To assess the effects of early skin-to-skin contact (SSC) on breastfeeding, physiological adaptation, and behavior in healthy mother–newborn dyads.
Systematic review and meta-analysis.
Thirty-four randomized controlled trials involving 2,177 participants (mother–infant dyads). The search strategy included the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2011), the Cochrane Neonatal Group's Trials Register (June 2011), and Medline (1976-2011). Selection criteria included randomized controlled trials comparing early SSC with usual hospital care.
We independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Data from more than two trials were available for only 10 outcome measures. We found statistically significant and positive effects of early SSC on breastfeeding at 1 to 4 months post birth (13 trials, 702 participants) (risk ratio 1.27, 95% confidence interval [CI] 1.06 to 1.53, and a trend toward significance (p = .06) in breastfeeding duration (seven trials, 324 participants) (mean difference [MD] 42.55 days, 95% CI –1.69 to 86.79). SSC infants were more likely to have a successful first breastfeeding (two trials, 54 participants) (MD in IBFAT scores 1.79, 95% CI 0.24-3.35). Late preterm infants had better cardio-respiratory stability with early SSC (one trial, 31 participants) (MD 2.88, 95% CI 0.53-5.23). SSC infants cried for a shorter length of time (one trial, 44 participants) (MD –8.01, 95% CI –8.98 to –7.04).
The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes. Limitations included methodological quality, variations in intervention implementation, and outcomes.
Conclusion/Implications for Nursing Practice
Mother–infant separation post birth is common in Western culture. Early SSC begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. This time may represent a psychophysiologically sensitive period for programing future physiology and behavior. The intervention appears to benefit breastfeeding outcomes, cardio-respiratory stability, and infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations, and exact probability values.