SKIN TO SKIN BENEFITS

This month’s newsletter is an article that I wrote for Robyn as featured on their website.

Robyn is a wonderful resource for families and new parents. I am happy to be working with them as an expert provider in their Parentbirth education program. Check them out and enjoy the article!

As an International Board Certified Lactation Consultant (IBCLC) in private practice for two decades and as a baby nurse in New York City for over ten years prior, I have had the privilege of observing mothers and babies bond in a way that is, in my opinion, truly unique and deeply intimate. My first observations focused on the effects of something for which we did not have a widely used term back in the 80s. Now the phrase known as “skin to skin contact" has become extremely popular. Understanding what skin-to-skin contact (sometimes referred to as kangaroo care) means, and the importance of skin-to-skin bonding for all of us, has become an area of study with great impact on how we now view our development as a species and as individuals. Research findings on this aspect of birthing and parenting have certainly informed my practice. It has helped me to inform my clients with appropriate recommendations for skin-to-skin contact between parents and their babies.

 

      Now I must confess something about my early years as a baby nurse. I absolutely loved simply holding babies! Between feedings, holding newborns, usually in dimly lit rooms, was one of the true perks of my job. I’d often hear from well meaning Grandparents “you know...you’ll spoil the baby if you hold him so much” and I would comply, but once we were alone, that baby would be back in my arms with my cheek in contact with theirs. I realized that these babies were so much more relaxed, slept better, and even fed better at the next session when held between their feedings - yet I did not fully understand why this was.

Sitting with mums and their newborns gave me many opportunities to witness the ancient magical connection. One of these mums, Justine H., a young mother of two, described her experience of birthing her babies at home. In a recent conversation, she spoke of the concerns and self doubt she felt in anticipation of going through birth for the first time. “How would I know what my baby needs, and would I be able to cater to those needs? The whole gamut of questions ran through my mind more and more as I got closer to birthing my first child. When she was born and laid on my bare chest as I reclined in relief in our bathtub, those questions went away. For some reason as her baby skin pressed against mine, she laid calmly, eyes open and didn't cry. Each breath sounded like a rhythm. While everyone checked on our vitals we were in an embrace and if I dare say in awe of each other.” The rhythm that Justine described between herself and her new baby girl had fascinated me in my early years as a baby nurse and ultimately inspired my desire to learn more and eventually become an IBCLC.

American psychologist Harry Harlow is known for the controversial and frankly cruel experiments he conducted with infant rhesus monkeys in the late Fifties into the Sixties. He separated the infants from their mothers and gave them a choice between a wire mesh or a soft terry cloth covered surrogate caregiver. The infants would cling to the terry covered “mother” even when it was not equipped with the ability to provide food. Whenever stressed or frightened, the infants would seek out and find comfort on the terry cloth surrogate until they calmed down. Thankfully, current research is showing us the importance of comforting touch without causing such harm to mums and babies.

 

In his book Breastfeeding and Perinatal Neuroscience Nils Bergman writes, "The salient stimuli that the newborn timetable requires at birth are the mother’s smell (perhaps reassuring of continuity) and skin-to-skin contact, which will provide touch, warmth, stability, and movement. Essentially, the rich parasympathetic and sympathetic innervation of the skin allows the maternal and newborn autonomic nervous systems to communicate directly." I recommend that anyone interested in learning a bit more about Nils Bergman and his research, begin with his overview lecture available on YouTube. His findings are definitely illuminating and exhilarating.

                 

Justine H. touched on these points when relating the birth of her second child. “A longer and honestly more stressful labor. Apart from the sigh of relief of the pain being over, the tears that he was finally in my arms overwhelmed me. I held him against my skin with a towel over me, everything around me a blur. The next few hours laying against my bare chest, we were both in a cycle of sleeping and nursing what felt like every hour. Exhausted I still smiled at this little body pressed on mine, sheer joy. He slept SO quietly I kept checking on him instead of sleeping...Both babies were incredibly active mentally and physically and we attribute it to the development of their senses through skin-to-skin bonding.”

How and when to start skin to skin

New parents and babies should start skin-to-skin bonding as soon as possible! For mums who give birth via Cesarean Section (c-section), this can still be done immediately if health care providers and hospital staff are informed. For kangaroo mother care, the baby's skin can be placed on the mother's bare chest or mother's breast or even cheek to cheek. A baby who is expected to spend time in the neonatal intensive care unit (NICU) during the hospital stay also benefits highly from skin-to-skin. It's important to ensure baby's health and stability first. As soon as the professionals give a thumbs up, skin-to-skin can begin.

 

In the first hours and first days of life, skin-to-skin contact actually helps to bring all of babies bodily functions into homeostasis which encourages deeper bonding (regulating baby's temperature, heart rate, blood sugar, stress hormones, etc). Being in a state of balance helps us all function at our best. More recent studies have shown that the benefits of skin-to-skin contact take place beyond the first few days, while emphasis prior was placed on the first few hours. 

 

With regards to skin-to-skin contact and breastfeeding, the breast crawl can take place naturally when baby's body is placed on the mother's body, specifically mum's chest, for about an hour after birth. The baby is more likely to practice successful latching this way without much assistance. The physical contact of the skin of the baby on mum helps to increase mum’s production of the hormone oxytocin which in conjunction with prolactin directly improves milk production and affects mum's letdown of breast milk.

Beyond Skin-to-Skin: Infant Massage

We often hear that the skin is our largest organ. Now Western medicine and modern research is giving us insight into the development of our babies. The ancient cultures of the world have actually been utilizing the benefits of skin-to-skin contact in ways that extend beyond breastfeeding. These have now become more popular in the industrialized world, most notably through the practice of regular infant massage.

 

Being from the Caribbean, (Trinidad & Tobago) I grew up being massaged by my mum who is of East Indian descent, as this was a wide practice in our culture.

 

I used many of the massage techniques on the infants in my care when I was a baby nurse and I found it to be relaxing for the babies and for me as well! This skill was useful particularly when one of my babies was just having a rough time - going through a growth spurt, or teething - which distressed them greatly. Infant massage was a wonderful tool in my little bag of baby care tricks!

 

The benefits of massage for infants have been studied at The Touch Research Institute, a part of the University of Miami Miller School of Medicine. Much of their work has been done with preterm infants with extremely interesting results. In a study conducted in 2007 looking at stress behaviors, it was found that premature babies (those who were born before the pregnancy reached full-term) who were given fifteen minute massages three times a day for five days in a row exhibited less stress behaviors and activity at the end of the study period. Multiple studies have illustrated the positive effects of massage on weight gain for preterm infants. One study in particular from 1994 published in The Journal of Perinatal Education presented many interesting findings. Infants were separated into treatment and control groups. Among the findings, infants in the massagers group gained 47% more weight than those in the control group. The treatment group spent an average of 6 days less in hospital and were discharged sooner than the control group.  

             

The studies also suggested more quiet sleep periods, and when awake, increased tracking, and alertness, while fussiness decreased following the massage. For non birthing partners, massaging their infants has been shown to have wonderful and positive effects. Another study at the Touch Institute was done with fathers, who massaged their infants for fifteen minutes as part of their bedtime routine for one month. At the completion of the study period, these fathers were shown to exhibit more warmth and were also more expressive with their babies during on the floor playtime. I believe this finding can be easily extrapolated to any caregiver who regularly massages the babies in their care. One of my favorite findings came out of a study done at the Touch Institute in 2001. Researchers looked at the effect of massage on infants and toddlers with sleep onset issues. They found that infants who were massaged for 15 minutes by their parents before bedtime fell asleep faster and with fewer delay behaviors than babies who were read bedtime stories. Truthfully, I really enjoy a good bedtime story so I’m sure there’s an easy way to combine both activities for an enjoyable bedtime routine. With sleep, or the lack thereof, being an important issue particularly for many new parents, during a breastfeed consult if the need arises, I encourage my clients to learn and incorporate infant massage into their baby care repertoire. It’s the main reason I sought the certification, to share these amazing and positive little details.

 

There are many resources available to learn more about infant massage and its benefits and so I extend my encouragement to Grandparents and older siblings. Learning together is a wonderful way of deepening familial bonds whatever the subject matter, and learning infant massage as a family can be an excellent way of including a sibling in the care routine or preparing them for the arrival of a new baby. Using a doll or a stuffed animal, a young child can be taught some simple massage techniques and gentle touch.

                        

We are just beginning to scratch the surface of what we can learn about the benefits of skin-to-skin contact. Science is showing us the evidence of something that we as a species have always innately known. When we observe our primate cousins, we see that they hold their young constantly and carry them everywhere they go. When not being held by parents, they are held by aunts, siblings or other members of the group. In the modern world, our extended family may not be in close proximity so we are less able to conduct our daily lives in ways similar to families that live in less industrialized countries where babywearing is a standard practice. I believe that most of us recognize that something has been lost which might explain the more recent surge of interest in babywearing in the more developed nations.

 

Touch is SUCH an integral part of the human experience and making the effort to give our children a good foundation for healthy and fulfilling lives. And it begins with simple, loving skin-to-skin contact.

References

                        

1. Breastfeeding and perinatal neuroscience by Nils Bergman. Supporting sucking skills in breastfeeding infants, 2013 Chapter 2, page 53

                        

2. Hernandez-Reif, M., Diego, M. & Field, T. (2007). Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behavior & Development, 30, 557-561.

 

3. Field, T. (1994). Infant Massage. The Journal of Perinatal Education, 3, 7-14

 

4. Cullen, C., Field, T., Escalona, A. & Hartshorn, K. (2000). Father-infant interactions are enhanced by massage therapy. Early Child Development and Care, 164, 41-47.

 

5. Field, T., & Hernandez-Reif, M., (2001). Sleep problems in infants decrease following massage therapy. Early Child Development and Care, 168, 95-104.