Incorporating Theory and Review of the Literature: Breast Feeding/Provide Skin To Skin Initially After Birth
There are many theories that are involved in the nursing practice. These theories are usually in line with the mission of every health care provider which is to provide care to promote safety, health and the well being of a patient. Every health practitioner seeking to achieve these objectives must have high degree of alertness, care as well as responsibility. Additionally, he or she must also be ready to practice in an institution that promotes illicit action, competency and sound ethical conduct expected to be inhibited by all health providers. This is why In McKean (2012), says: “”A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.” (In McKean, 2012). This paper seeks to discuss the effects early skin-to-skin contact for mothers and their healthy newborn infants.
In many cultures across the world, babies are cradled naked and placed on their mother’s bare chest at birth. The main idea behind this was that skin-to-skin contact between a mother and her baby triggers neurobehaviors that lead to the fulfillment of basic biological needs of an infant (Annie et al, 2014). This is no longer the case more so in the western culture where babies are separated from their mothers once they are born only to be brought back to their mothers after being cleaned and dressed up and then taken to nurseries only to be reunited with their parent after four hours for feeding (Bigelow et al, 2014). According to mammalian neuroscience, this is prevents the invoking of these neurobehaviors and they may prevent initial interaction between a mother and her child straight from birth. Historically, it was argued that skin-to-skin contact between a mother and her child was necessary for the baby’s survival. However, this is no longer the case, and it has been argued that mother-infant separation after birth may interfere with early mother and baby interaction having many harmful effects. This review of the literature was carried out to investigate if indeed there are any effects of skin-to-skin contact between a mother and her infant’s behavior, health or even breastfeeding.
According to a research carried out by Fox et al, (2015) it was recorded that babies that were exposed to skin-to-skin contact with their mothers post birth responded more to their mothers and also tended to cry less than babies that receive the usual hospital care. Fox et al (2015) argued that this may be because of many reasons, with the most primary one being that a baby gets used to its mother’s vibrations while in the womb; hence they calm the baby down even after going through the process of birth. Ludington & Morgan (2014) also argue that there is a fact that after exposing babies to skin-to-skin contact, mothers are more likely to breast feed for longer times especially in the first three months than those exposed to the routine hospital care. Additionally, these authors say that babies exposed to skin-to-skin contact with their mothers are more likely to have better relationships at an early age although it is difficult to measure the exact extent of this measure. Schafer & Genna (2015) also argues that mother-infant skin-to-skin contact reduces infant crying, provides cardio-respiratory stability. Research shows that exposing babies’ skin-to-skin with their mothers has no adverse effects on either party.
Today, this practice is not as common as it used to be before the 21st century. This is because while babies used to be born in more traditional environments where mothers giving births could do so at home with the help of a qualified midwife, this practice now takes place in a hospital environment. During post-delivery in the hospital environment, the infant is usually taken to a separate room (a nursery) for cleaning and other medical checkups follow before it is handed back to its mother (Orun, Yalcin & Mutlu, 2013). This is different from the traditional practices after child birth where neonatal survival was mainly concerned with close and continuous maternal contact. According to mammalian biology, y argues that it is necessary to maintain the maternal milieu after a birth so as to elicit innate behaviors. This is more so to promote the mother-infant bond that encourages successful breastfeeding ensuring the survival of a baby. When babies are separated from their mothers, this milieu is severed leading to distress. Infants express this distress through cries and other protest-despair behaviors. Licat et al (2014) argue that human infants that are separated from their mothers tend to cry at least 10 times more than those exposed to skin-to-skin contact with their mothers during early development stages.
Hane et al (2015) also argue that infants who are exposed to skin-to-skin contact with their mothers employ a specific set of innate behaviors immediately after birth. Mammalian biologists teach that even puppies or even rat pups develop the same kind of behavior shown by humans when exposed to skin-to-skin contact with their mothers. These authors argue that all mammalian infants can localize the nipple of their mother through a heightened response to odor and by smell a few hours after delivery. Schafer & Gena (2015) state that there are nine innate behaviors that are followed by all mammalian infants after birth and he discusses them as follows. The first behavior is that an infant has to cry after birth, then relaxation, opening the eyes or the awakening, activity (this involves things like rooting, looking at the mother and breast, hand to mouth movement followed by soliciting sounds), a second resting phase, searching for the nipple, licking and suckling and finally falling asleep. Schafer & Gena (2015), describes this as a sensitive period which allows a mother and an infant to develop a harmonized and well synchronized interaction pattern as long as both of them are in intimate contact. These authors suggest that infants who are allowed to have skin-to-skin contact with their mothers and then become self-attached to the mother’s breast nurse more effectively and at an early stage other than those who are first taken to “a strange world” only to be brought back to their mothers with little to no skin-to-skin contact.
According to Price et al (2015) skin-to-skin contact between a mother and an infant is vital because it acts sensory stimuli through warmth, touch and odor. These aspects affect the release of many maternal hormones such as Oxytocin. This hormone makes the skin temperatures of the mother rise creating comfort as well as warmth necessary for calming an infant. When a mother is in a comforting environment such as her home, and an infant is exposed to skin-to-skin contact, it becomes calmer and more relaxed and ready to adjust to its new environment (Moore, 2013). However, if this is not the case and the infant believes to be in dangerous environment, stress mechanisms can be triggered as the baby focuses on survival through a theory called allostasis. The theory of allostasis can be perceived as the relationship that exists between psychological manifestations of illness and health, and psycho-neurohormanal responses. Moore (2013) is of the perception that allostasis is beneficial in its own manner because its main aim is to try and balance any aberrant physiological responses.
This review and application of this theory is significantly important because many westernized countries continue to separate infants from their mothers at birth. This is when there is mounting evidence to shows that this practice may affect the development as well as the behavior of an infant. Research shows that postpartum hospital routines can significantly affect early maternal-infant development because they disrupt aspects such as breastfeeding. The notion in this aspect is that this separation can be stressful for an infant and it can lead to persistent harmful effects throughout the existence of an individual (Feldman, Rosenthal & Eidelman, 2014). Additionally, there are also concerns brought about by the fact that breastfeeding among women has been on a significant decline and this is a concern for public health. Everybody knows the power of first impression in everything that we do in life. This is the same with babies especially when they are placed on their mothers bare chest forth thing after birth. Researchers argue that thee first impression we give to a baby after birth may have short term as well as long term effects on the baby. According to Feldman, Rosenthal & Eidelman (2014), babies who are exposed to skin-to skin contact with their mothers after birth experience a better transition in terms of temperature, respiratory as well as in terms of glucose stability. He also echoes that word of Moore (2013) that they also tend to cry less showing reduced levels of stress in their new environment.
Accoding to Moore et al (2012) skin to skin contact between the mother and the infant also affects mothers. These authors argue that mothers who hold their babes on their bare chest after birth also show more confidence and also inhibit maternal behaviors after birth. They also tend to breastfeed for longer hours and tend to enjoy holding their babies for the first 10 years of development. Research continues to shows that separating a mother and infant immediately after birth for whatever reasons has many negative effects brought about by this separation. After an infant has been in the womb for around 266 days, it is advisable that even when it comes to the outside world should be exposed to its mother more so because it had been used to a rhythmic and intuitive heartbeat pattern with its mother; hence it should be welcome the same way into this strange world. Normal infants are born with intuitive ability to locate the nipple and even adjust to their new environment as long as they feel the comfort of their mother around them. This point makes a lot of sense because our first impression after being born is dictated by the kind of welcome we receive. Every culture has a way of welcoming new babies into this world after birth, but they all hold this moment as a sacred moment that is honored and cherished by every individual in the family and the whole community.
Hane et al (2015) say that when the baby is in the womb, it has the luxury of all of its needs being met. This is whereby the placenta and the uterus provides protection, warmth, oxygen, nutrition as close as well as continual proximity to the heart as well as the voice of the mother. Therefore, one can argue that a mother’s womb can be perceived as the “natural habitat” for any unborn infant. After the baby is born either through a caesarean or a vaginal birth, all this changes and they only thing that can related to the familiarity is skin to skin contact with the mother. According to Dollberg et al, (2013) the warmth of the mother’s breasts as well as the warmth of the body takes over the function of the placenta and the uterus immediately after birth. They tend to provide the feeling of protection, warmth, and support for optimal oxygenation, nutrition and also close proximity to the voice as well as the heart beat of the mother. Therefore, skin to skin contact with the mother creates a sense of security and familiarity to the womb making the baby to feel calm as it gets used to the new environment. This creates a sense a new “natural habitat” where all of the infant needs are met.
This can be seen in all mammals for babies will always be in less distress when they are within the proximity of the mothers’ heart, voice and breast where they feel there are provided with warmth, comfort and protection among other important aspects of development (Moore, 2013). Everywhere one looks in the relationship between mammals and their mothers, newborns and their mothers are in comfort when they in close skin to skin contact with each other and this should be no exception for humans. As a matter of fact, one can argue that nature is very wise for it provides instincts that tend to provide intuitive instincts that facilitate the development of behaviors that can assure survival of all species. There are many documents advantages that come with mother-infant skin to skin contact.
Accofing to Orun, Yalcin & Mutlu (2013), mother-infant skin to skin contact provides a platform for improving physiological stability for both infant and the mother. This is more so at a time when a baby is significantly vulnerable after birth. This skin to skin contact between mother and an infant supports infant brain development, increases chances of maternal attachment behaviors between a mother and the infant, and also promotes initiation of the first time breast feeding. This skin to skin contact between a mother and an infant leads to increased breastfeeding initiation for the first time as well as increased duration rates. According to Ludington & Morgan (2014) skin to skin contact between a mother and an infant leads to the stabilization of an infant’s oxygenation and respiration rates and also the increase of glucose levels reducing hypoglycemia.
These authors also say that it also helps in maintaining an infant’s optimal temperature for an infant is provides with just as much warmth as it was enjoying in the womb. They also says that other benefits includes regulation of blood pressure, reduction of stress hormones, and increases quite alert state for it reduces crying and other discomforts. They analyze this through the aspect of thermal synchrony, a phenomenon where temperature levels of the mother’s chest heightens to warm a cold baby in the new environment, and it can also decrease to cool down an overly warm infant. This phenomenon is very common among in the kangaroo species and it is believed to perform that same way in humans. Human infants who had just exited the warmth and the comfort of a mother’s womb to an a much cooler extra-uterine environment which is mostly wet and easily chilled need close and optimal contact with their mother for comfort and encourage physical and emotional development. Accoding to Schafer & Genna (2015) infants who are held by their mothers usually inhibit higher glucose and temperature levels that the ones that are left alone under clothing meant to keep them warm.
The most import aspects of this theory in skin to skin contact between a mother and an infant is that it leads to enhanced maternal attachment behaviors (Annie et al, 2014). These authors argue that maternal attachment is vital in development of newborns in a new environment where the most entrusted companion is their mother. In mammals, nature has provided numerous biochemical activators that veer the brain of both the mother and the infant towards increased maternal care giving practices. For instance, there are specific hormones which are responsible for enhancing maternal attachment between a mother and an infant and they can be enhanced by skin to skin contact between them. A good example in this case would be oxytocin which is sometimes referred to as the “love hormone” for it is believed to enhance relaxation, facial recognition, attraction, and also all other maternal behaviors (Feldman, Rosenthal & Eidelman, 2014). All these are important aspects that dictate a lot on the survival of an infant. Research shows that oxytocin is increased during mother-infant skin to skin contact and it tends to spike in levels whenever an infant touches a mother’s breast.
There have been many researches done in relation to this phenomenon in the last few decades. A research conducted in 2002 revealed that mother who had as little time as 10 minutes to have skin to skin contact with their newborns were more compassionate than mothers who just viewed their babies after birth and then taken to nurseries only to be reunited four hours later for feeding (Bigelow et al, 2014). This research also showed that the mothers who had skin to skin contact with their babies were also more confident in handling their young ones. They were also more caring and comforting and they tended to kiss their children more often than those who had been separated with their babies at birth without any skin to skin contact. This research revealed that these results tended to last well beyond the neonatal period for even up to three months, the mother who had skin to skin contact after birth spent more time with their babies. They also demonstrated more maternal attachment behaviors such as constant touching, kissing, mimicking and speaking behaviors, baby holding and kept more follow-up appointments with their care providers and also breast fed their babies for longer times (Aghdas, Talt & Sepideh, 2014).
Price et al (2015) also argue that skin to skin contact tends to protect both mother and child from the threats and the negative effects of separation. These authors argue that a mother should always interact with their babies and this promoted by the first impression that occurs when a mother holds the baby for the first time. Moore (2013) also argues that a baby is alert and fixated on the mother’s face especially if it has not been exposed to excessive medication. This is usually evident to all people who are present immediately after delivery. This is because an infant and the mother are literally one organism until the cord is cut. Several months later the baby and the mother are still one organism and this can be promoted by mother-infant skin to contact.
Aghdas, K., Talat, K., & Sepideh, B. (2014). Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial. Women and Birth, 27(1), 37-40.
Annie Yoon, S., A. Kelso, G., Lock, A., & Lyons-Ruth, K. (2014). Mother–Infant Joint Attention and Sharing: Relations to Disorganized Attachment and Maternal Disrupted Communication. The Journal of genetic psychology, 175(6), 494-510.
Bigelow, A. E., Power, M., Gillis, D. E., Maclellan‐Peters, J., Alex, M., & McDonald, C. (2014). BREASTFEEDING, SKIN‐TO‐SKIN CONTACT, AND MOTHER–INFANT INTERACTIONS OVER INFANTS’FIRST THREE MONTHS. Infant mental health journal, 35(1), 51-62.
Bigelow, A., Power, M., MacLellan‐Peters, J., Alex, M., & McDonald, C. (2012). Effect of Mother/Infant Skin‐to‐Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(3), 369-382.
Dollberg, D., Feldman, R., Tyano, S., & Keren, M. (2013). Maternal Representations and Mother-Infant Relational Behavior Following Parent-Infant Psychotherapy. Journal of Infant, Child, and Adolescent Psychotherapy, 12(3), 190-206.
Feldman, R., Rosenthal, Z., & Eidelman, A. I. (2014). Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biological Psychiatry, 75(1), 56-64.
Fox, N. A., Snidman, N., Haas, S. A., Degnan, K. A., & Kagan, J. (2015). The relations between reactivity at 4 months and behavioral inhibition in the second year: Replication across three independent samples. Infancy, 20(1), 98-114.
Hane, A. A., Myers, M. M., Hofer, M. A., Ludwig, R. J., Halperin, M. S., Austin, J., … & Welch, M. G. (2015). Family Nurture Intervention Improves the Quality of Maternal Caregiving in the Neonatal Intensive Care Unit: Evidence from a Randomized Controlled Trial. Journal of Developmental & Behavioral Pediatrics, 36(3), 188-196.
Licata, M., Paulus, M., Thoermer, C., Kristen, S., Woodward, A. L., & Sodian, B. (2014). Mother–infant Interaction Quality and Infants’ Ability to Encode Actions as Goal‐directed. Social Development, 23(2), 340-356.
Ludington-Hoe, S. M. (2015). Skin-to-Skin Contact: A Comforting Place With Comfort Food. MCN: The American Journal of Maternal/Child Nursing, 40(6), 359-366.
Ludington-Hoe, S. M., & Morgan, K. (2014). Infant assessment and reduction of sudden unexpected postnatal collapse risk during skin-to-skin contact. Newborn and Infant Nursing Reviews, 14(1), 28-33.
Moore, E. R. (2013). Early Skin‐To‐Skin Contact for Mothers and Their Healthy Newborn Infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(s1), S86-S86.
Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5(3).
Örün, E., Yalçın, S. S., & Mutlu, B. (2013). Relations of maternal psychopathologies, social-obstetrical factors and mother-infant bonding at 2-month postpartum: a sample of Turkish mothers. World Journal of Pediatrics, 9(4), 350-355.
Price, K., Weaver, J., Tribbett, S. B., & Carpenter, C. (2015). Using the Lean Process to Achieve Skin‐to‐Skin after Cesarean Births. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(s1), S16-S17.
Price, K., Weaver, J., Tribbett, S. B., & Carpenter, C. (2015). Using the Lean Process to Achieve Skin‐to‐Skin after Cesarean Births. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(s1), S16-S17.
Schafer, R., & Genna, C. W. (2015). Physiologic Breastfeeding: A Contemporary Approach to Breastfeeding Initiation. Journal of Midwifery & Women’s Health, 60(5), 546-553.