Practicing skin-to-skin contact is not exclusive to the early hours of postpartum, but this can be performed at any time in the newborn’s life. It is a practice that is considered safe under normal conditions, but it is not without risk, with sudden unexpected postnatal collapse (SUPC) being the most worrisome. The presence of a pathology or medications are the main factors that increase the risk of this condition. Therefore, it is essential to perform skin-to-skin contact after birth safely, knowing the conditions that may increase the risk and offering health education to the family to avoid these situations.

What is sudden unexpected postnatal collapse?

The definition of SUPC varies slightly depending on the author. It is generally described as any situation that causes temporary or permanent stopping of breathing or cardiorespiratory failure in a healthy-term newborn, where other possible medical conditions are excluded. Falling down is also another cause for concern in the immediate postnatal period.

The incidence rate is estimated at 2.6 to 133 cases per 100,000. But as the hours of life pass, the risk decreases. Several authors agree that most events occur within the first 2 hours of life. Then the risk decreases as time passes, with events extending into the first week of life.

Regarding it’s risk factors, particular caution should be taken in those mother-infant dyads with any of the following situations:

Maternal situations:

• Medication such as general anesthesia, sedative analgesia, magnesium sulfate, and so on have been given to the mother.
• Substantial maternal fatigue and tiredness
• Distractions (for example, the mother interacts with a mobile phone).

Neonatal situations:

• When the baby needs reanimation.
• Low Apgar score (less than 7 at 5 minutes)
• Dystocic delivery or prolonged expulsion

Frequent monitoring of the newborn’s breathing, activity, color, tone, and position by trained healthcare professionals can prevent breathing obstructions and sudden collapse. It is also essential to provide this information to the birth partner of the mother-newborn dyad. Although they do not replace the role of healthcare professionals, they can collaborate in this observation.

Regarding the positioning of the baby during skin-to-skin contact, it is recommended:

• The face of the newborn should be seen.
• The nose and mouth of the baby are not covered
• The baby’s head is turned to one side, with a straight neck.
• The baby’s shoulders and chest are facing the mother.
• The baby’s legs are bent
• The baby’s back is covered with a warm cloth

If the mother needs rest, she can maintain skin-to-skin contact with her baby while her birth partner is with her, who actively and carefully monitors both.

After the birth, a mother and newborn should never be left alone, so active care participation of the birth partner is important. Information aimed at a continuous assessment of the newborn needs to be provided so that the warning signs to watch out for are explained. They are changes in breathing, changes in the color of the skin or lips, or changes in the baby’s muscle tone, and the partner needs to be instructed on how to report these warning signs when they are observed. Healthcare professionals must ensure that the partner understands the instructions, and healthcare professionals must be kept up to date.

However, preventing sudden unexpected postnatal collapse and the risk of falls depends primarily on healthcare professionals. They must be up to date, they need to actively participate in the monitoring of the mother-newborn dyad, and involve the birth partner or companion by providing adequate information according to the needs of each individual family.

 

References:

1. WinterL, GoldsmithJP, AAPCOMMITTEEONFETUSAND NEWBORN, AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics. 2016;138(3):e20161889 
2. Jenik A, Rocca Rivarola M, Grad E, Machado Rea ES, Rossato NE. Recomendación para disminuir el riesgo de colapso súbito e inesperado posnatal. Arch Argent Pediatr 2020;118(3):S107-S117
3. Matthijsse PR, Semmekrot BA, Liem KD. Huid-op-huidcontact en borstvoeding na de geboorte [Skin to skin contact and breast-feeding after birth: not always without risk!]. Ned Tijdschr Geneeskd. 2016;160:D171. Dutch. PMID: 27484419.
4. Grupo de trabajo de la Guía de Práctica Clínica sobre lactancia materna. Guía de Práctica Clínica sobre lactancia materna. Ministerio de Sanidad, Servicios Sociales e Igualdad; Agencia de Evaluación de Tecnologías Sanitarias del País Vasco-OSTEBA, 2017. Guías de Práctica Clínica en el SNS