Oct 7, 2015

Interview Transcript

Interviewer: The importance of skin-to-skin contact for mom and baby. You'll learn more about that next, on The Scope.

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You know, it seems like mothers are always looking for ways to ensure their baby is happy, and more importantly healthy. One of the simplest things you can do is also one of the best, it's simple skin-to-skin contact which doesn't necessarily always happen the way that it should.

We're talking beyond breastfeeding, by the way. Elizabeth Smith is a board certified lactation consultant at the University of Utah healthcare. Skin-to-skin contact with mom and baby sounds pretty basic, but for some reason we're talking about it so it must not be happening, why is that?

Elizabeth: It is happening but it's not always happening for every baby and every mom. And the reason that I want to talk about this is because for years, for about 10 years we've been really encouraging the skin-to-skin contact. We've been encouraging it because it helps so much with breastfeeding, and helps to get that relationship off to a good start. But what we fail or where we forget is that the moms who are not able to breastfeed and babies who are unable to breastfeed don't get that benefit all the time and it's so important for all of them to get it.

Interviewer: Okay so if a mother is chosen or is unable to breastfeed, that skin-to-skin contact needs to still happen. Where it's naturally happening if a woman is breastfeeding.

Elizabeth: Yeah, it's an automatic that if mom says she's breastfeeding we're going to get the baby skin-to-skin so that they can start that whole process and have it happen. But sometimes we forget if mom is not choosing to or if there is a medical reason why she's not, we forget that that is so important, and maybe even more critical for those babies.

Interviewer: Let me jump in and say if you have chosen to breastfeed you should continue to listen because there's still some good advice here as far as skin-to-skin contact, when it should start happening, how long, that sort of thing.

Elizabeth: Yeah absolutely.

Interviewer: Let's talk about the benefits for baby, and there's a lot of great research that supports what you're about to tell us.

Elizabeth: Yeah, the research is continuing to come out. It's daily that I get information about a new study that's been done, showing the benefits.
So what we know is that if a baby is put skin-to-skin on mom's chest right after birth, as soon as possible, then mom and baby are both going to have an oxytocin response. And so that oxytocin is going to help mom to calm and it's going to help baby to calm, which helps the transition for baby to being from inside the womb to breathing air. It's going to help with that, and then mom is also going to have some better benefits for the rest of the laboring process, as the placenta comes out, it's going to help with that.
So those are good benefits, and then baby will maintain a better body temperature, typically have glucose, respiration, heart rate, and all of those things that are so critical in the immediate after-birth period.

Interviewer: Okay so these numbers sound great that they've got better temperature, better glucose, but I mean does it really make a difference in the health of the baby?

Elizabeth: It does make a difference in the health of the baby long-term, but the other area that often times has not been studied as much, or doesn't get emphasized, is the colonization of the gut. And so by taking that baby and putting him or her on mom's chest, then what happens is an immediate colonization so that the flora of the gut is healthy, versus if we put that baby in a sterile environment or an unfamiliar environment, where it's going to change that flora.
And as we look at inflammation being as the cause of most disease, what we're finding is that if we can have that flora be good in the very beginning and that colonization happen, then we're going to have a long-term health benefit for that baby because of a decrease of inflammation through-out their life span.

Interviewer: So it's good for the baby, it's also good for the mom or are there other mom benefits?

Elizabeth: The biggest mom benefits are the calming of mom, the oxytocin released, the prolactin that gets released into her system. All of those things are going to definitely benefit mom.
Involution of the uterus so that it clamps down quicker and better. So involution is that the uterus does need to, it needs to get smaller after growing to the size of a baby, it now needs to go down to the size of a grapefruit in about five minutes. The oxytocin is really going to benefit her.

Interviewer: That's really crazy how skin-to-skin contact can invoke such a physical reaction, deep inside the mother.

Elizabeth: It's the hormones, they really work so well to have all of these biological responses happen. Interviewer: How soon should skin-to-skin contact happen? You had mentioned like, as soon as after-birth as possible, what does that even mean? Like as soon as it comes out, bam?

Elizabeth: That's what it means, we want the baby to go to mom's belly or chest as soon as possible. The cord length can determine where that baby is placed initially, and then should be brought up to the chest, because that's where you get the highest response. Mom has, her chest will actually get hot to heat that baby because of that oxytocin response.
So you want that to happen immediately. We also know that there are some times when a baby may not be medically stable, or mom may not be medically stable, and they might have to have separation. So in those instances, the baby should be brought to mom as soon as both, one or the other whoever, as soon as they're both medically stable and can be put in that skin-to-skin.
Now if mom is the one that is medically unstable, baby could be placed on dad, or an alternate care-giver so that that skin-to-skin contact can also have a benefit. I want to note to that, it's not quite as good as it is with mom, but it is still a benefit. Male care-givers can heat a baby, but they don't cool off the way a mom does, and so we can actually over-heat a baby by putting them on dad, so we want to just be careful, watching out for temperatures.

Interviewer: So even before the umbilical cord is cut, there needs to be skin-to-skin contact, how long does that go on then?

Elizabeth: So the skin-to-skin contact, we want it to happen for at least the first hour, up to two hours if possible in labor and delivery, and that should be uninterrupted skin-to-skin contact. So if grandmas, or aunts, or other people are coming into the delivery room, it really should be that mom is the one who is doing that skin-to-skin contact and we wait . . .

Interviewer: Yeah . . .

Elizabeth: . . . to pass baby around. Baby is going to go into a deep sleep after they get that initial rush from being born, and that's a good time for other people to be holding, and oohing and ah-ing over the baby.

Interviewer: Does that contact then need to continue even beyond this point?

Elizabeth: It absolutely should continue. Babies should skin-to-skin several to numerous times daily over the first few days and weeks of life. And then it also can be a good calming and soothing technique that parents can use even up to several months of life.

Interviewer: Is this happening in hospitals right now? I guess, I mean, I've never been in a delivery room, so I don't know.

Elizabeth: It is the standard of care in most hospitals, some do better than others, and as the research evolves it does happen frequently, but there are times that it does get neglected and sometimes when mom says she's not choosing to breastfeed, that gets overlooked, and it shouldn't. We still need to make sure that those babies are getting placed skin-to-skin with mom.

Interviewer: Okay. What can a mother do to ensure that things go smoothly during the delivery, I mean after the delivery to make sure that this does happen in the hospital? Because I mean you wouldn't know if your hospital is doing or not.

Elizabeth: The biggest thing to do is ask, and the majority of the time in Salt Lake, you're going to find that hospitals will say, "Yes we do that as a standard of care", but even with that yes as the answer, mom should still make sure that when she goes in for delivery that she lets the nurses and the care-givers know that that is important to her. Also her support person should be aware of that, so that as soon as the baby is born if baby isn't put right next to mom, that the care-giver can step in and say, "Oh, we want to have the baby on mom's chest," so that it does happen.

Interviewer: Trying to give our listeners some perspective here. Out of all the things that are going on before and during and after delivery, how crucial is it that this is one of the things that does happen?

Elizabeth: I think it's really one of the most important things that happens, and if the baby is put skin-to-skin with mom, then the transition is going to go better, baby is going to have that better adaptation, and it actually is a benefit to the care staff, because if they are not having to be as observant of a baby, taking that baby to a warmer and having to watch what's going on, then they can do everything else that they need to do post-delivery a little bit easier.
We've even had comments from nurses who have said this since we started doing that as our standard of care, that they have found that it is easier for everyone involved.

Interviewer: Any final thoughts, anything I forgot to ask? Or anything you feel compelled to say?

Elizabeth: I just want to say that this is the best thing for moms and babies, and that we need to make sure that it's a priority.

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