1. Spatz, Diane L. PhD, RN-BC, FAAN

Article Content

Systematic reviews and meta-analyses have demonstrated the benefits of skin-to-skin contact (SSC) for both healthy term infants and infants requiring intensive care (Abdulghani et al., 2018; Conde-Agudelo & Diaz-Rossello, 2016; Moore et al., 2016). For healthy term infants, the most important benefit is facilitating the establishment of early and exclusive breastfeeding (Moore et al.). In the most recent Cochrane Review, women who participated in SSC versus standard contact were more likely to be breastfeeding at 1 to 4 months post birth (average risk ratio [RR] 1.24, 95% confidence interval [CI] 1.07 to 1.43; participants = 887; studies = 14; I2 = 41%; GRADE: moderate quality; Moore et al.).


Despite the benefits for establishment of breastfeeding, the worldwide prevalence of SSC remains quite variable from 1% to 98%, based on research representing 28 countries (Abdulghani et al., 2018). In the United States during the early months of the COVID-19 pandemic, some hospital practices negatively affected SSC. Data collected by the Centers for Disease Control and Prevention found that a mere 13.3% of hospitals encouraged SSC between mothers with suspected or confirmed COVID-19 (Perrine et al., 2020). Of great concern is that 14.0% of hospitals discouraged SSC and 6.5% prohibited SSC between mothers with suspected or confirmed COVID-19 and their newborns (Perrine et al.). Fortunately, as knowledge of COVID-19 has evolved, most of these restrictive practices have been modified.


Evidence for SSC in the form of kangaroo mother care (KMC) demonstrates a multitude of benefits for the infant and for breastfeeding. Kangaroo mother care is associated with a significant reduction in the risk of mortality (RR 0.60, 95% CI 0.39 to 0.92; eight trials, 1,736 infants), nosocomial infection/sepsis (RR 0.35, 95% CI 0.22 to 0.54; five trials, 1,239 infants), and hypothermia (RR 0.28, 95% CI 0.16 to 0.49; nine trials, 989 infants; Conde-Agudelo & Diaz-Rossello, 2016). Kangaroo mother care was found to increase weight gain (mean difference [MD] 4.1 g/d, 95% CI 2.3 to 5.9; 11 trials, 1,198 infants), length gain (MD 0.21 cm/week, 95% CI 0.03 to 0.38; three trials, 377 infants), and head circumference gain (MD 0.14 cm/week, 95% CI 0.06 to 0.22; four trials, 495 infants; Conde-Agudelo & Diaz-Rossello). Kangaroo mother care has a positive impact on exclusive breastfeeding at hospital discharge (RR 1.16, 95% CI 1.07 to 1.25; six studies, 1,453 mothers) and at 1 to 3 months' follow-up (RR 1.20, 95% CI 1.01 to 1.43; five studies, 600 mothers; Conde-Agudelo & Diaz-Rossello). Despite benefits of SSC for sick infants, overall prevalence of SSC for infants requiring intensive care also remains low. Many years ago, I developed an educational and training video for how to implement SSC for infants who are intubated. This video is available to institutions by contacting me.


Given the extensive supportive evidence on benefits of SSC for both healthy and sick infants, examine SSC practices in your institution. Track your SSC rates for healthy and sick infants and consider quality improvement initiatives to continually improve your SSC rates. There is need for more high-quality research on implementation of ideal SSC practices. Nurses should make sure SSC is a high priority as part of routine mother-baby care.




Abdulghani N., Edvardsson K., Amir L. H. (2018). Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review. PloS One, 13(10), e0205696.[Context Link]


Conde-Agudelo A., Diaz-Rossello J. L. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic Reviews, 2016(8), CD002771.[Context Link]


Moore E. R., Bergman N., Anderson G. C., Medley N. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. The Cochrane Database of Systematic Reviews, 11(11), CD003519.[Context Link]


Perrine C. G., Chiang K. V., Anstey E. H., Grossniklaus D. A., Boundy E. O., Sauber-Schatz E. K., Nelson J. M. (2020). Implementation of hospital practices supportive of breastfeeding in the context of COVID-19 - United States, July 15-August 20, 2020. Morbidity and Mortality Weekly Report, 69(47), 1767-1770.[Context Link]