Rediscovering
Skin to Skin...Rediscovering
Skin to Skin...
Kangaroo mother method (KMM) rediscovered
for low birth weight and premature infants, as reported in the
INFACT Canada Newsletter, Winter 1993, is making a comeback (1) as an effective and inexpensive
partial replacement for traditional intensive neonatal care. Studies
(2) have reported benefits
in both developing and industrialized countries. Better survival
rates, improved ability to breastfeed, improved temperature control,
heart rate, breathing, growth and reduced respiratory infections
have been demonstrated. And a recent report (3) from Quito, Ecuador suggests that the benefits of
KMM may be even more effective in populations where breastfeeding
is not common. Significantly, reports of KMM breastfeeding outcomes
(2) describe improved prevalence, frequency
and duration, suggesting that the simple act of skin to skin contact
between a mother and her new infant has an important influence
on her ability to breastfeed.
Perinatal care for the full term infant and mother in the clinical setting is all too frequently based on routines facilitating institutional needs. Research (4) documenting the scientific basis for delivery practices, maternal care and nursery routines is sparse.
At the same time research in developmental neurobiology has advanced considerably over the past few years. Important observations (5) on the interaction between parent and offspring which have sensorimotor, thermal and nutrient-based impact on infant behaviour and physiology have been gained from studies with various mammalian species. Other research (6) has given us insights into the importance of early sensory stimulation on the development of the central nervous system, with its intricate wiring of neurons, axons, dendrites, synapses.
Although the basis of reproduction and care for the newborn mammal is essentially the same from species to species, our comprehension of human innate knowledge of child care and nurturing is scant. North American culture with its powerful influences of mass media and advertising allows for little or no transfer of traditional breastfeeding and childcare knowledge and skills. Our willingness to banish a newborn infant to a nursery at night and respond to its cries with a bottle of artificial milk is confirmation of our ignorance. Is this the response the newborn infant expects? What are the hormonal consequences? the neural, behavioural repercussions? the nutritional effects? Are they negative? What happens to a new mother's levels of oxytocin and other hormones when she is deprived of the sensory stimuli of touch, smell, sight and cry of her infant?
To remedy incompatible institutional practices, a different body of knowledge is needed. Practices must be based on the recognition that a newborn's critical physical and intellectual development and a mother's ability to breastfeed and nurture is shaped by a dynamic interplay of sensory and hormonal stimuli between herself and her newborn infant. The rhythmic heart beat, the matched sleeping and breathing patterns and easy access to nipple and nourishment cradles the new infant between birth and growing independence.
Well over 20 years ago Klaus and Kennell's (7) ground breaking research, demonstrated the importance of mother and infant physical contact immediately after birth and its impact on prolonging the duration of breastfeeding. Others since have found that infants who experienced skin-to-skin contact and suckling immediately post partum were breastfed for approximately 2 1/2 months longer than controls who received neither. Both the release of oxytocin and the sensory response to touch after birth when the areola and nipple are extremely sensitive have been cited as reasons for the positive effects. Still others have demonstrated the importance of sleep synchronicity when mother and baby pairs snooze together (an activity still hovering in the forbidden zones of childrearing). Clearly, this universal practice not only facilitates breastfeeding behaviour but also reduces the risk of sudden infant death (8), (9) .
The globally applicable Baby-Friendly Hospital Initiative has given us tools to relearn the innate and simple symbiotic act of skin-to-skin. Are we willing to learn?