1. The Benefits of Skin to Skin TAMARA JOY LITTLES, CNM

2. Overview  History of the separation of mother and baby  How the medical establishment came to embrace Skin to Skin  The benefits of Skin to Skin for mother, baby, and partner  How to ensure continuous Skin to Skin  What to do when you’re told Skin to Skin is not appropriate for you  How to incorporate the partner in Skin to Skin

4. 1979 - Dr. Rey and Dr. Martinez started a program called Kangaroo Care in Bogota, Colombia, in response to shortage of incubators and severe hospital infections. 1996 - First International Workshop on Kangaroo Care held in Trieste, Italy, developed the term Kangaroo Mother Care.

5. Definitions: Kangaroo Mother Care (KMC) is the care of infants carried skin to skin with the mother. It is a powerful, easy to use method to promote the health and wellbeing of infants born preterm as well as full-term. Its features include: Early and continuous skin to skin contact between mother and baby Exclusive breastfeeding (ideally) It is initiated in the hospital and can be continued at home Small babies can be discharged home early

6. Benefits according to WHO: Heart rate, respiratory rate, oxygenation, blood glucose, sleep patterns and behavior observed in preterm/low birth weight infants held skin to skin tend to be similar or better than those separated from their mother. Takes advantage of the “alert” 1-2 hours after birth. “Contact” and “suckling” are interrelated. Suckling movements start at a peak of 45 minutes. Increase in breastfeeding rates at 2 to 3 months.

7. Promotes maternal behavior. Newborn skin temperatures were higher, blood glucose levels were higher, and plasma base-excess returned to normal faster. The newborn cried less. Salivary cortisol, an indicator of possible stress, appears to be lower. Mothers report being significantly less stressed during kangaroo mother care than when the baby is receiving conventional care. Mothers preferred skin to skin care and exhibited increased confidence, self-esteem, and feeling of fulfilment.

8. Cochrane Review: 34 randomized studies involving 2177 Mothers and Babies “Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, 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 behavior.”

9. Physiologic and Emotional Parameters: Statistically significant findings: Maintenance of infant temperature and blood glucose levels Decreased crying Scores of affectionate love/touch and contact behavior early postpartum Holding the infant positively and affectionate touch at one year Mothers also indicated that they preferred Skin to Skin over holding their infants swaddled in blankets

10. Breastfeeding: Statistically significant positive effect on the success of the first breastfeeding breastfeeding status day three postpartum breastfeeding one to four months postpartum breastfeeding duration maternal breast engorgement pain infant recognition of own mother’s milk odor

11. The Magical Hour: Stage 1: The Birth Cry The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby’s lungs expand. Stage 2: Relaxation The second stage is the relaxation stage. During the relaxation stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped. The baby is skin to skin with the mother and covered with a warm, dry towel or blanket. Stage 3: Awakening The third stage is the awakening stage. During this stage the newborn exhibits small thrusts of movement in the head and shoulders. This stage usually begins about 3 minutes after birth. The newborn in the awakening stage may exhibit head movements, open eyes, show some mouth activity and might move shoulders.

12. Stage 4: Activity The fourth stage is the activity stage. During this stage, the newborn begins to make increased mouthing and sucking movements as the rooting reflex becomes more obvious. This stage usually begins about 8 minutes after birth. Stage 5: Rest At any point, the baby may rest. The baby may have periods of resting between periods of activity throughout the first hour or so after birth. Stage 6: Crawling The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 minutes after birth.

13. Stage 7: Familiarization The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the mother by licking the nipple and touching and massaging her breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more. Stage 8: Suckling The eighth stage is suckling. During this stage, the newborn takes the nipple, self attaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. If the mother has had analgesia/anesthesia during labor, it may take more time with skin to skin for the baby to complete the stages and begin suckling. Stage 9: Sleep The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1½ to 2 hours after birth.

15. BREAST CRAWL VIDEO

16. Barriers of Skin to Skin: Cesarean Section NICU admission Mother unable

17. How can a necessary Cesarean still be a positive birth experience? Gentle Cesarean techniques  Minimize extra people in OR, dim lights, music if desired  Doula or midwife in OR in addition to maternal partner  Observe infant being delivered through abdomen  Delayed cord clamping with infant inches away from mother  Skin to skin in OR  Support latch on in the OR

18. Gentle Cesarean  Provides immediate skin-to-skin benefits for moms and babies  Changes the experience for families from a “surgery” to a birth  Can be healing for women with traumatic prior birth experiences

20. Skin to Skin with Partners: Benefits of skin-to-skin contact for Partners!  You will be empowered to care for your baby and not feel helpless or useless or redundant  You will become central to the caring team  Better bonding  Emotional healing  You are calmer  Able to read your baby’s unique cues for hunger or stress  You can get more sleep - Kangaroomothercare.org

21. Lee Salk (child psychologist) said: “There's no harm in a child crying: the harm is done only if his cries aren't answered. If you ignore a baby's signal for help, you don't teach him independence... what you teach him is that no other human being will take care of his needs."

22. Resources: Breastcrawl video- http://www.breastcrawl.org/video.shtmlhttp://www.breastcrawl.org/video.shtml Kangaroomothercare.com Skintoskincontact.com

23. References: Breastcrawl.org. Breast Crawl - Initiation of Breastfeeding - Nutrition, Malnutrition, Emotional Development, Mother-infant Attachment, Bonding, Protection. 2016. Available at: http://www.breastcrawl.org/index.shtml. Accessed February 13, 2016. Kangaroomothercare.com. Home -. 2016. Available at: http://kangaroomothercare.com. Accessed February 13, 2016. Magicalhour.com. The Magical Hour. 2016. Available at: http://magicalhour.com. Accessed February 13, 2016. Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub3. Who.int. WHO | Kangaroo mother care: a practical guide. 2016. Available at: http://www.who.int/maternal_child_adolescent/documents/9241590351/en/. Accessed February 13, 2016.