MYTH  “Preterm babies must be stable before they can start skin-to-skin contact”

FACT – It is the absence of skin-to-skin contact that makes the baby unstable.

This statement of fact is to me the most pressing and urgent issue in newborn care in this time. It applies of course to every newborn baby: it is mothers’ warm touch and safe pressure contact of her hug that provides the REGULATION that is necessary for the newborn baby. Since mother provides all the warmth needed, the baby has all those calories available to focus on growing. However, at birth and the first 1000 minutes that follow, it is TRANSITION which is the critical accomplishment of every newborn mammal. Quite suddenly and abruptly the placenta stops working, and the lungs must begin. In the process the heart pumps differently, no longer bypassing the lungs. The immune system must also kick in with full force, there is no more protection inside the womb. Key to this is the microbiome from mother, and from the breastmilk. This is one additional reason why suckling at the breast should begin before there is any separation of any kind.

It is the absence of skin-to-skin contact that makes the baby unstable. Mother provides a host of reassuring sensations, and the sum of them are necessary for the baby’s transition and wellbeing, both in the immediate present, as well as the far future. Maternal absence is the sudden removal of all the needed sensory stimulations that drive transition and regulation. Skin-to-skin contact provides simultaneously maternal smell, warmth, pressure contact, sounds of mothers heart and her voice, and movement.  To the newborn brain, absence of skin-to-skin contact means, “no mother, I am in severe danger”. This is traumatic to the newborn, and we do know that the infant is fully conscious at birth, “a small human being with all its senses developed open and receptive” (john Lind). The brain response is well-defined, first vigilance, then a state of fear with “freeze”, and then a state of terror with “dissociation”. But the maternal sensations also regulate the baby’s body: maternal absence leads to a rapid DYSREGULATION of the newborn.

So how different are preterm babies, and those born low birth weight? These are the ones that our current culture believes must first become stable before they can “tolerate” skin-to-skin contact. The science is absolutely clear, the clinical research evidence equally clear but less well known: the smaller the baby, the more it needs all the sensory input from the mother in order to stabilise. We use the word stabilise, but in the science it is first transition that is needed, and then ongoing regulation. It is failure of these fundamental physiological processes that lead to instability. I have provided a detailed science and evidence base position statement for this on my website for health professionals. Here you can also find references for 1500 clinical studies on skin-to-skin contact, all of which concur that “SSC is better”.

Premature babies are not in incubators because they are unstable.
Premature babies are unstable because they are in incubators.