Below is a selection of studies exploring the impact of skin-to-skin contact on infant and maternal health. Find out more about how skin-to-skin works.
Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates
This study examines the interactive effects of maternal depression and breastfeeding on mother and infant affectionate touch, as well as infant temperament and cortical maturation patterns across early development. A total of 113 mothers and their infants aged between 1 and 3 months were assessed to determine levels of maternal depressive symptoms, feeding, and temperament. Tonic EEG patterns (asymmetry and left and right activity) were collected, with data analysis showing that EEG activity and mother-infant affectionate touch differed as a function of mood and feeding method. Notably, only infants of depressed mothers that bottle-fed showed right frontal EEG asymmetry and attenuated change in the left frontal region across 3 months. Breastfeeding positively impacted affectionate touch behaviors and was associated with increased left and decreased right frontal EEG activation even for depressed groups, suggesting that breastfeeding and the infant’s positive temperament influence mother-infant affectionate touch patterns and result in neuroprotective outcomes for infants, even those exposed to maternal depression within early development.
Hardin, JS. et al. 2021. Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates. Neuropsychobiology 2021;80:158–175. https://doi.org/10.1159/000511604
Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight
Findings from a new study coordinated by the World Health Organization (WHO) demonstrate that initiation of kangaroo mother care (KMC) alongside skin-to-skin contact and exclusive breastfeeding dramatically improves survival outcomes for preterm or low-weight babies when started immediately after birth. Outcomes suggest that early initiation of KMC could save up to 150,000 more lives each year.
The WHO is currently in the process of reviewing its 2015 recommendations on initiating KMC upon stabilisation of the infant in light of the new evidence that has become available. You can read more on this study on the Baby Friendly blog.
Approximately 1 in 5 women in low- and middle-income countries experience postpartum depression, and the risk is higher among mothers of low-birth-weight (LBW) infants. Kangaroo mother care (KMC) is effective in improving survival among LBW infants, but the benefits of KMC for mothers are not well described. This randomised clinical trial explores whether the practice of community-initiated kangaroo mother care (ciKMC), an intervention encompassing skin-to-skin-contact and exclusive breastfeeding, during the neonatal period reduces the risk of moderate-to-severe postpartum depressive symptoms among mothers of low-birth-weight (LBW) infants. The trial included 1950 mothers of stable LBW infants from low-income areas in India, with findings suggesting that ciKMC practice may substantially reduce the risk of moderate-to-severe maternal postpartum depressive symptoms. This evidence supports KMC as an intervention to be incorporated in essential newborn care programs in low- and middle-income settings.
Synchronous caregiving from birth to adulthood tunes humans’ social brain
This birth-to-adulthood study tested the effects of maternal–newborn contact and synchronous caregiving on the social processing brain in human adults. Authors observed mother-child social synchrony of preterm and full-term neonates who received or lacked initial maternal bodily contact for two decades, with findings demonstrating the long-term effects of maternal care giving in humans, similar to their role in other mammals and particularly in tuning core regions implicated in salience detection, simulation, and interoception that sustain empathy and human attachment.
Yanviv. A. et al. 2021. Synchronous caregiving from birth to adulthood tunes humans’ social brain. Proceedings of the National Academy of Sciences Apr 2021, 118 (14) e2012900118; DOI: 10.1073/pnas.201290018
Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth and Neurodevelopment in Preterm Infants
This study investigates the impact of kangaroo mother care (KMC) on breastfeeding and health outcomes in preterm infants and concludes that KMC effects are significant in promoting a higher proportion of mothers’ milk used during hospitalisation, less feeding intolerance at discharge, higher rates of exclusive breastfeeding at 6 months, improved growth and neurodevelopment.
Wang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med. 2021 Feb 2. doi: 10.1089/bfm.2020.0358. Epub ahead of print. PMID: 33533688.
The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies
This review of studies found that preterm and low birthweight infants receiving a kangaroo mother care intervention initiated breastfeeding 2 days 14 h 24 min earlier than infants who received the “conventional” care of the radiant warmer/incubator method.
Mekonnen, A, Yehualashet, S and Bayleyegn, D, (2019). The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and low birthweight infants: a meta-analysis of published studies. International Breastfeeding Journal, doi.org/10.1186/s13006-019-0206-0
Effects of paternal skin-to-skin contact in newborns and fathers after cesarean delivery
This study of neonates born via elective cesarean delivery and their fathers investigated the effects of paternal skin-to-skin contact (SSC) on newborns and fathers after cesarean delivery. Newborns who received SSC shortly after delivery had a more stable heart rate and forehead temperature, less duration of crying, and started feeding behavior earlier. The duration of breastfeeding after SSC in the treatment group was longer as well, with statistical significance, than the control group. In addition, fathers in the treatment group had lower scores of anxiety and depression and better role attainment than those in the control group, with statistical significance.
Hospital breastfeeding support and exclusive breastfeeding by maternal pre‐pregnancy BMI
This US study explored the impact of the Ten Steps to Successful Breastfeeding on supporting breastfeeding amongst mothers with obesity, who have disproportionately lower rates of exclusive breastfeeding than mothers who are not obese. Researchers found that holding babies in skin-to-skin contact for the first time and being encouraged to feed on demand were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin‐to‐skin significantly less often than other mothers. They concluded that interventions aimed at helping mothers with obesity to hold their babies skin‐to‐skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.
Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section
This video ethnography of skin-to-skin contact highlights the impact of the operating theatre environment on health professionals’ actions and mothers’ perceptions of closeness and ‘ownership’ of their babies. They found that the maternal body was divided in the operating theatre and mothers were perceived as ‘separate’ from their baby in the operating theatre and recovery. Obstetricians’ were viewed to ‘own’ the lower half of women; anaesthetists were viewed to ‘own’ the top half and midwives were viewed to ‘own’ the baby after birth. Midwives’ responsibility for the baby either negatively or positively affected the mother’s ability to ‘own’ her baby, because midwives controlled what maternal-infant contact occurred. Mothers desired closeness with their baby, including skin-to-skin contact, however they realised that ‘owning’ their baby in the surgical environment could be challenging. The authors emphasise the importance of skin-to-skin contact and avoiding maternal-infant separation.
Mapping, measuring, and analyzing the process of skin-to-skin contact and early breastfeeding in the first hour after birth
Researchers in this study explored the practice of skin-to-skin contact in a Baby Friendly designated hospital in the US. The algorithm used in the study enabled the authors to identify instances in which optimal skin-to-skin contact (i.e. immediately after birth) had not occurred, for example following emergent caesarean birth, and in turn highlighted opportunities for targeted interventions such as additional staff training.
Cadwell, K, Brimdyr, K, et al (2018). Mapping, measuring, and analyzing the process of skin-to-skin contact and early breastfeeding in the first hour after birth. Breastfeeding Medicine, doi.org/10.1089/bfm.2018.0048
An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth
This algorithm seeks to analyse the implementation of skin‐to‐skin care in the first hour after birth in order to explore the successes, barriers, and opportunities for improvement to achieving this standard of care for babies.
An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation
This study of 915 mother-newborn dyads found that skin-to-skin contact, mode of birth, labour duration and neonatal unit admission were all significantly associated with likelihood of early breastfeeding initiation. For example, women with immediate skin-to-skin contact were more likely to initiate early breastfeeding across different modes of birth, and in the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. The findings demonstrate the importance of prioritising immediate skin-to-skin contact to support mothers to get breastfeeding off to a good start.
Lau, Y, et al (2017), An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation, Maternal & Child Nutrition, DOI: 10.1111/mcn.12492
Early skin-to-skin contact for mothers and their healthy newborn infants
This review of randomized control trials examined the impact of early skin-to-skin contact on breastfeeding and infant physiology. Researchers found that skin-to-skin contact supported both the establishment and maintenance of breastfeeding. There was also some evidence to suggest a positive impact on the stability of the cardio-respiratory system in infants who received skin-to-skin, although larger sample sizes would be needed to support this further.
Kangaroo mother care for preterm infants
A 20 year follow-up study of the impact of kangaroo care (KMC, or skin-to-skin contact) on preterm and low birthweight babies found significant, long-lasting social and behavioural protective effects even 20 years after the intervention. The effects of KMC at one year on IQ and home environment were still present 20 years later in the most fragile individuals, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group.
Healthy Birth Practice #6: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding
This review explores the evidence supporting the value of immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. The authors argue that unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes.
Effect of kangaroo care on physical growth and breastfeeding
This study of 110 neonates found that the use of kangaroo care improved the infants’ physical growth and increased breastfeeding rates.
Benefits of skin-to-skin to baby and mother
A review of 34 studies found that skin-to-skin contact improved breastfeeding rates, infant cardio-respiratory stability and blood glucose levels.
Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). In: The Cochrane Library, Issue 2 2003. Oxford: Update Software.