The worldwide pandemic of Covid has made it rather clear that physical contact is necessary for our wellbeing. Not only adults need skin to skin contact, babies require it as a basic need, as shown by ample scientific research. It is even harmful to separate a baby from her mother after birth.
Picture by Foto Justine
The order for social distancing and limitation of social contacts as well as the fear of being infected with the virus that has settled in people’s minds, causes people to isolate themselves. Single and elderly people in particular experience the deprivation of physical contact. They suffer from what we call “hunger for touch”.
There is crushing scientific evidence that babies experience this as well. Skin to skin contact is a basic need of every human being. The younger this being is, however, the more vital the need becomes.
In this article I will describe why skin contact is not only a treat but a bare necessity for every newborn baby. I will also explain why separating a baby from its mother is harmful.
Go straight to
* We descend from primates carrying their young
* Skin contact is normal
* Skin-to-skin entails the right stimuli
* Weight loss by lack of skin contact
* How teen mums ‘discovered’ kangaroo care
* A dreadful experiment
* Skin to skin in practice
* The importance of skin contact for premature babies
* Separation is harmful
We descend from primates carrying their young
Human evolution may not have been all that straightforward, but whether we descend from homo habilis or homo erectus, all of our fore-mothers have massively invested in the care for their offspring. We do not descend from mothers who left their babies all by themselves in the cave or on a pile of chopped wood. If this ever happened, those babies cannot have but died from either the cold or from predators.
Some mammalians may leave their offspring behind sometimes, as is the case for rabbits or deer. In neuroscience this phenomenon is described as “separation tolerance”. A deer calf will instinctively stay very quiet and as invisible as possible when its mother leaves him for a moment to graze elsewhere. But with mammalians carrying their young (as is the case for all primates) this tolerance does barely or not exist. It is DNA-imprinted that such a situation is a very dangerous one; therefore the young will make himself heard loudly and clearly when abandoned.
A human baby is neurologically the least developed: he will develop more slowly and will show the most dependence to his carer for the longest time after birth – compared to other primates. The evolution of highly motivated carers allowed neurologically immature and vulnerable human babies to survive. This human baby needed to be close and carried continuously by his mother. Due to immature neurological structures, a baby was and is not capable of walking, crawling or following his mother – except with the eyes that is. From this evolutionary perspective we can understand how and why human mothers care for their baby and why such an investment is necessary.
Over two million years, the mother’s body has been the habitat for human DNA to develop. Our fore-mothers did not own cots, prams, nappies or accessories. Still their babies thrived, because the mother’s body provided everything the baby required.
Society may have changed a lot, yet our DNA remains roughly the same as it has been for thousands of years. The mother’s body is the only place where newborn human babies survive and thrive.
A baby born today has a blueprint to be carried continuously and to be in close contact with his parents for a considerable time..The physiological habitat of a human baby is his mother, and more specifically his mother’s skin.
Swedish paediatrician and neuroscientist Nils Bergman has done research for years on the importance of skin-to-skin contact in (premature) babies. The results of this research are freely available on his website, where this article highlights its most important findings.
Picture by Marijke Thoen
Skin contact is normal
Any parent of a newborn baby will confirm that the baby is most relaxed and at peace when he is in skin-to-skin contact with (either of) them. From a biological point of view it is considered abnormal to remove a baby from this space. Moreover, persisting in doing so causes stress: babies will immediately frown, wave their arms or start to cry. Continuous or chronic stress is harmful for the baby’s developing brain.
After birth, humans display certain behaviour leading to suckling – just like other mammals. Newborn babies also display this highly conserved neuro-endocrine behaviour. Without any help, they are able to crawl from the mother’s belly to the breast and start suckling. The only condition to make this behaviour possible, is that mother and child are not separated after birth. Therefore one may call the human skin more valuable than gold, as skin-to-skin contact during the first weeks of life outside the womb is way more than a brief moment or a treat.
Whether someone is living in the arctic or around the equator, human body temperature will remain both alike and stable around 37°C. This is not the case for a baby, however, as his thermostat is not yet regulated. Skin contact with the mother generates warmth, so the baby does not need to waste energy in keeping its temperature steady.
Picture by Marijke Thoen
Skin-to-skin entails the right stimuli
Mothers provide their babies with the first stimuli to set off the baby’s brain to work properly. Maternal stimuli regulate the baby’s heartbeat and blood pressure as well as his appetite and level of hormones. Compare the system to a car if you will: when you set the car at high revs, the engine will also use more petrol (energy) when in rest, causing it to malfunction more quickly Optimum maternal stimuli ‘teach’ the baby what the normal stress level is, and adds it to his programming. The more skin contact the mother-baby pair enjoys, the more easily the baby’s body will be able to return to the (default) rest mode in a later stage.
Stimulating the baby’s brain is of vital importance! A brain getting few or no stimuli will not be able to grow toward the complex organ we know. In a newborn’s brain, enormous amounts of neurons are present, ready to interlink. However, non stimulated neurons die.
In this respect birth and the first hours after are critical. The very first stimuli lay the foundation of a baby’s essential brain wiring:
- The mother’s scent (and that of her breasts in particular) fires specific stimuli to the frontal lobe of the baby’s brain.
- Direct skin contact sends signals toward the amygdala, whose job it is to ascertain the safety or danger of situations
- Skin contact stimulates the orientation to approach: “it is safe here”!
Skin contact will make sure the brain feels safe, and lead the baby to approach the breast and ensure sleep cycles.The first hour after birth, the so-called “golden hour”, should therefore be completely undisturbed for the mother-and-baby dyad.
Sleep
In the weeks following the birth skin contact remains equally important. Sin-to-skin makes sure REM sleep will take place during the phase of light sleep, and REM sleep contributes largely to the human brain’s development. During REM-sleep, polysensorial stimuli are sent to the brain, and they occur most often during skin contact. These stimuli link the neurons and so wire the brain by creating synapses. When more synapses are formed, the brain will be wired accordingly. Six to eight weeks post birth shows critical timing for these developing wires.
Picture by Marijke Thoen
Influence on the mother
Mother and baby are considered a dyad. The baby’s brain is not the only one being positively influenced by continuous skin contact: the same goes for the mother’s brain (and body). Around the time of birth, maternal neuroplasticity occurs, by which we mean that the brain is capable of creating new nervous paths and wires. Under the influence of pregnancy hormones the amygdala and hippocampus will show more elaborate crossways, becoming more forged through stimuli by the newborn baby. This will result in a larger network of dopamine and oxytocin in the brain’s reward centre. When this network is activated, the mother will be “addicted” to secure the baby’s wellbeing. Caring for her baby will be effortless and will remain the mother’s principal focus during the first weeks post birth.
Picture by Marijke Thoen
Weight loss by lack of skin contact
Separation of mother and baby disturbs physiology and makes the brain lose resilience. This may even cause the baby to not gain enough weight.
In all mammalian young the primitive brain drives two programmes: defense and feeding. Those programmes cannot function simultaneously. When a mammal’s young is separated from its mother, the defense mechanism is activated and stress hormones rise to high levels. When skin contact is reinstated, the level of stress hormones drop by no less than 74%, and the feeding system can get to work (digestion of food, gaining weight). When mother and baby are separated, higher levels of somatostatin are excreted into the blood. This hormone inhibits growth by limiting the blood flow to the bowel and decreasing the absorption of nutrients.
Often mothers fear their baby does not gain enough weight because they don’t produce enough milk, but this is not usually the case. We often see the mother is putting in extra effort to pump her milk and offer it as a complement in a bottle. But when the baby produces ample nappies of urine and poo and is satisfied and content after a feed, this is the best indication of sufficient milk intake. In the scenario of inadequate weight gain, the best solution may be to camp in bed for a couple of days to provide continuous skin contact with the baby. Very often the baby will start to grow faster and suddenly gain more weight.
The first clues for the positive effects after skin-to-skin contact were first seen in the nineteen seventies. In Bogota, Colombia, two doctors named Rey and Martinez, noticed that prematurely born babies of young, teenage mothers – who didn’t have the money to pay for care in a neonatal hospital unit – thrived better than those premature babies who were in an incubator in the neonatal unit.
Because for these mothers no better or more affordable options existed, the doctors swaddled the babies onto their mother’s body and sent them home this way. Much to their surprise, the babies proved to be happy and healthy: they gained weight faster than the premature babies on the neonatal unit. Because those swaddled premature babies reminded them of marsupials, Rey and Martinez called it the “Kangaroo Mother Method”, of which the name Kangaroo Mother Care stems.
Kangaroo care is not only important for premature or small for gestational age babies. Biologically speaking, human babies are immature at birth and dependent of the care of their mother for a rather long time.
A lot of research has been done about the importance of skin-to-skin contact between parents and their baby during the first hour after birth.
Consensus exists among doctors and midwives about the necessity of this ‘golden hour’. It has therefore been adopted in WHO guidelines. Many efforts are made worldwide not to separate mothers from their baby after birth. This is primarily the case in the so called BFHI hospitals, where women in labour are offered the space to birth the way they want (in the tub, on the birthing stool, …), and where the aim is to initiate breastfeeding immediately ad in optimum conditions. Rule of thumb here is undisturbed skin-to-skin contact during the first hour of life outside the womb.
Picture by Nele Watty
A dreadful experiment
In our western culture mother and baby are often separated after that first golden hour. We can wonder why, as there is no scientific evidence to prove that this separation is just and correct. It is primarily done as a routine. There is also no clear-cut randomised controlled trial available to demonstrate that this practice is “wrong”, even though medicinal experiments with other mammalians do show that separating a mother from its young is indeed harmful.
In human babies these types of experiments have not been performed. Or perhaps they have? In her book Plato & Cola of het geheim van jouw brein, professor Veerle Vissers-Vandewalle describes an experiment done in the USA in 1944. It shows the disastrous effects of separating parents and their babies. In the experiment forty newborn babies were divided into 2 groups. IN the first (experimental) group the babies were only provided with their basic needs, at least, according to what was then considered to be basic. They were fed, changed and given baths in warm water. The carers were explicitly requested to NOT touch the babies more than strictly necessary nor make eye contact with them. No facial or verbal communication with the babies and no interaction aside from taking care of the basic needs was allowed. In the second (control) group the babies received the same basic care but they were touched, cuddled and the carers communicated with them.
After four months the experiment was suspended, when half of the babies in the experimental group had died. The remaining babies in this group were immediately removed from the harsh setting but this did not prevent most of them to die. No physical cause of death was found. Scientists did notice that shortly before they died, the babies did not show any effort to communicate with their carers. They sort of slid in an extreme sort of apathy and passed away. The few babies surviving the experiment were psychologically damaged as well as mentally deformed. All babies in the control group were well and thrived.
It was a dreadful, gruesome experiment, yet in touch with a certain reality, as this happened often in many Romanian orphanages during the 1970 and 1980s. After the fall of Ceaucescu in 1989 images emerged of the terrible circumstances in which Romanian orphans used to live under his regime. The children’s brain was so retarded and under-developed, they were never to catch up on lost time and were damaged for life.
Skin to skin in practice
Listening to the baby’s heartbeat, checking his mouth, doing clinical observations… all this is possible while the baby is on the mother’s tummy after birth. Only there and then can we provide care that is in sync with human biology.
For partners, too !
Men cannot breastfeed, unfortunately perhaps. But men and partners in general, do own a well-functioning skin, serving perfectly as a baby’s home in the first weeks of life. Especially in (very) premature babies, partners should be involved routinely for Kangaroo care. It is very touching to see how partners respond to the skin contact with their baby, and in the long term develop an even more special bond with their child.
Skin contact is safe, when a few basic rules are adhered to:
- The baby’s airway should remain free and clear at all times
- The baby is in foetal position with maximum skin contact
- Baby’s back should be covered with a blanket or sheet
- No alcohol, tobacco or narcotic medication should be consumed prior to skin to skin contact
The importance of skin contact for premature babies
The more prematurely a baby is born, the less resilient he will be and the more skin-to-skin contact will be required. In practice, however, it is these babies who are more often separated from their mothers, although research clearly shows that kangaroo care is of vital importance, especially for preemies. In 2016 Pediatrics, the scientific magazine, published a meta-analysis of 1035 studies, concluding that the mortality rate in low-weight newborns receiving kangaroo care, was 36% lower compared to the standard care. Furthermore, kangaroo care proved to be beneficial in lowering the risk of neonatal septicemia, hypothermia, hypoglycaemia and hospital admittance while increasing exclusive breastfeeding. Newborns receiving kangaroo care have healthier breathing frequency and show less signs of pain. They have higher oxygen saturation levels and temperature, and their head circumference increases better.
Picture by Marijke Thoen
Separation is harmful
Strangely enough researchers still talk about “advantages” and “beneficial effects” of skin-to-skin contact between mother and baby, thus creating the perception that separating a baby from her mother is normal because it is the standard protocol to do so.
Research shows the perception needs to be the other way around.: continuous skin to skin contact with the carer should be considered the default.. Nils Bergman states as follows: “Based on the biological normalcy of skin contact, our western way of dealing with newborns is inferior and worse”.
Skin contact is not considered spoiling nor treatment or cure. It is not a medicine you can give your baby an overdose of. Skin contact is vitally important and separation of mothers and babies is disadvantageous and harmful.
Better choice of words would be “the disadvantage of non-skin-to-skin contact”. When babies are not in skin contact we notice:
- They are less able to keep their body temperature stable (and therefore waste energy in trying to maintain their temp)
- They have lower blood sugar levels (10,56 mg/dl lower)
- They have shorter breastfeeding duration and less parental bonding
- They experience more discomfort and pain during stimuli and interventions
- They have lower oxygen saturation
- They suffer more from apneus (respiratory arrest)
- They cry more
The previous points lead to the most important insight of the last decades. A newborn baby is largely part of the mother’s body, even after birth. In a baby’s cells there is a blueprint for a myriad of complex processes during his life, but the baby needs touch and proximity to help those capacities to develop and prevail.
The baby’s brain development depends on the care he receives. Upto a certain level the baby’s brain can be moulded or shaped. Human children (from 0 to 5 years of age) are probably the species who is most dependent on the care and they received as a baby.
Skin to skin contact provides your baby with a basic feeling of trust, allowing him to be more independent later in life. The tiny connection between nerve cells you made possible as a parent, the wire between nerve cells you formed by providing skin to skin, can make a huge difference later in life.
About the author
After studying languages and music academy in Brussels, Tom Van den Broeck decided to steer his career in the direction of midwifery. He started working as a self-employed midwife shortly after graduation, and combined this calling with a half- time position in the St Augustinus hospital in Antwerp at first. He worked on the delivery and maternity wards there for eight years. With three colleagues he set up a midwifery practice in Antwerp, “La Madrugada”, in 2008. Two years later he acquired the international IBCLC title as a lactation specialist and added this to his curriculum. Ever since, he has been into the physiology of the newborn and is a regular guest speaker during trainings and courses in the domain of midwifery and lactation.