Early skin-to-skin contact involves placing the naked baby prone on the mother's bare chest at birth or soon afterwards (< 24 hour). This could represent a 'sensitive period' for priming mothers and infants to develop a synchronous, reciprocal, interaction pattern, provided they are together and in intimate contact. Routine separation shortly after hospital birth is a uniquely Western cultural phenomenon that may be associated with harmful effects including discouragement of successful breastfeeding.
To assess the effects of early skin-to-skin contact on breastfeeding, behavior, and physiology in mothers and their healthy newborn infants.
The Cochrane Pregnancy and Childbirth Group and Neonatal Group trials registers (December 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002), MEDLINE (1976 to 2002).
Randomized and quasi-randomized clinical trials comparing early skin-to-skin contact with usual hospital care.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.
Seventeen studies, involving 806 participants (mothers and babies), were included, but data from more than two trials were available for only four outcome measures. We found statistically significant and positive effects of early skin-to-skin contact on breastfeeding at one to three months postbirth [8 trials; 329 participants] (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.10 to 4.22), and breastfeeding duration [6 trials; 266 participants] (weighted mean difference (WMD) 41.99, 95% CI 13.97 to 70.00). There was some evidence of improved summary scores for maternal affectionate love/touch during observed breastfeeding within the first few days postbirth [3 trials; 119 participants] (standardised mean difference (SMD) 0.73, 95% CI 0.36 to 1.11) and maternal attachment behaviour [5 trials; 211 participants] (SMD 0.76, 95% CI 0.47 to 1.04) with early skin-to-skin contact.
Limitations included the methodological quality of the studies, variations in the implementation of the intervention and outcome variability. Early skin-to-skin contact appears to have some clinical benefit especially regarding breastfeeding outcomes and infant crying and has no apparent short or long-term negative effects.
Further investigation is recommended. To facilitate meta-analysis of the data, future research in this area should involve outcome measures consistent with those used in the studies included here. Published reports should also clearly indicate if the intervention was skin-to-skin contact and include means, standard deviations and exact probability values.