Early skin-to-skin contact boosts breastfeeding in premature babies

More premature babies who had early skin-to-skin contact with their mother were being breastfed at the time of discharge from hospital and for up to one year afterwards. However, this is far from the only benefit.

A team from St. Olavs Hospital and the Norwegian University of Science and Technology (NTNU) have looked at this issue in a number of articles. They now hope that more hospitals will change their practice so that premature babies are not separated from their mother during the first few hours after birth.

The first few hours after birth are an early sensitive period. During this period, the first contact between mother and child is established."

Laila Kristoffersen, Associate Professor, Department of Public Health and Nursing at NTNU

The research team at NTNU and St. Olav's Hospital in Trondheim have therefore investigated whether immediate skin-to-skin contact after birth for very premature babies and their mothers has an effect on the child's development in both the short and long term.

Early skin-to-skin contact is standard practice for full-term babies

Healthy babies born after reaching full term are normally placed on their mother's chest immediately after birth. Skin-to-skin contact between mother and baby helps strengthen bonding, promote breastfeeding and reduce stress. However, this practice has not been as widespread for premature babies.

"Since premature babies often need medical care after birth, the standard practice is for them to be placed in an incubator and transferred to a neonatal intensive care unit," said Kristoffersen.

This results in mother and baby being separated for several hours, or in the worst case scenario, several days after birth.

From birth, premature babies are more vulnerable than full-term babies, as their brains and other organ systems are not fully developed. This makes it particularly important to facilitate early bonding and a gentle start in life," said Kristoffersen.

This is also in line with the latest WHO recommendations, which recommend immediate skin-to-skin contact for all premature babies.

In Norway, St. Olavs is one of very few hospitals to facilitate such a practice. However, the researchers believe that skin-to-skin contact immediately after birth is safe for babies born as early as week 28 of pregnancy. A normal pregnancy lasts around 40 weeks.

More mothers breastfeed after early skin-to-skin contact

The research team has published a number of articles from the study. The latest, published in JAMA Network Open, finds a link between early skin-to-skin contact and breastfeeding.

"More mothers who had skin-to-skin contact with their baby after birth were breastfeeding at the time of discharge from the neonatal unit and for the first year of their baby's life," said Kristoffersen.

The research team considered a total of 108 premature babies born between twelve and eight weeks before full term. In one group, babies had skin-to-skin contact with their mother after birth, while the other group received the standard treatment, which involved being transferred to an incubator in a neonatal intensive care unit.

"Breastfeeding promotes the bond between mother and baby. It also protects against infections. Furthermore, breast milk contains vital nutrients, hormones and enzymes, which we believe are particularly beneficial for premature babies. We therefore consider these findings to be a good reason to facilitate immediate skin-to-skin contact, even for very premature babies," she said.

Long-term development

The researchers also examined the cognitive and motor development of the children after a period of two to three years, but found no difference between the groups in this regard.

"It didn't really surprise us that two hours of skin-to-skin contact after childbirth did not affect cognitive or motor development at two to three years of age.

Many factors affect the development of premature babies.

"It takes a lot for interventions like this to have long-term consequences that can be measured using the tools we have," said Kristoffersen.

In addition, all three neonatal units that were included in the study were good at facilitating early parent–premature baby interaction during the hospital stay.

"In this case, an intervention lasting two hours can only make a relatively small difference," said Kristoffersen.

Safe and wanted by their mothers

"The researchers have previously shown that immediate skin-to-skin contact following premature birth is feasible and safe for both mother and child. This is also true in the case of births through caesarean section," said Kristoffersen.

During the interviews, it also became apparent that the mothers themselves want to have close contact with their baby following a premature birth.

"The mothers said that having their baby on their chest after birth was important for early bonding and to promote a feeling of security and coping," she said.

"The positive effect of early skin-to-skin contact between mother and baby is accepted as a matter of course when a baby is born full term. There are good reasons why we should offer the same opportunity to vulnerable premature babies who we know are at greater risk of attachment problems and tend to face a variety of challenges relating to mental health and behaviour," concluded Kristoffersen.

At St. Olavs Hospital, the procedures were revised back in 2007, when they facilitated immediate skin-to-skin contact between mothers and premature babies from week 32 onwards (eight weeks before the due date).

Many years of experience at St. Olavs Hospital

"In 2014, we began the study where we have facilitated skin-to-skin contact for premature babies from as early as week 28 of pregnancy. These babies were born twelve weeks before their due date," said Kristoffersen.

Since the study was concluded in 2020, immediate skin-to-skin contact has also been the standard practice for babies born as early as week 28 of pregnancy.

She said that the staff are very experienced in dealing with babies who are in need of medical care in the form of simple respiratory support following premature birth, for example.

"This can be done without any problems when the child is lying on the mother's chest. In this way, we can ensure that premature babies and parents are also able to be together during that early sensitive period following birth

She and her colleagues hope the findings can help more people to see how important it is to revise the procedures that are followed when babies are born prematurely.