With the first breath, the lungs expand, and gas exchange begins due to decreased lung resistance. Blood circulation is modified, and in the heart, the orifices and ductus that favor the passage of blood to the fetal brain close. This is a critical moment for the newborn, and it is essential that they are able to make this transition calmly and to the best of their abilities.

The transition to life outside the uterus is the time immediately after birth, which is facilitated by skin-to-skin contact. During pregnancy, lung function is performed by the placenta, as the lungs do not develop their function until after birth. The placenta provides this role in the uterus. The functioning of the heart is also different, and the blood circulation protects the important structures of the fetus. Just after birth, they begin to function as they will for the rest of their lives. This change is called the neonatal transition.

Skin-to-skin contact with the mother immediately after birth has been shown to be effective in this transition and provides great benefits, not only for the newborn but also for the mother.

For the mother, this includes:

• Faster expulsion of the placenta
• Reduced bleeding in the immediate postpartum period.
• Reduced maternal stress levels
• Increases breastfeeding self-efficacy.

In the newborn, it provides:

• Optimization of temperature regulation
• Decreased crying
• More optimal suction
• Earlier initiation of breastfeeding
• Decreased formula supplementation during the hospital stay

Having the newborn on top of her body brings calmness to the mother, it improves her vital signs and provides an important release of oxytocin, which reduces the risk of possible postpartum complications (where postpartum hemorrhage is the main complication) and contributes to the early initiation of breastfeeding and the mother-child bond.

In the newborn, being on top of the mother’s body favors thermal and metabolic stability, as well as its vital signs, and all this will facilitate the transition to extrauterine life.

Once the newborn is stabilized and adapted to life outside of the womb, skin-to-skin favors the appearance of a series of innate stages in all newborns, culminating in sucking at the breast and the onset of breastfeeding:

1. The birth cry, during the transition into respiratory function
2. Relaxation
3. Awakening, shows signs of activity, small movements of the head, arms and legs
4. Activity, where mouth- and sucking movements become more evident
5. Resting can be spread throughout the different stages
6. Crawling, more extensive movements to approach the breast
7. The newborn is getting familiar; the search and rooting reflexes can be observed
8. Sucking
9. Sleep: after around two hours of life, the newborn falls into a deep and restful sleep where they can stay for 6-8 hours in a row asleep.

Still, the usual practice in hospitals is to wrap the newborn in towels and offer it to the mother’s arms. And in the case of cesarean birth, newborns are sometimes routinely separated from their mothers for observation of adaptation or are given into the arms of the birth partner. But in both cases, unrestricted skin-to-skin contact with the mother immediately after birth, regardless of the route of delivery, should be the norm.

After birth, the newborn should be placed in the prone position, head to one side, on top of the mother’s abdomen or thorax. The newborn’s airways should always be clear. A warm towel should be placed over them. Early cord clamping is a technique that has also negative consequences in the transition to life outside of the womb for the newborn, so it is a practice that needs to be eradicated.

In the case of a cesarean, the same steps can be performed, although the clamping of the umbilical cord cannot be done in a physiological way. So, in this case, the steps to follow to be able to incorporate skin-to-skin contact in the operating theater are as follows:

• Placing the electrocardiogram electrodes in the shoulder area
• Releasing one sleeve of the nightgown to allow it to be opened, so the newborn can be positioned properly
• The blood pressure monitor and pulse oximeter can be placed on the same arm to allow the mother to hold her baby better
• The sterile blanket can be kept lower on the chest to allow space for positioning the newborn baby
• The newborn should be placed on top of the mother’s thorax, in a prone position, with the head tilted to one side. For greater stability and safety, the newborn can be placed along the mother’s thorax, with the head on the breast and the feet in the direction of the pubis. If this is not possible, it can be positioned transverse to the mother’s body, with the head on the mother’s breast.
• Before entering the operating room, the birth partner will be informed about the important aspects to consider when taking care of the mother and the newborn, making sure that the baby’s head is tilted and the lips are pink, and telling the team if there are any doubts.
• Both, mother and child will be covered with a warm towel over them.

References:

1. Widström AM, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019 Jul;108(7):1192-1204. doi: 10.1111/apa.14754. Epub 2019 Mar 13. PMID: 30762247; PMCID: PMC6949952.
2. Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016 Nov 25;11(11): CD003519. doi: 10.1002/14651858.CD003519.pub4. PMID: 27885658; PMCID: PMC6464366.
3. Feldman-Winter L, Goldsmith JP; COMMITTEE ON FETUS AND NEWBORN; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics. 2016 Sep;138(3):e20161889. doi: 10.1542/peds.2016-1889. Epub 2016 Aug 22. PMID: 27550975.
4. Ministerio de Sanidad. Guía de Práctica Clínica sobre Lactancia Materna. Administración de la Comunidad Autónoma del País Vasco; 2017. Disponible en: https://www.sanidad.gob.es/organizacion/sns/planCalidadSNS/lactanciaMaterna.htm 
5. Comité de Lactancia Materna de la Asociación Española de Pediatría; Contacto piel con piel en las cesáreas. Aspectos prácticos para la puesta en marcha. 2017. Disponible en: https://www.aeped.es/sites/default/files/documentos/201702-cpp_en_cesareas.pdf