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Meta-Analysis
. 2012 May 16;5(5):CD003519.
doi: 10.1002/14651858.CD003519.pub3.

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

Elizabeth R Moore  1 , Gene C Anderson, Nils Bergman, Therese Dowswell
Affiliations
Meta-Analysis

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

Elizabeth R Moore et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior.

Objectives: To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), made personal contact with trialists, and consulted the bibliography on kangaroo mother care (KMC) maintained by Dr. Susan Ludington.

Selection criteria: Randomized controlled trials comparing early SSC with usual hospital care.

Data collection and analysis: We independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results: Thirty-four randomized controlled trials were included involving 2177 participants (mother-infant dyads). Data from more than two trials were available for only eight outcome measures. For primary outcomes, we found a statistically significant positive effect of early SSC on breastfeeding at one to four months postbirth (13 trials; 702 participants) (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.06 to 1.53, and SSC increased breastfeeding duration (seven trials; 324 participants) (mean difference (MD) 42.55 days, 95% CI -1.69 to 86.79) but the results did not quite reach statistical significance (P = 0.06). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 31 participants) (MD 2.88, 95% CI 0.53 to 5.23). Blood glucose 75 to 90 minutes following the birth was significantly higher in SSC infants (two trials, 94 infants) (MD 10.56 mg/dL, 95% CI 8.40 to 12.72).The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes.

Authors' conclusions: Limitations included methodological quality, variations in intervention implementation, and outcomes. The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations and exact probability values.

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Figures

Figure 1
Figure 1. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Figure 2
Figure 2. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
Figure 3
Figure 3. Funnel plot of comparison: 1 Skin-to-skin versus standard contact healthy infants, outcome: 1.1 Breastfeeding 1 month to 4 months postbirth.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. [published data only]

    2. Anderson GC, Chiu SH, Dombrowski MA, Swinth JY, Albert JM, Wada N. Mother-newborn contact in a randomized trial of kangaroo (skin-to-skin) care. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2003;32(5):604–11. - PubMed

    3. ​

      ​

    4. Chiu SH, Anderson GC. Effect of early skin-to-skin contact on mother-preterm infant interaction through 18 months: randomized controlled trial. International Journal of Nursing Studies. 2009;46(9):1168–80. - PMC - PubMed

    5. ​

      ​

    6. Hake-Brooks SJ, Anderson GC. Kangaroo care and breastfeeding of mother-preterm infant dyads 0-18 months: a randomized, controlled trial. Neonatal Network. 2003;27(3):151–9. - PubMed

    1. [published data only]

    2. Bergman N. Kangaroo mother care from birth compared to conventional incubator care. 22nd Conference on Priorities in Perinatal Care in South Africa; Free State, South Africa. 2003 March 11-14.2003.

    3. ​

      ​

    4. Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization. Acta Paediatrica. 2004;93(6):779–85. - PubMed

    5. ​

      ​

    6. Bigelow A, Littlejohn M, Bergman N, McDonald C. The relation between early mother-infant skin-to-skin contact and later maternal sensitivity in South African mothers of low birth weight infants. Infant Mental Health Journal. 2010;31(3):358–77. - PubMed

    1. [published data only]

    2. Bystrova K, Ivanova V, Edhborg M, Matthiesen AS, Ransjo-Arvidson AB, Mukhamedrakhimov R, et al. Early contact versus separation: effects on mother-infant interaction one year later. Birth. 2009;36(2):97–109. - PubMed

    3. ​

      ​

    4. Bystrova K, Matthiesen AS, Vorontsov I, Widstrom AM, Ransjo-Arvidson AB, Uvnas-Moberg K. Maternal axillar and breast temperature after giving birth: effects of delivery ward practices and relation to infant temperature. Birth. 2007;34(4):291–300. - PubMed

    5. ​

      ​

    6. Bystrova K, Matthiesen AS, Widstrom AM, Ransjo-Arvidson AB, Welles-Nystrom B, Vorontsov I, et al. The effect of Russian maternity home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Human Development. 2007;83(1):29–39. - PubMed

    7. ​

      ​

    8. Bystrova K, Widstrom AM, Matthiesen AS, Ransjo-Arvidson AB, Welles-Nystrom B, Vorontsov I, et al. Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg. International Breastfeeding Journal. 2007;2(1):9. - PMC - PubMed

    9. ​

      ​

    10. Bystrova K, Widstrom AM, Matthiesen AS, Ransjo-Arvidson AB, Welles-Nystrom B, Wassberg C, et al. Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg. Acta Paediatrica. 2003;92(3):320–6. - PubMed

    1. [published data only]

    2. Carfoot S, Williamson PR, Dickson R. The value of a pilot study in breast-feeding research. Midwifery. 2004;20(2):188–93. - PubMed

    1. [published data only]

    2. Carfoot S, Williamson P, Dickson R. A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding. Midwifery. 2005;21(1):71–9. - PubMed

References to studies excluded from this review

    1. [published data only]

    2. Abdel Razek A, Az El-Dein N. Effect of breast-feeding on pain relief during infant immunization injections. International Journal of Nursing Practice. 2009;15(2):99–104. - PubMed

    1. [published data only]

    2. Ali Z, Lowry M. Early maternal-child contact: effects on later behavior. Developmental Medicine and Child Neurology. 1981;23:337–45. - PubMed

    1. [published data only]

    2. Anisfeld E, Lipper E. Early contact, social support, and mother-infant bonding. Pediatrics. 1983;72:79–83. - PubMed

    1. [published data only]

    2. Castral TC, Warnock F, Leite AM, Haas VJ, Scochi CG. The effects of skin-to-skin contact during acute pain in preterm newborns. European Journal of Pain. 2008;12(4):464–71. - PubMed

    1. [published data only]

    2. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A, et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatrica. 1998;87(9):976–85. - PubMed

References to ongoing studies

    1. [published data only]

    2. Keshavarz M. [accessed 6 December 2010];Comparison the effect of skin to skin contact and music during skin to skin contact on maternal state anxiety in cesarean section unit. IRCT Iranian Registry of Clinical Trials. 2010 www.irct.ir

Additional references

    1. [published data only]

    2. Affonso D, Wahlberg V, Persson B. Exploration of mother’s reactions to the kangaroo method of prematurity care. Neonatal Network. 1989;7(6):43–51. - PubMed
    1. Alberts JR. Learning as adaptation of the infant. Acta Paediatrica Supplement. 1994;397:77–85. - PubMed
    1. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496–506. - PubMed
    1. Anderson GC. Risk in mother-infant separation postbirth. Image. 1989;21:196–9. - PubMed
    1. Anderson GC, Chang H-P, Behnke M, Conlon M, Eyler FD. Self- regulatory mothering (SR) postbirth: effect on, and correlation between, infant crying and salivary cortisol. Pediatric Research. 1995;37(4 Pt 2):12A.

References to other published versions of this review

    1. Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2003;(Issue 2) DOI: 10.1002/14651858.CD003519. - PubMed

    1. * Indicates the major publication for the study

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