Newborns placed skin-to-skin with their mothers show an inborn sequence of behavior similar to that seen in other mammals. The purpose of this study was to make a detailed exploration of hand movements and sucking behavior in healthy term newborns who were placed skin-to-skin on their mothers' chests, and to study maternal oxytocin release in relation to these behaviors.
Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were video-recorded from birth until the first breastfeeding. Video protocols were developed based on observations of the videotapes. Each infant's hand, finger, mouth, and tongue movements, positions of the hand and body, and sucking behavior were assessed every 30 seconds. Maternal blood samples were collected every 15 minutes, and oxytocin levels were analyzed by radioimmunoassay. A statistical test for establishing the relationship between maternal oxytocin levels and infants' hand movements or sucking behavior was developed.
Infants used their hands to explore and stimulate their mother's breast in preparation for the first breastfeeding. A coordinated pattern of infant hand and sucking movements was also identified. When the infants were sucking, the massagelike hand movements stopped and started again when the infants made a sucking pause. Periods of increased massagelike hand movements or sucking of the mother's breast were followed by an increase in maternal oxytocin levels (p < 0.005).
The findings indicate that the newborns use their hands as well as their mouths to stimulate maternal oxytocin release after birth, which may have significance for uterine contraction, milk ejection, and mother-infant interaction.
"The physiological reason is that women have similar reproductive physiology as other female mammals where, in undisturbed birth, uterine atony and therefore PPH is rare (Abrams and Rutherford, 2011). Left undisturbed, the newborn mammal remains in close contact with its mother (Nisbett and Glander, 1996; Fahy, 2008; Henry et al., 2009); immediately searches for the breast and suckles, causing oxytocin levels to peak in both the mother and newborn (Nissan et al., 1995; Matthiesen et al., 2001). For women, skin to skin contact and breast feeding (pronurturance) occur naturally when labour is peaceful and undisturbed – in that situation both the woman and baby are under the influence of the parasympathetic nervous and hormonal system; appropriately termed the state of 'calm and connect' (Uvnas-Moberg, 2013). "
[Show abstract][Hide abstract] ABSTRACT: Objective: to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH. Design: retrospective cohort study. Setting: two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia. Participants: after excluding women (n ¼3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n ¼ 7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX. Intervention: skin to skin contact and breast feeding within 30 minutes of birth. Measures: outcome measure was PPH i.e. blood loss of 500 ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted). Findings: after adjustment for covariates, women who did not have skin to skin and breast feeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breast feeding (aOR 0.55, 95% CI 0.41–0.72, p o0.001). This apparently protective effect of skin to skin and breast feeding on PPH held true in sub-analyses for both women at 'lower' (OR 0.22, 95% CI 0.17–0.30, po 0.001) and 'higher' risk (OR 0.37 95% CI 0.24–0.57), p o0.001. Key conclusions and implication for practice: this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have pronurturance during third and fourth stages of labour.
"The benefits of skin-to-skin contact for the mother include an increase in the level of oxytocin in response to the massage-like movements that the infant makes on the breast during presuckling . These movements may prepare the mother to provide milk, and are also a means for attachment with the newborn infant (Matthiesen et al., 2001). It has been suggested that increased levels of oxytocin may strengthen the mother's instinct to protect and care for her infant (Moore et al., 2012). "
[Show abstract][Hide abstract] ABSTRACT: Objective
To explore midwives’ experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section.
Qualitative interviews with semi-structured questions.
Setting and participants
Eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth.
Transcribed material was analysed and interpreted using qualitative content analysis. The analysis yielded the theme ‘fighting an uphill battle’.
Skin-to-skin contact was considered to be important, and something that midwives strove to implement as a natural element of postnatal care. However, in daily practice, midwives experienced many obstacles to such care, such as lack of knowledge among parents and other professionals about the benefits of skin-to-skin contact, the mother's condition after the caesarean section, and other organisational difficulties (e.g. collaboration with other professionals, lack of time). Introducing more skin-to-skin care was a challenge for the midwives, who sometimes felt both dismissed and disappointed when they tried to communicate the benefits of this type of care.
Skin-to-skin contact is not prioritised because many health-care practitioners are unaware of its positive effects, and their care reflects this lack of knowledge. There is a need for education among all health-care practitioners involved in caesarean procedures. Another difficulty is that many parents are unaware of the benefits of skin-to-skin contact. Maternity outpatient clinics need to inform parents about the benefits of such care, so mothers will understand the importance of skin-to-skin contact.
"The mechanism of the comforting effect of breastfeeding and KMC is likely related to the release of oxytocin [78,79]. Oxytocin has been referred to as the love hormone due to its role in affiliative behaviors [80-83]. "
[Show abstract][Hide abstract] ABSTRACT: Skin-to-skin contact (SSC) between mother and infant, commonly referred to as Kangaroo Mother Care (KMC), is recommended as an intervention for procedural pain. Evidence demonstrates its consistent efficacy in reducing pain for a single painful procedure. The purpose of this study is to examine the sustained efficacy of KMC, provided during all routine painful procedures for the duration of Neonatal Intensive Care Unit (NICU) hospitalization, in diminishing behavioral pain response in preterm neonates. The efficacy of KMC alone will be compared to standard care of 24% oral sucrose, as well as the combination of KMC and 24% oral sucrose.
Infants admitted to the NICU who are less than 36 6/7 weeks gestational age (according to early ultrasound), that are stable enough to be held in KMC, will be considered eligible (N = 258). Using a single-blinded randomized parallel group design, participants will be assigned to one of three possible interventions: 1) KMC, 2) combined KMC and sucrose, and 3) sucrose alone, when they undergo any routine painful procedure (heel lance, venipuncture, intravenous, oro/nasogastric insertion). The primary outcome is infant's pain intensity, which will be assessed using the Premature Infant Pain Profile (PIPP). The secondary outcome will be maturity of neurobehavioral functioning, as measured by the Neurobehavioral Assessment of the Preterm Infant (NAPI). Gestational age, cumulative exposure to KMC provided during non-pain contexts, and maternal cortisol levels will be considered in the analysis. Clinical feasibility will be accounted for from nurse and maternal questionnaires.
This will be the first study to examine the repeated use of KMC for managing procedural pain in preterm neonates. It is also the first to compare KMC to sucrose, or the interventions in combination, across time. Based on the theoretical framework of the brain opioid theory of attachment, it is expected that KMC will be a preferred standard of care. However, current pain management guidelines are based on minimal data on repeated use of either intervention. Therefore, regardless of the outcomes of this study, results will have important implications for guidelines and practices related to management of procedural pain in preterm infants.
ClinicalTrials.gov Identifier: NCT01561547.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.