 15 studies, women had a cesarean birth, and in 10 studies, the babies were healthy but born preterm (from 34 weeks but before 37 weeks of pregnancy). Thirty-two studies were conducted in high-income countries, 25 in upper-middle-income countries, and 12 in lower-middle-income countries, including India, Nepal, Pakistan, Vietnam, and Zambia. No studies were conducted in low-income countries.
Main results
Women who have immediate skin-to-skin contact with their newborns are probably more likely to exclusively breastfeed at hospital discharge and up to one month after birth (12 studies, 1556 mother-infant pairs) and from six weeks to six months after birth (11 studies, 1135 mother-infant pairs).
Babies who have immediate skin-to-skin contact with their mothers probably have higher body temperatures 30 minutes to 2.5 hours after birth, although the difference is not clinically meaningful (11 studies, 1349 newborns). Skin-to-skin contact probably increases infants' blood glucose levels (3 studies, 144 newborns) and may improve their breathing and heart rate (2 studies, 81 newborns). Skin-to-skin contact may have little to no effect on the time until the delivery of the placenta (4 studies, 450 women) or maternal bleeding after a vaginal birth (2 studies, 143 women), although the result for maternal bleeding is very uncertain.
What are the limitations of the evidence?
We are moderately confident in most findings, though we are less confident in the results for breathing and heart rate and time to delivery of the placenta, and we are not confident in the result for maternal bleeding. Descriptions and definitions of skin-to-skin contact, breastfeeding, other interventions, and standard contact were inconsistent between studies. In addition, the mothers and staff knew which mothers were receiving skin-to-skin contact, which could have affected the results. Finally, many studies were small, with fewer than 100 women and newborns participating.
How up to date is this evidence?
This review updates our previous review. The evidence is current to 22 March 2024.