Does Skin to Skin Contact Promote Breastfeeding in Neonates?

Breastfeeding

Back in the day, when babies were born in homes they were kept close to the mother following the birth. As society evolved and the deliveries started occurring in nursing homes or hospitals, the skin to skin contact (SSC) norm began fading away. Some introduction should be given about what SSC really is. SSC is basically when the naked new born baby is placed on the mother's bare chest subsequent to the birth. (Moore, Anderson, Bergman & Dowswell, 2012) Interventions were done on mammals to reveal how separation of the baby and mother went on to affect the baby.

The idea for the closeness for breast feeding came forward when this pattern was observed in animals. If the mammal delivery and post partum behavior is needed, then it is seen that the interactions of the mother and the pup for instance is mandatory. It is required because that encourages the mammal attaining milk from the mother thus leading it to survival. In case the animal is separated from the mother during this time, distress cries are heard which shows that they are affected. When this sort of behavior is observed in animals, something similar is also seen in humans as well. Babies who were placed in their respective cots as opposed to next to their mothers made more noise and were whining more as opposed to infants placed near their mothers. (Moore et al., 2012)

The reason why this research is an important one is due to the growing trend of separating mothers from babies after birth. The trend is still being continued despite the knowledge of benefits of post birth SSC. The procedures that carry on in the delivery room in the hospital after the delivery become an obstacle in close bonding between mothers and neonates. Breastfeeding is one of the close bonds that develop soon after birth. It has been stated that the baby has an adrenaline rush right after birth due to which he or she wishes to breastfeed right that instant. Since there is a possibility that the separation of child and mother after birth can go on to cause problems that persist throughout the life, then this needs to be looked into with more detail. (Moore et al., 2012)

Another reason why this study is being conducted is due to the growing amount of women turning away from breastfeeding. As it is known, breast feeding has many advantages. It is important for the emotional and intellectual growth of the baby. Apart from passing crucial immunization to the baby, it develops a bond between the mother and the child. After looking at the data taken up by the U.S. Food and Drug Administration in the years 2005 to 2007, it is has been revealed that 83% of the women started off breast feeding to their babies, however only 43% retained the activity during the hospital stay. (Moore et al., 2012) Out of all the studies done regarding the topic of skin to skin contact, the outcome that is being sought after is whether skin to skin contact does promote breastfeeding. Breastfeeding isn't as simple and easy as it looks. The baby has to develop a bond to his mother where as the mother needs to feel confident enough to be a good breast feeder. (Moore et al., 2012)

Population

The participants that were taken were mothers and their newborn babies. The babies were either full term or premature babies. In one of the study, the SSC was started in time less than 24 hours subsequent to birth. It should be noted that the mothers who were taken were of different race and gender and ages. This study represents a cumulative data of different studies carried out. No correlation or link was placed in any of the studies conducted. That is to say that the result of the reviews regarding this topic merely depended on the fact that whether the babies were given skin to skin contact or not.

As for the study for infant suckling competency, the population taken was from childbirth preparation classes. The study took place at Vanderbilt University Medical Center in Nashville in the labor and delivery unit. (Moore&Anderson, 2010) Overall description of the women was that they were older than 18 and did not have any medical problems from before. The women had neither a chronic illness nor a drug abuse problem. The population was also keen on having their delivery vaginally and they were also enthusiastic about having breastfeeding done for at least one month after the delivery. This was a significant factor as many women in the industrialized countries now prefer to put their babies on bottle as soon as their born. Their reluctance to not breast feed could end up in a limitation in the study thus leading to inaccurate results. Another major factor that was significant about this population was that all the babies were full term and they had to weigh more five pounds. Thus this gives an assortment in studies whereas the former study consisted of both pre-term and full term babies. The population chosen also went on to be more specific since the women had to be in for this experience for the first time. Since this study also went on to see the results subsequent to the birth, and then the presence of a previous breastfeeding experience or any other children at home would give inaccurate conclusions.

Another study was done which reviewed a collected forty right studies. The study was funded by the national institute of health. This study was again not homogenous such that it comprised of low birth weight infants, pre-mature infants and even babies on respiratory support. (Renfrew, Dyson, McCormick, Misso, Stenhouse, King & Williams, 2009)

The study to see the effect on Kangaroo Mother care was observed at four varied NICUs located hospital in assorted countries in Sweden. (Flacking, Ewald & Wallin, 2011) This study was different tin the sense that it only included the pre-term infants. That is to say that the babies selected had to be less than 37 weeks of gestation. The final set included of 300 babies out of which 103 were born before 32 weeks and 197 were born between 32 to 36 weeks. (Flacking, Ewald & Wallin, 2011)

Intervention

As mentioned earlier, the studies that were conducted on this topic compared the usual post partum behavior as opposed to SSC. It should be noted that SSC has to be done in a specific manner. Three categories were chosen to express the issues of SSC. Firstly, there was birth SSC in which the baby was placed in just a minute after birth. As mentioned earlier, the baby should be placed naked on mother's bare chest or abdomen. In this method, if suctioned was required it would be done so while the baby was on the mother. To make sure that the temperature doesn't drop, the infant's head was covered with a dry cap or back had blanket on top of it. The second intervention that was taken up was very early SSCs in which the contact begins 30-40 minutes subsequent to birth. In this scenario there was no requirement for a cap or not. The third and subsequent intervention in one of the studies was where the SSC could have been carried out any time between one to twenty four hours. (Moore et al., 2012) Again, emphasis was required to assure that the baby was naked and the contact that was carried out should have been from front of the body to front of the body. In medical terms, that is stated that contact should be ventral to ventral.

The interventions in one group of studies included simultaneous milk ejection from breasts in early weeks after delivery, the support of the community and the hospital, Kangaroo skin to skin contact, and staff training. (Renfew et al., 2009) A major interest was shown in how effective and supportive staff can really enhance SSC and eventually lead to beneficial results. Renfew et al., 2009)

The intervention of the study of KMC was done on what the parents filled out in the report. The parents were supposed to fill a form which states the duration and the onset of KMC between the mother and the baby. They had to keep a record of how it done and for how long the KMC was conducted. Subsequent to that nurses contacted the mothers via phone at the end of two weeks to ask about the breastfeeding progress. With gaps of two weeks, the results kept being collected from the mother at 2, 4 and 6 months of age of the baby. (Flacking, Ewald & Wallin, 2011) The questions specially focused on whether the infant took milk from the breasts or whether other methods were used or not.

Comparison

When the question of whether SSC promotes breast feeding comes up front, the study that was done a comparison of two types of post partum behavior. It is not in every hospital that the staff encourages SSC between the baby and the mother. Thus in the randomized trial conducted to see whether this phenomenon really works out, the comparison was placed between the usual post partum procedures and procedures which encouraged and supported the mother in SSC with the baby.

Outcomes

To trying to see the evidence, many outcomes are looked for after the studies. Breastfeeding was the one that our paper revolves around and this was depicted by how many mothers continued breastfeeding for one to four months after delivery. Another crucial factor that was looked into was that was the duration of breastfeeding. A secondary outcome that was part of the study was the effective breastfeeding and how much it actually went on to affect the baby. The maternal breast temperature at time of the skin to skin contact was seen. Another minor outcome that was looked into was the puffiness of the maternal breasts due to the skin to skin contact. Even though these factors were not significant to the question posed earlier in the discussion, but the studies also depicted the state of the mother and the infant. It was also observed whether the mother is sensitive to the infant's reactions and the sense of bonding that the two shared. It is true that breastfeeding and close contact affected the baby as well. Thus another result of the study that was looked into was how long was the baby crying or what weight changes were seen in the baby. (Moore et al., 2012) The main focus however was placed on the breast feeding results.

Another study was carried out to measure the outcomes of breastfeeding throughout one month. In doing so the outcomes were measured by the Infant Breastfeeding Assessment tool. (Moore&Anderson, 2010) This tool measured the sucking competency of the infants and which infants were likely to go breast feeding sooner. It had been proposed that skin to skin contact actually leads to the baby crawling towards the nipple and start breastfeeding him or herself. This could be due to the high levels of adrenaline measured earlier and the fact that he feels more closed to the mother. Thus the study basically had a controlled trial to see whether SCC affected the competency of the baby to suckle, it also went to elaborate whether SSC led to reduced problems mothers had to face while trying to get their child to breastfeed. (Moore&Anderson, 2010) The problems however were linked to the first month after delivery. Another thing that was looked at was what the status or level of breastfeeding was a month after.

Gaps in studies

The studies that were carried out did have some methodological gaps in them. The criteria established to consider the quality methodologically was not met in all of the studies. (Moore et al., 2012) Surely a low risk bias was maintained in most of the studies yet they didn't seem to have a significant impact on the results of the study. Thus it can be noted that the gaps in the studies do not affect their results as such. The gaps were also seen in this study because some of the women had to blind about this trial. Some studies found that hard to do as the women wouldn't feel comfortable with the interrogation and explaining the procedure wasn't easy to some as well.

Most of the studies reviewed showed the effects on mothers and babies short after delivery. Thus, the results went on to show the most immediate effects and the long-term affects are still not known. The data collected was valid and credible yet with the absence of long-term effects, this area of study still needs more work on it. (Renfew et al., 2009)

Conclusion

Out of the thirty four sets of studies done with a total of 2977 mother and infant pairs, all of them were qualitatively viable to be considered a review. The result of the overall studies showed that the breastfeeding status did improve. (Moore et al., 2012) All the other outcomes mentioned earlier were affected as well but will not be discussed in the paper. The overall result of the combined studies revealed that there was a relevant SSC effect to promote and cause breastfeeding right after birth. (Moore et al., 2012)