Friday, April 13, 2012

Skin 2 Skin

From Kate Paxton...

Early this morning, I was called to a birth of young woman.  Her labor had progressed significantly and it became obvious she would inevitably deliver her baby at just 33 weeks and 5 days.  We called in one of my favorite Neonatology Nurse Practitioners (NNP) – she’s aware of the need to evaluate and help babies transition as smoothly as possible.  Now this kind little boy – Brannon – helped us tremendously by flinging out his tiny arms and giving a nice big howl.  I placed the baby onto the mother’s abdomen and he continued to cry and transition well – allowing us to delay clamping or cutting the cord, so he could get all the extra blood he could from his placenta.  The mother was able to speak with the baby and welcome him to this world.

Perhaps the sweetest moment of every birth is that moment when the baby arrives and snuggles up, babies chest to mother's chest, in mother’s arms.  This moment is not just a nice scene – there’s a lot of science to support the practice of skin-to-skin contact in the immediate postpartum period.

My favorite way to help a baby transition to the “extrauterine environment” – that’s science-speak for ‘the world outside the womb’ – is to deliver the baby to the mother’s abdomen.  As long as the babe is stable, this allows for delayed cord clamping and skin-to-skin contact.  Delayed cord clamping has been shown to result in improved iron status of babies up to even six months of age.  The baby can obtain about a fifth of its blood volume through placental transfusion following the birth – and this may make a big difference in the health and well-being of a baby.  For preterm babies – like little Brannon this morning  - delaying cord clamping for even a short time can help the babies transition more smoothly.  The World Health Organization Reproductive Health Library and the Cochrane review suggest delayed cord clamping is the standard for care of stable infants.

As we allow the cord to pulse oxygen-rich blood into the baby, who is using his lungs to breathe air for the very first time, a lovely place to put that baby is on the mother’s chest.  In a Chochrane review of over 30 studies, the research showed “that babies interacted more with their mothers, stayed warmer, and cried less. Babies were more likely to be breastfed, and to breastfeed for longer, if they had early skin-to-skin contact. Babies were also, possibly, more likely to have a good early relationship with their mothers, but this was difficult to measure.”  The WHO Reproductive Health Library described the ideal situation – that “early skin-to-skin contact (SSC) begins immediately after birth by placing the naked newborn baby prone on the mother’s bare chest.”  This library also reviewed a great number of studies and found that SSC after birth helped reduce crying, improve the mother-infant interaction, keeps the baby warm, and helps the mother successfully breastfeed.

The International Breastfeeding Center lists a number of benefits of SSC from birth to the first hour: The baby…
•  Is more likely to latch on

•  Is more likely to latch on well

•  Maintains his body temperature normal better even than in an incubator

•  Maintains his heart rate, respiratory rate and blood pressure normal

•  Has higher blood sugar

•  Is less likely to cry

•  Is more likely to breastfeed exclusively and breastfeed longer

•  Will indicate to his mother when he is ready to feed

Although we understand how special these first moments are on an intuitive level, there are untold numbers of hormonal and sensory interactions occurring in these precious moments – perhaps areas available for future research.  Until then, we can trust that there’s good science to support these midwifery practices.  Mothers should be encouraged to hold, smell, kiss and snuggle their newborns on their own chest, with direct skin to skin contact.  This is the time when mothers are learning their baby’s cues and babies are learning their mother’s environment.  So, consider these practices when writing your birth plan.  The midwives at Bethany Womens Healthcare are happy to support these practices for your birth.