SUBJECT:
SKIN TO SKIN CONTACT AND SELF ATTACHMENT TO THE BREAST
PURPOSE:
To establish a standard of nursing practice for skin to skin contact and self attachment to the breast
immediately after delivery.
STATEMENTS:
A. Continuous, uninterrupted skin to skin contact beginning immediately after birth is beneficial for mother and
baby and should be promoted as long as maternal and newborn condition allow.
B. The American Academy of Pediatrics (AAP) recommends that healthy newborns be placed and remain in
direct skin to skin mother-infant contact until after the first breastfeeding.
C. Newborns, like all mammals are capable of using instinctive, olfactory and visual senses to crawl to the nipple
without assistance within the first hour following birth.
D. Benefits to mother and baby include:
a. Improved thermoregulation
b. Optimal blood glucose levels
c. Increased maternal oxytocin levels
d. Increased duration and exclusivity of breastfeeding
e. Enhanced maternal newborn bonding
PROCEDURE:
A. Infants are placed onto mother’s chest immediately after delivery. Infants and mothers are dried and
covered with a warm blanket.
B. Babies should be placed onto mother’s chest with eyes at or just below the nipples with the head turned to
one side. Skin to skin contact should be maximized by extending the baby’s arms and legs across the
mother’s chest.
C. Ideally, the cord should be left long, and trimmed once skin to skin is complete.
D. Routine care should be given while the baby is skin to skin. (Maternal vital signs, bleeding and fundal
checks as well as newborn vitals and assessments).
E. Eye treatment should be delayed until after first breastfeeding. (See newborn policy “Eye Treatment at
Birth”).
F. The following safety precautions should be followed:
a. Parents should be instructed in what to expect, and how to care for their baby during this time.
b. Care should be taken continuously by parents and staff to assure that the infant’s airway is free of
obstruction
c. Mother’s should be positioned to comfortably support the baby, and advised that babies may
jump, slide, or move unexpectedly during their attempt to crawl to the breast. Care should be
taken by mother, staff and support people to anticipate this potential, sudden movement and
watch the baby carefully.
G. If the mother’s condition is such that she is unable to provide skin to skin contact, the infant should be
given the opportunity to be placed skin to skin with the father or partner.
H. For Cesarean Birth:
a. Infants should be placed skin to skin as soon as possible after delivery, taking care to avoid
contact with the sterile field.
b. Infant should be placed skin to skin lying horizontally so head is between the breasts. Maximize
skin to skin contact by extending the infants arms and legs.
c. Follow safety precautions as mentioned in section F above.
d. Continue to promote skin to skin during the PACU period.
(over)
REFERENCES:
1. Bramson L; Lee JW; Moore E; Montgomery S; Neish C; Bahjri K; Melcher CL. (2010). Effect of Early
Skin to Skin mother-infant contact during the first 3 hours following birth on exclusive breastfeeding
during the maternity hospital stay. Journal of Human Lactation, 26 (2): 130-7
2. Bystrova K, Ivanova V, Edhborg M, Matthiesen A, Ransjo-Arvidson A, Mukhamedrakhimove R,
Uvrias-Moberg K, Widstrom A. (2009). Early contact versus separation: effects on mother-infant
interaction one year later. Birth, 36:2 97-109.
3. Colson, S. Meek, J. Hawdon, J. (2008) “Optimal positions for the release of primitive neonatal
reflexes stimulating breastfeeding.” Early Human Development: 84, 441-449.
4. Erlandsson, K, Dsilna, A, Fagerberg, I, Christensson, K. (2007) Skin to skin care with the father after
cesarean birth and its effect on newborn crying and prefeeding behavior. Birth. 34:2:105-114.
5. Gouchon.S, Gregori, D. Picotto, A, Patrucco, G, Nangeroni, M. DiGiulio, P., (2010). Skin to skin
contact after cesarean delivery: an experimental study. Nursing Research, 59(2) 78-84.
6. Widstrom A., Lilja, P., Aaltomaa-Michalias, A., Dahllof, M., Lintula, E. Nissen. (2010) Newborn
behaviour to locate the breast when skin to skin: a possible method for enabling early selfregulation. Acta Paediatrica 100: 79-85.
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