Early Skin-to-Skin Contact Between Mother and Newborn: A Focus on Barriers
by Pearl Anne Ante
When neonates are born, they have to undergo major physiological adjustments outside the womb. Since they are not yet well adapted to the extra-uterine environment, they are susceptible to certain conditions such as low blood sugar, hypothermia, stress and infection. This period immediately after birth may represent a ‘sensitive period’ for future physiology and behavior (Moore et.al, 2012).
Some studies have shown that early skin-to-skin contact (also called Kangaroo care) between the mother and newborn gives several benefits to both which provide the neonates optimal adaptation to extra-uterine life, increasing their chances of survival (ICEA, 2015). According to Moore et.al (2012), early skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. It 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. Based from mammalian neuroscience, the intimate contact in SSC where the mother’s body and breast act like the uterus and placenta (natural habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs (Moore et.al, 2012).
WHO and UNICEF are now strongly recommending the integration of this practice to newborn care. Although, in spite of the benefits, strong recommendations and studies to support early skin-to-skin contact; it is still not widely used and accepted globally. Only 45% were put on the mother’s breast within the first hour of life world-wide in 2015 which means 77 million newborns had to wait before experiencing early skin-to-skin contact and breastfeeding (UNICEF, 2015). In fact, delaying the initiation of breastfeeding has been associated with 1 in 4 neonatal deaths in the developing world (Gates, 2014).
Cultural beliefs surrounding colostrum had been one of the challenges to early skin-to-skin contact. Colostrum is produced in a mother’s breasts from the first hour of birth to the second or third day after delivery which is rich in nutrients and antibodies (Gates, 2014). Because it looks different from the usual breast milk, some cultures have traditionally perceived colostrum as “dirty,” “unhealthy,” or even “infectious” (Gates, 2014). As a result, they may discard it and delay breastfeeding during the production of colostrum, waiting until the expected milk comes in (Gates, 2014), which in turn delays the initiation of early skin-to-skin contact between mother and infant. Siedman et al. (2015) also said that maternal factor is a major barrier which includes finding the baby too difficult or heavy to hold, discomfort on the chest or back, and exhaustion. Mothers’ medical issues also pose a major challenge to practice. These medical issues included pain from episiotomy repair, recovery from caesarean section, postpartum depression, and general maternal diseases (Siedman et al., 2015). There is also the insufficiency of quality research studies regarding the benefits of early skin-to-skin contact making it harder for healthcare professionals to accept and practice it. According to Hung and Berg (2011), operating room staff members were initially skeptical, reluctant, and afraid to change their routine habits and behaviors, but after they learned about the importance of early SSC, they slowly began to adapt it to their practice.
Conclusion and Recommendations
Early skin-to-skin care offers numerous benefits to both mother and newborn for free with no short-term nor long-term adverse effects. Still, not everyone knows, accepts and practices it. Learning and understanding the challenges to early skin-to-skin contact will help families, clinicians and policy makers in making steps and changes to fully integrate it to routine newborn care.
It is also important to remember that these barriers can come not just from clinicians, society, culture and the healthcare system, but they can also come from the mothers and families themselves. Policies and programs should start from the smallest unit which is the mother and their family to the biggest unit which is society. Educating people about the benefits of early SSC will raise awareness and will increase the demand after birth. Moreover, respecting the implementation of early SSC in spite of routine newborn and maternal care irrespective of the mode of delivery should be prioritized. Conducting more research on this area will also increase the trust of healthcare professionals and communities.
Through collaborative efforts, strong advocacy and gradual acceptance of recommendations from WHO and UNICEF, early skin-to-skin care will one day be a global standard.