Skin-to-skin contact - Baby Friendly Initiative (2023)

Skin-to-skin contact is a key part of the UNICEF UK Baby Friendly Initiative standards. It helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

What is skin-to-skin contact?

Skin-to-skin contact is usually referred to as the practice where a baby is dried and laid directly on the mother’s bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and can help boost a mother’s milk supply. Skin-to-skin contact is vital in neonatal units where it is often known as ‘kangaroo care’. Here it helps parents bond with their baby and supports better physical and developmental outcomes for the baby.

Why is skin-to-skin contact important?

There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers. The practice:

  • calms and relaxes both mother and baby
  • regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
  • stimulates digestion and an interest in feeding
  • regulates temperature
  • enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection
  • stimulates the release of hormones to support breastfeeding and mothering.

Skin-to-skin contact also provides benefits for babies in the neonatal unit, in that it:

(Video) Unicef UK Baby Friendly Initiative | Meeting baby for the first time

  • improves oxygen saturation
  • reduces cortisol (stress) levels, particularly following painful procedures
  • encourages pre-feeding behaviour
  • assists with growth
  • may reduce hospital stay
  • improves milk volume if the mother expresses following a period of skin-to-skin contact, with the expressed milk containing the most up-to-date antibodies.

What happens during skin-to-skin contact?

When a mother holds her baby in skin-to-skin contact after birth, it initiates strong instinctive behaviours in both. The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies’ instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother’s breast and achieve self-attachment, it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

After birth, babies who are placed skin-to-skin on their mother’s chest will:

  • briefly cry a very distinctive birth cry
  • enter a stage of relaxation where they display very little movement as they recover from the birth
  • start to wake up, opening their eyes and showing some response to their mother’s voice
  • begin to make small movements of the arms, shoulders and head; as these movements increase, the baby will draw up their knees and appear to move or crawl towards the breast
  • often rest once they have found the breast (this can often be mistaken as the baby not being hungry or not wanting to feed)
  • begin to familiarise with the breast after a period of rest, perhaps by nuzzling, smelling and licking around the area (this familiarisation period can last for some time and is important, so should not be rushed; try to remain patient and allow the baby to work out how to best attach themselves)
  • self-attach and begin to feed (it may be that mother and baby need a little help with positioning at this stage)
  • come off the breast once they have had a chance to suckle for a period of time. Following this, often both mother and baby will fall asleep.

Most term healthy babies will follow this process, providing it is not interrupted by anything, for example taking the baby away to weigh or the mother going for a shower. Interrupting the process before the baby has completed this sequence or trying to hurry them through the stages may lead to problems at subsequent breastfeeds. If the mother has been given a lot of analgesia during labour, the baby may be drowsy and this process can take longer.

(Video) Baby Friendly Practices and Immediate Skin-to-Skin Contact - Andrea Traynor, M.D.

Skin-to-skin contact in the Baby Friendly standards

The Baby Friendly standards require that skin-to-skin contact is valued and supported in hospitals.

Maternity units are required to ensure that:

  • all mothers have skin-to-skin contact with their baby after birth, at least until after the first feed and for as long as they wish
  • all mothers are encouraged to offer the first feed in skin contact when the baby shows signs of readiness to feed
  • mothers and babies who are unable to have skin contact immediately after birth are encouraged to commence skin contact as soon as they are able, whenever or wherever that may be.

Neonatal units are required to ensure that:

(Video) Baby Friendly Practices and Immediate Skin-to-Skin Contact - Andrea Traynor, M.D.

  • parents have a conversation with an appropriate member of staff as soon as possible about the importance of touch, comfort and communication for their baby’s health and development
  • parents are actively encouraged to provide comfort and emotional support for their baby, including prolonged skin contact, comforting touch and responsiveness to their baby’s behavioural cues
  • mothers receive care that supports the transition to breastfeeding, including the use of skin-to-skin contact to encourage instinctive feeding behaviour.

Safety considerations

Vigilance of the baby’s well-being is a fundamental part of postnatal care immediately following and in the first few hours after birth. For this reason, normal observations of the baby’s temperature, breathing, colour and tone should continue throughout the period of skin-to-skin contact in the same way as would occur if the baby were in a cot (this includes calculation of the Apgar score at 1, 5 and 10 minutes following birth). Care should always be taken to ensure that the baby is kept warm. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern.

Staff should have a conversation with the mother and her companion about the importance of recognising changes in the baby’s colour or tone and the need to alert staff immediately if they are concerned.

It is important to ensure that the baby cannot fall on to the floor or become trapped in bedding or by the mother’s body. Mothers should be encouraged to be in a semi-recumbent position to hold and feed their baby. Particular care should be taken with the position of the baby, ensuring the head is supported so the infant’s airway does not become obstructed

(Video) International Childbirth Initiative Step 12: Promote breastfeeding and skin-to-skin contact

Notes – Mothers

  • Observations of the mother’s vital signs and level of consciousness should be continued throughout the period of skin-to-skin contact. Mothers may be very tired following birth and so may need constant support and supervision to observe changes in their baby’s condition or to reposition their baby when needed.
  • Many mothers can continue to hold their baby in skin-to-skin contact during perineal suturing, providing they have adequate pain relief. However, a mother who is in pain may not be able to hold her baby safely. Babies should not be in skin-to-skin contact with their mothers when they are receiving Entonox or other analgesics that impact consciousness.

Notes – Babies

All babies should be routinely monitored whilst in skin-to-skin contact with mother or father. The following observations should be included.

(Video) Step 4 - Skin-to-skin contact

  • Checking that the baby’s position is such that a clear airway is maintained – observe respiratory rate and chest movement. Listen for unusual breathing sounds or absence of noise from the baby.
  • Colour – the baby should be assessed by looking at the whole of the baby’s body, as the limbs can often be discoloured first. Subtle changes to colour indicate changes in the baby’s condition.
  • Tone – the baby should have a good tone and not be limp or unresponsive.
  • Temperature – ensure the baby is kept warm during skin contact.

Always listen to parents and respond immediately to any concerns raised


What are the baby friendly initiative aims? ›

Baby Friendly works to support all families to develop close and loving relationships with their newborn and to understand the importance of this for their baby's development.

WHO guidelines for skin-to-skin contact? ›

Premature babies should be given skin to skin contact immediately after birth to improve their survival and health outcomes, the World Health Organization (WHO) said, in new guidelines published on Tuesday.

What are the benefits of skin-to-skin with baby? ›

The Benefits of Skin-to-Skin

Calms you and baby. Helps baby cry less. Releases hormones that relieve stress and stabilize baby's temperature, breathing rate, heart rate, and blood sugar. Releases a hormone that lowers mom's stress and promotes healing.

How effective is the Baby Friendly Initiative? ›

The review demonstrates that the Unicef UK Baby Friendly Initiative increases breastfeeding rates up until the age of six weeks and that this is consistent with studies conducted in other resource rich countries.

How will you show initiative to newborn babies? ›

Allow your infant the opportunity and time to play alone for short periods of time. Encourage this behavior by smiling and talking to your infant when he is playing independently. Encourage your infant when she is trying something new.

What is the importance of baby friendly? ›

Mother-baby Bonding Begins Immediately after Birth

Baby-Friendly hospitals commit to support nursing for newborns within one hour of their birth, because studies show that this helps mothers experience much more long-term breastfeeding success.

At what age is skin-to-skin contact beneficial? ›

Babies can benefit from skin-to-skin for months. Some experts recommend it for at least three months for full-term babies and six months for premature babies. So snuggle up with your baby and enjoy the experience of being a parent. JoLyn Seitz, M.D. is an obstetrician and gynecologist with Sanford Health.

Why is skin-to-skin contact important? ›

“The skin-to-skin contact causes a release in oxytocin—known as the 'love hormone'—in the mom. It helps the uterus contract, which reduces bleeding, and also warms up the mother's body, which comforts the baby and results in less crying and lower rates of hypoglycemia,” Crowe explains.

What are the 4 signs of good attachment? ›

Signs of an effective attachment
  • you are comfortable.
  • baby looks comfortable, relaxed and not tense, frowning or wriggling.
  • baby's mouth is open wide against the breast with nipple and breast in mouth.
  • baby's chin is touching the breast.
  • cheeks not sucked in.
  • baby has deep jaw movement with drinking.
18 May 2020

What is skin-to-skin contact called? ›

Skin-to-skin contact, also called kangaroo care, consists of placing your nearly naked baby (perhaps just wearing a diaper and a beanie) directly on your bare chest, skin to skin, with a blanket, gown, or shirt wrapped over you and his back for extra warmth.

How to do skin-to-skin contact with baby? ›

Skin-to-skin means your full-term, healthy baby is placed belly-down, directly on your chest, right after birth. Your care provider dries your baby off, puts a hat on him or her, covers him or her with a warm blanket, and gets your baby settled on your chest.

Why do babies need more skin protection? ›

The skin of all infants (not just those who have fair skin) is particularly vulnerable to sun damage. This is partly because they haven't yet developed all the melanin — the natural skin pigment that provides some sun protection — that they will have when they get older.

What is the most effective way babies learn? ›

Your child learns best by actively engaging with their environment. This includes: observing things, watching faces and responding to voices. listening to sounds, making sounds and singing.

Is Baby-Friendly evidence based? ›

Baby-Friendly practices are evidence-based and highly beneficial to both mother and baby when implemented properly. Baby-Friendly protocols are designed to support individualized care and appropriate clinical decision-making, not inflexibility or rigid adherence at all cost.

How many BFHI steps are there? ›

WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) in 1991 to help motivate facilities providing maternity and newborn services worldwide to implement the Ten Steps to Successful Breastfeeding.

How will you show your initiative to the children? ›

Be a helpful guide as children identify challenges, reflect on their choices, arrive at decisions, adjust strategies, and plans next steps. Listen and encourage. Be a role model. Show them how you get things done but don't do things for them that they can do for themselves.

How do you build initiative in children? ›

Children are expected to learn how to take initiative, not to just follow the rules, wait for someone to offer options but do the work themselves.
5 Mar 2021

What is an example of baby friendly care? ›

Giving infants no food or drink other than breast milk, unless medically indicated. Practicing “rooming in” — allowing mothers and infants to remain together 24 hours a day. Encouraging breastfeeding on demand. Giving no pacifiers or artificial nipples to breastfeeding infants.

What it means to be baby friendly? ›

Baby-Friendly Means a Verified Optimal Level of Care

The rigorous designation requires birth centers to have policies that enhance mother-baby bonding, offer optimal care for infant feeding and ensure a baby's nutritional needs are adequately met, regardless of whether a mom chooses to breastfeed or formula-feed.

What are 3 important items you need to care for a baby? ›

Baby Essentials for the First 3 to 4 Months

Baby linens, including crib and bassinet sheets, baby blankets, and swaddles. Babyproofing gear. Feeding gear. Diaper essentials.

Can you do skin-to-skin with clothes on? ›

In public, you can still simulate skin-to-skin time through babywearing. Even with clothes on both of you, your baby feels your warmth, enjoys your smell and can hear your heartbeat, all of which makes her feel cozy inside.

What age is skin care most important? ›

The Short Answer

So, starting a basic skin-care routine in your teens and 20s is a good idea. But, if you are older, it's not too late to start caring for your skin. Forming healthy skin-care habits and routines will help you at any age.

How long is the skin-to-skin contact? ›

This is according to a recent World Health Organization (WHO) study, which found that 90 minutes of uninterrupted skin-to-skin contact, where a baby is dried and laid directly on their mother's bare chest after birth, maximizes the chance for babies to be physically ready to breastfeed.

What happens if you don't do skin-to-skin? ›

Double The Risk Of Postpartum Haemorrhage

Women who did not have immediate skin-to-skin contact and breastfeeding were found to be twice as likely to experience a postpartum haemorrhage (PPH) than women who did have skin-to-skin contact and breastfeeding.

Why do toddlers like skin-to-skin contact? ›

“The brain likes comfort and associates comfortable things with whatever was happening in the moment,” says Kolari. Toddlers look for comforting sensations that were familiar to them as babies—sucking, touching, skin-to-skin contact—and find a way to repeat them.

Is skin-to-skin evidence based practice? ›

Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference.

What are the 7 stages of attachment? ›

Guest Blog from AC Education: The Seven Steps of Attachment Theory in Children
  • Claiming: birth – two years. ...
  • Attunement: birth – two years. ...
  • Affective attunement: birth – two years. ...
  • Impulse regulation: six months – four years. ...
  • Shame regulation: six months – four years. ...
  • Rage management: six months – four years.
24 Mar 2016

What are the 3 stages of attachment? ›

Stages of Attachment
  • Stranger Anxiety - response to arrival of a stranger.
  • Separation Anxiety - distress level when separated from carer, degree of comfort needed on return.
  • Social Referencing - degree that child looks at carer to check how they should respond to something new (secure base).
18 Aug 2022

What are the 4 infant attachment styles? ›

The major determinant of the infant's pattern of attachment (secure, avoidant, ambivalent, or disorganized) appears to be the quality of care the primary caregiver(s) provides.

Is skin-to-skin a nursing intervention? ›

Intermittent skin-to-skin care is widely recognised as a beneficial component of holistic care provision for both term and pre-term neonates. These benefits are just as important for all neonates in providing appropriate developmental care.

Is skin-to-skin beneficial for toddlers? ›

Child Development

According to the research1, skin-to-skin cuddles assist in brain development, help establish breastfeeding and even improve a parent's mental health. It all comes down to touch.

Does skin-to-skin help babies calm down? ›

The Benefits of Skin-to-Skin

Skin-to-skin time: Calms you and your baby. Helps your baby cry less. Stabilizes your baby's temperature, breathing rate, heart rate and blood sugar.

What causes baby skin problems? ›

Skin conditions in babies and kids may include rashes, hives, warts, acne, birthmarks and more. These conditions may be caused by dermatitis, viral infections, bacterial infections, fungal infections or other diseases. Treatment varies from anti-itch creams to pain relievers to antibiotics, depending on the condition.

How sensitive is baby's skin? ›

Baby skin is extremely delicate and much more sensitive than the skin of older children or adults. Babies don't develop a full skin barrier until they're around 2 years old, so their skin isn't able to maintain moisture levels and is less resistant to irritants.

What is the main purpose of essential newborn care protocols? ›

The ENC Protocol seeks to provide a firm foundation for an environment that complies with the “Ten (10) Steps to Successful Breastfeeding” of the Mother-Baby Friendly Hospital Initiative (MBFHI), breastfeeding initiation crucial to the IYCF WHO global strategy and in the implementation of the R.A. 10028.

What are the 10 steps to Baby Friendly designation? ›

  1. Step 1 – Policy, The WHO Code, BFI Monitoring.
  2. Step 2 – Employee Competency.
  3. Step 7 – Mother-Infant Togetherness.
  4. Step 8 – Cue-Based Feeding.
  5. Step 9 – Education Around Artificial Teats.
  6. Step 10 – Continuity of Care Between Hospital and Community.

What are UNICEF's aims? ›

UNICEF works for children around the world

UNICEF, the United Nations Children's Fund, works to build a better world for every child, every day, everywhere. UNICEF provides more children with clean water, life-saving food and vaccines, education and protection from violence than any other humanitarian organisation.

What is baby friendly services? ›

The Baby-Friendly Hospital Initiative (BFHI), a global program that was launched by the World Health Organization and the United Nations Children's Fund in 1991, recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding.

What are the 4 basic needs of a newborn? ›

Babies have the right to be protected from injury and infection, to breathe normally, to be warm and to be fed. All newborns should have access to essential newborn care, which is the critical care for all babies in the first days after birth.

What is the first priority in caring for a newborn? ›

With every newborn contact, respiratory evaluation is necessary because this is the highest priority in newborn care. The Silverman and Andersen index can assess respiratory distress and its varying degrees.

What are the five steps in newborn care? ›

➌ The 5 initial steps include the following: provide warmth, dry, stimulate, position the head and neck to open the airway, clear secretions from the airway if needed.

What are the 5 needs of the baby? ›

Kids must feel safe and sound, with their basic survival needs met: shelter, food, clothing, medical care and protection from harm.

What are 5 things a baby needs? ›

Top 10 things baby needs
  • Car seat. The infant car seat sits at the top of the list because, at the end of the day, the hospital won't let you take the baby home without one. ...
  • Crib or bassinet. ...
  • Formula or breastfeeding supplies. ...
  • Diapers and wipes. ...
  • Changing table or pad. ...
  • Bathtub. ...
  • Clothes. ...
  • Stroller or baby carrier.
2 May 2022

What are UNICEF's four priorities? ›

Describe UNICEF's vision and approach to programming with and for adolescents across the four programming areas: health and wellbeing, learning and skills, safety and protection, and civic engagement and participation in development and humanitarian contexts.

What are UNICEF's 5 focus areas? ›

We employ committed professional to work in our five focus areas: Child Survival and Development, Basic Education and Gender Equality, HIV/AIDS, Child Protection and Policy Advocacy and Partnerships.

What is the motto of UNICEF? ›

The story of UNICEF is that of every child we reach.

What it means to be Baby-Friendly? ›

Baby-Friendly Means a Verified Optimal Level of Care

The rigorous designation requires birth centers to have policies that enhance mother-baby bonding, offer optimal care for infant feeding and ensure a baby's nutritional needs are adequately met, regardless of whether a mom chooses to breastfeed or formula-feed.

When did Baby-Friendly start? ›

To improve worldwide breastfeeding initiation and duration rates, the WHO and UNICEF launched the Baby-Friendly Initiative (BFI) in 1991. The goal was to protect, promote and support breastfeeding by adherence to the WHO's “Ten Steps to Successful Breastfeeding”.

How should a carer talk to a baby? ›

Shorter sentences, speaking slightly more slowly and clearly, avoiding a high pitch and leaving spaces of silence for the hearer to cogitate before answering can all aid in the communication process.


1. Baby Friendly Initiative | Call to Action
(Baby Friendly Initiative UK)
2. Bringing Evidence to Practice: Introducing the Baby-Friendly Initiative
(BFI Strategy for Ontario)
3. Unicef UK Baby Friendly Initiative | Importance of relationship building
(Baby Friendly Initiative UK)
4. Unicef UK Baby Friendly Initiative | Communication in pregnancy
(Baby Friendly Initiative UK)
5. Kangaroo Care: Skin-to-skin after birth
(Summa Health)
6. The Baby-Friendly Initiative: Strengthening Indigenous Families and Communities
(BFI Strategy for Ontario)
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