| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
Early skin-to-skin contact (SSC) involves placing the naked newborn prone on the mother's bare chest at birth or soon afterwards (within 24 hours of birth). Although from an evolutionary perspective skin-to-skin contact is the norm, separating the newborn from its mother soon after birth is common practice in many settings. The aim of this review was to examine the effects of early skin-to-skin contact on breastfeeding exclusivity and duration, and maternal–infant behaviour and physiology.
Seventeen studies involving 806 women met the inclusion criteria. Of these, 16 were randomized controlled trials and one quasi-randomized. None of them met all of the reviewers’ methodological quality criteria. The overall quality of the included studies was considered “marginally adequate”. The two most problematic areas were allocation concealment (implementation of random allocation sequence without foreknowledge of intervention assignments) and provider performance bias (the delivery and postpartum staff could be aware of the group assignment of the mothers).
There were important variations between studies in how the intervention was implemented and in their measured outcomes. Both these variations seriously limited the ability of the reviewers to conduct meta-analysis of the data. This is a serious impediment to developing sound practical recommendations on this topic. For example, duration of skin-to-skin contact ranged from approximately 15 minutes to 48 hours of continuous contact. Although 40 clinical outcomes were included, only 11 were measured by more than one study, and only three outcomes were evaluated in five or more studies.
The review found statistically significant and positive effects of early skin-to-skin contact on: (i) breastfeeding at 1–3 months postbirth—8 trials, 329 participants; odds ratio (OR) 2.15, 95% confidence interval (CI) 1.10–4.22; and (ii) on breastfeeding duration—trials; 266 participants; weighted mean difference 41.99 days, 95% CI 13.97–70.00).
The review also demonstrated statistically significant benefits of skin-to-skin contact on the maintenance of infant temperature in the neutral thermal range, infant crying, infant blood glucose, summary scores of maternal affectionate love touch and contact behaviour during breastfeeding within the first few days postbirth. No important negative effects of early skin-to-skin contact were identified.
Although the review was last updated in April 2003, it is already requires further updating since a number of relevant new studies have been published during the last three years. These include a large study (204 mother–baby pairs) examining the effects of skin-to-skin contact on breastfeeding initiation and duration (1). Other recent work has explored the intervention’s influence on temperature and pain control, behaviour effects and its relevance to preterm infants. Possible negative consequences (e.g. bradycardia and desaturation) of skin-to-skin contact have also been evaluated.
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