Skin-to-Skin… The Fourth Stage of Labour

The first hour after the delivery of the placenta is known as the fourth stage of labour.

During this stage mum will hopefully be able to get comfortable with baby and spend at least an hour of undisturbed time together. Government guidelines suggest that:-

‘women should be encouraged to have skin-to-skin contact with their baby as soon as possible after birth’

And

‘separation of a woman and her baby within the first hour of the birth for routine postnatal procedures, for example weighing, measuring and bathing, should be avoided.’

Nice Guideline CG37 Published July 2006

After birth, if everything seems well, then the baby should be passed, still naked, onto the skin of the mother’s tummy or chest. This is called skin-to-skin. It is the best way for both mother and baby to adapt after the birth, and has many important benefits. Some of the benefits of skin-to-skin are:-

  • It reduces stress in both mother and baby. Babies who have spent at least an hour in skin-to-skin contact are significantly less stressed. This means their breathing and heart rate are more stable, they cry less, and when they start to feed, they digest their food better. The mother produces increased levels of hormones, such as oxytocin, which help her to feel relaxed and content.
  • Being close to mum will allow the baby to pick up some of the good bacteria that colonise the mother’s skin. Babies have been surrounded by amniotic fluid, which is sterile, so it is important that they pick up helpful bacteria after birth.
  • The skin of the breasts and chest of women can change temperature to keep the baby at the correct temperature. If the baby’s body temperature drops, then the mother’s skin temperature will increase to help the baby stay warm. This helps the baby to stabilise its temperature and not use resources trying to keep warm.
  • Skin-to-skin provides the ideal opportunity for the first breastfeed. If baby is left on the skin of the chest, it will begin to move towards the nipple, and will eventually latch on with minimal or no help.
  • Having the baby skin-to-skin will cause the mother to produce hormones including prolactin, which supports milk production, and oxytocin, which is important in bonding and relationship forming. A similar effect will be seen in the baby, with skin-to-skin causing a rise in oxytocin. This hormone surge helps the baby’s brain to organise its pathways to the interaction it receives. This is thought to influence relationships into adult life.
  • When a baby is placed on the mother’s chest or tummy, its wriggling movements stimulate the uterus to contract. This can help to reduce bleeding.
  • Skin-to-skin allows the baby to be close to woman’s face. This allows her to smell her baby, and also to kiss and ‘taste’ her baby. She will begin to ‘know’ her baby and will be attracted to her baby’s odour above others. Baby similarly will smell the mother. The baby already knows the smell of its amniotic fluid, and will be attracted to the mother’s nipple which releases an odour similar to the amniotic fluid. Babies are attracted to their mother’s chest even if they are not breastfed. They find the familiar smell calming, therefore reducing crying and stress levels.

 

If baby is not able to have skin-to-skin contact immediately after birth, then everything is not lost.

Some women do not feel able to handle their baby immediately, and might ask that the baby be placed on the bed so they can look at him/her first and begin to touch them and pick them up in their own time. Others might prefer their baby to be wrapped up and be passed to them or their partner so that they can unwrap them slowly when they feel ready.

In some circumstances it might be necessary to separate mother and baby straight after birth. If this happens, then skin-to-skin can be started as soon as possible once mother and baby are reunited. If it feels ok to the mother, then the father or birth partner can enjoy skin-to-skin with the baby in the meantime.

After birth the woman continues to produce elevated levels of hormones, and these are further raised by nurturing and holding her infant. The more she holds and feeds her baby the higher her hormone levels will raise, allowing her to bond with her baby and experience the same benefits as with immediate skin to skin.