If you’re currently pregnant and reading this, you will probably have heard some mention of the ‘first hour’ after birth and the term ‘skin-to-skin’. Standard practice in most Irish maternity hospitals, particularly those which are BFHI (Baby Friendly Hospital Initiative) accredited, is to place a baby in skin-to-skin contact on its’ mothers’ abdomen immediately after birth. The HSE’s National Infant Policy states that “7.4.8 All mothers and their babies should have skin-to-skin contact immediately following the birth and it should be continued uninterrupted for at least 60 minutes.”
But have you ever wondered why this first hour of uninterrupted skin-to-skin contact between mother and baby is so important? And why there has been such a strong push internationally and nationally to implement and protect this first hour? In a nutshell, undisturbed skin-to-skin contact after birth keeps baby calm, promotes bonding and improves breastfeeding initiation and duration rates.
Newborn babies are little mammals. They are entirely helpless when they are born, but they do come with a strong survival instinct and innate behaviours and reflexes that help them find their mother’s breast when they are placed skin-to-skin with her immediately after birth. It’s as if they are born with a pre-programmed micro-chip which has all the instructions for what to do to get to the breast and feed. While in utero babies learn the skills they need to breastfeed (eg swallowing and sucking). And placing the baby on its’ mother’s abdomen after birth creates the optimal conditions for the baby to use these skills and successfully breastfeed. The mother’s body is a familiar place for the baby. The baby recognises the mother’s smell, her familiar heartbeat and her rhythm of her breath. And all of this calms and soothes baby, and helps to ease his transition from womb to the world. The mother’s body is this little mammals’ natural habitat and the place where he feels safe.
And some pretty amazing things happen on a physiological level when baby is in skin-to-skin contact with his mother. Baby’s heart rate, breathing, body temperature, blood glucose level and blood pressure become stable. And baby is far less likely to cry. Skin-to-skin also supports optimal brain development as it causes nerve impulses to be sent to the brain which activate the limbic brain and the prefrontal-orbital pathway.
According to a 2001 study,
“The dyadic interaction between the newborn and the mother constantly controls and modulates the newborn’s exposure to environmental stimuli and thereby serves as a regulator of the individual’s internal homeostasis.” – Ovt-scharoff, Neuroscience 2001.
From the baby’s perspective, separation is life threatening and results in crying and elevated stress levels.
Skin-to-skin also has benefits for the mother as it enhances the flow of oxytocin, often referred to the ‘love’ hormone. Oxytocin contracts the uterus and reduces post-partum haemorrhage, triggers the ‘letdown’ reflex which releases colostrum/milk, and increases mothering behaviours, bonding, facial recognition, relaxation and attraction to the newborn.
“Mothers who hold their newborns skin-to-skin after birth have increased maternal behaviours, show more confidence in caring for their babies and breastfeed for longer durations.” – Philips 2013
So back to breastfeeding. Recent research has found that newborn babies go through 9 instinctive stages after they are born and placed in skin-to-skin contact with their mothers. The first stage is the birth cry. Then after a little rest, baby natural instincts to find the breast will kick in. It will start to move its’ hands, shoulders, feet and head, all in an effort to wriggle closer to the breast. This is known as the ‘breast crawl’ and it was first observed by Swedish researchers in the 1980s. As your baby moves towards your breast, he will also be drawn to the smell of your milk and to the sight of your darkened areola (it darkens during pregnancy for a reason!). Eventually, with a little help and support, and patience, your baby will wriggle towards the breast, latch on and suck. There are more details about the individual stages here.
Try to be patient with your baby. It might take an hour or two before he starts to suck. So avoid trying to rush him – pushing him to the breast could upset or confuse him. Give him a chance to adjust to his new surroundings and to initiate breastfeeding himself. Trust that your baby knows what to do. Also, try to avoid interrupting this special time – weighing, cleaning and checks by hospital staff can wait until after your baby has had his first feed. Remember that the HSE policy states that the first hour should be UNINTERRUPTED (assuming baby is physiologically stable and that there are no concerns for his health).
Enjoy the first hour – make it a gentle welcome to the world for your baby.
If your baby doesn’t feed within the first hour or two (sometimes babies can be a little sleepy), don’t hesitate to ask for help. You may need to hand express some colostrum and feed it to your baby in a syringe or cup until he is ready to feed at the breast. Your baby will need just a tiny amout as his tummy has a capacity of only 5ml at birth. So every drop counts.
In the event that you have a caesarean birth, skin-to-skin might still be possible, depending on the hospital policies. If skin-to-skin can’t be facilitated, the next best thing is for baby to be placed in skin-to-skin contact with your partner until you are ready to hold him. If separation is unavoidable, don’t worry because you can make up this time later – your baby retains the newborn instincts and reflexes for a couple of months after birth, so even if your baby has spent time in ICU it is not too late to do skin-to-skin. You and your baby can benefit from skin-to-skin at any time.
Caoimhe is teaching a Preparing for Breastfeeding Workshop in YD Ranelagh on Sunday, 26th March
FIND OUT MORE
About the Author
Caoimhe is an International Board Certified Lactation Consultant (IBCLC), Cuidiu Breastfeeding Counsellor and mum of three children aged 9, 6 and 3. She is passionate about supporting and empowering women during pregnancy and in the early days of new motherhood, and helping them to have an experience of breastfeeding that they are happy with. Caoimhe is also a fully qualified yoga and pregnancy yoga teacher with 13 years teaching experience, which she brings to her breastfeeding classes.