Skin to Skin contact and breastfeeding, kangaroo mother care

1. THE RATIONALE FOR SKIN-TO-
SKIN CONTACT AT BIRTH AND
ROOMING IN
DR VARSHA ATUL SHAH
Lecture 4

2. Skin to skin contact and Breast crawl
http://breastcrawl.org/video.htm

3. Skin to skin contact
• SSC positions build on the Tummy to Mummy
position
• The baby lying on top of the mother
• Mother does not have to hold the baby
• Gravity maintains baby position
• Baby’s chest is in close contact with mum’s tummy
• Unrestricted access to breast

4. Advantages of Skin to skin
contact- for baby
• Warmth- prevents hypothermia
• Comfort- baby cries less
• Metabolic adaptation- less hypoglycaemia
• Quality of attachment-bonding

5. Advantages of Skin to skin contact- for
mother
SSC releases oxytocin (hugging, love hormone)
•Expulsion of placenta
•Reduce post partum hemorrhage
•Makes mother calm
•Lower heart rate
•Higher pain threshold
•Higher social interaction
•Less anxious
•Reduces use of oxytocin, entomox
•and anesthetics for episiotomy suture

6. Rooming in

7. A hospital
arrangement where a
mother/baby pair stay
in the same room day
and night, allowing
unlimited contact
between mother and
infant
Slide 4.7.2

8. Rooming in
• Routine separation should be avoided.
• Separation should only occur for an
individual clinical need.
• If separation of a mother and her infant is
required because of a medical situation,
document the reason for this separation in
the mother/baby record

9. Rooming-in. Why?
• Helps establish and maintain
breastfeeding
• Baby sleep better and cry less
• Reduced exposure to infection
• Helps mother to learn about her baby’s
feeding and behavioral patterns
• Reduces costs
Slide 4.7.3

10. Helps establish and maintain
breastfeeding
• Study on effects of Rooming in on breastfeeding
frequency for first 24 hours.
• Findings: The frequency of breastfeeding per 24 hours
was significantly higher in rooming-in than non-rooming-
in infants from day 2 to day 7 (p<0.01).
• This study demonstrated that rooming-in infants had
significantly higher breastfeeding frequencies than non-
rooming-in infants during the first week of life.
Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding
variables. Acta Paediatr Scand, 1990, 79:1019.

11. Effect of rooming-in on frequency
of breastfeeding per 24 hours
Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-
in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990,
79:1019.
Slide 4.7.5

12. Effect of the maternity ward system
on the lactation success
of low-income urban Mexican women
Slide 4.5.5
From: Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. Effect of the
maternity ward system on the lactation success of low-income urban Mexican
women. Early Hum Dev., 1992, 31 (1): 25-40.
NUR, nursery, n-17
RI, rooming-in, n=15
RIBFG, rooming-in with
breastfeeding
guidance, n=22
NUR significantly
different from
RI (p<0.05) and RIBFG
(p<0.05)

13. Determinants of lactation performance across
time in an urban population from Mexico
• Milk came in earlier in the hospital with rooming-in
where formula was not allowed
• Milk came in later in the hospital with nursery (p<0.05)
• Breastfeeding was positively associated with early
milk arrival and inversely associated with early
introduction of supplementary bottles, maternal
employment, maternal body mass index, and infant
age.
Adapted from: Perez-Escamilla et al. Determinants of lactation performance
across time in an urban population from Mexico. Soc Sci Med, 1993,
(8):1069-78.
Slide 4.6.5

14. Baby is exposed to less
infections
• Study on positive impact of rooming-in policy on
prevention of infectious disease when infants
rooming-in were compared to newborns not
rooming-in with their mothers (Soetjiningsih et
al.).
• Average length of newborn hospitalization after
roomimg in is 1,8 days compared to 3.2 days for
babies not roomed in

15. Average length of newborn hospitalization
Sanglah Hospital, Indonesia
3.2
1.8
0
0.5
1
1.5
2
2.5
3
3.5
Before rooming-in After rooming-in
Days
Transparency 6.15
±1.4 days ±0.8 days
Adapted from:Soetjiningsih and Sudaryat Suraatmaja. The advantages of rooming-in.
Paediatrica Indonesiana, 1986, 26:229-35.

16. Morbidity of newborn babies at Sanglah
Hospital before and after rooming-in
Adapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in.
Pediatrica Indonesia, 1986, 26:231.
Slide 4.7.4
0%
2%
4%
6%
8%
10%
12%
Acute otitis
media
Diarrhoea Neonatal sepsis Meningitis
%ofnewbornbabies
6 months before rooming-in
6 months after rooming-in
n=205
n=17
n=77
n=11
n=61
n=17
n=25
n=4

17. Morbidity of newborn babies at Sanglah Hospital
before and after rooming-in
• Prospective study in Bali, Indonesia, over one year in which this study
examined morbidity, mortality, amount of milk formula and IV fluid consumed,
and length of hospital stay in the maternity ward and newborn nursery for the 6
months pre and post rooming in policy instituted
• Diarrhoeal diseases, otitis media, neonatal sepsis, and meningitis decreased in
low-birthweight and normal full-term infants
• Mortality due to infection decreased (41 or 2.21% vs. 16 or 0.81%); whereas
deaths due to other causes did not greatly change during this period (58 or 3.13
% versus 51 or 2.59%).
• Need for milk formula decreased from 105.6 tins to 25.6 tins per month (400 g
tin of powdered milk formula).
• Need for IV fluid dropped from 135.8 bottles to 74.1 bottles per month (500
cc/bottle).
• Number of days in the hospital was reduced from 4.2 to 1.8 days

18. Babies sleep better and cry less
• A study to compare the state behavior of newborns who
roomed-in with their mothers at night with those who
were cared for by the traditional nursery-at-night method.
• Infants in the mother's room had significantly, p less
than.001, more quiet sleep (33% vs. 25.4%), less
indeterminate (4.8% vs. 11.2%), and less crying (0.6%
vs. 7.5%) states than infants who remained in the
nursery.
• Adapted from:Keefe MR,Nursing Research
(1987,36(3):140-144

19. Cost savings of rooming-in compared to separate
recovery rooms at the Clinical Hospital of the
Catholic University of Chile
13.5
$3.57 $3.57
9
$2.35 $3.05
0
2
4
6
8
10
12
14
16
Full-time nurses
and aides
Personnel cost per
patient per day
Personnel + capital
costs* per patient
per day
Separate recovery
Rooming-in
Transparency 6.19
14% savings34% savings
Adapted from Valdes et al. The impact of a hospital and clinic-based breastfeeding
promotion programme in a middle class urban environment. Journal of Tropical
Pediatrics. 1993, 39:142-151.

20. Cost analysis of maintaining a newborn nursery at the
Dr. Jose Fabella Memorial Hospital
Transparency 6.20
Hospital Statistics:
Average daily deliveries: 100 babies
Daily newborn census: 320 babies
Adapted from: Gonzales R. Cost Analysis of Maintaining a Newborn Nursery at Dr. Jose
Fabella Memorial Hospital, Manila. (Transparencies presented in meeting in Manila,
Philippines), 1990.

21. Summary of costs for maintaining a
newborn nursery
Transparency 6.21
Feeding bottle sets/year
124,800 x 20 P = 2,496,000 P
Milk formula cans/year
17,521 x 36 P = 630,720 P
Salary of nursing staff/year
900 x 3,000 P x 12 = 3,240,000 P
Salary of formula room staff/year
6 x 2,000 P x 12 = 144,000 P
________________________________________
Total 6,510,720 P
(310,037 USD)

22. Possible barriers to rooming in
• Concerns that mothers are tired
• Taking babies back to nursery for
procedure
• Babies need to be monitored
• Mothers ask for their babies to be taken to
Nursery

23. Concerns that mothers are tired
• Ward routines - to facilitate the mother’s rest
with quiet times
• Make sure that staff knows how to help mothers
who have had Caesarean sections choose
breastfeeding techniques and positions that are
comfortable and effective.

24. The impact of infant rooming-in on maternal sleep at night.
• A two-group comparison study was designed to investigate
differences in sleep patterns for a group of mothers who
roomed-in with their infants at night as compared with a group
who was separated from their infants at night.
• The data collected from the mothers in the study indicated that
mothers did not sleep longer or better when their infants were
returned to the nursery during the night.
• Keefe MR ,Children's Hospital, Denver, CO 80218-1088.
Journal of Obstetric, Gynecologic, and Neonatal Nursing :
JOGNN / NAACOG [1988, 17(2):122-126]

25. Taking babies back to nursery for
procedure
• Baby care should generally take place at the mother’s bedside or
with the mother present.
• This can provide reassurance and teaching opportunities for the
mother as well as providing comfort for the baby if distressed
(Example: Weighing baby before and after breastfeeding) Other
procedures can be performed in the mother’s room.
• Review advantages to mother and time saved by
physician when he examines the infant in front of the
mother.

26. Babies need to be monitored
• Baby can be observed next to the mother
as easily as in a nursery
• Mother often notices change before a
busy nurse notices them..

27. Mothers ask for their babies to be taken to
Nursery
• Explain to the mother why the hospital
encourages rooming-in
• Discuss the reason why the mother wants
the baby taken to the nursery
• Address the benefits of rooming-in during
antenatal contacts.

28. Case study
• Carol had a long labour for her first baby and delivered her baby via forceps
delivery. When her baby was born, she had skin to skin contact with him for
an hour and baby managed to latch on for twenty minutes.
• Staff nursed baby in nursery as Carol had verbalized she was very tired
after the long labor The staff gave him a bottle of infant formula for the next
two feeds as Carol had pain score of 5 early part of the night. She was given
analgesia after which her pain score was reduced to 1 to 2.
• Carol's baby was brought to her early the next morning - 10 hours after
birth. The nurse told her to breastfeed as her baby had been crying for
about 5 to 10 mins. When she tried to breastfeed her baby took her breast
and sucked a few times, then fell asleep.
• She had difficulty arousing baby and getting baby to suckle

29. Question 1- Circle the correct answer
• Based on Carols 'pain score and pain management she should be encouraged
to breastfeed her baby instead of supplementation
True/ False
• Baby should be nursed in nursery instead of rooming in because Carol would be
too tired to look after her baby
True / False
• Infant formula Supplement increases protection from Breastfeeding – True/
False
• Based on pain management guidelines, Carol should be educated on
importance of taking pain killers regularly to achieve better pain control
True/ False
• Rooming in allows baby to be fed on early cues instead of feeding baby
when he is crying which is a late indicator of hunger.
True/ False

30. Question 2
• The benefits of rooming in include the
following except:
-Increased immunity for mother
- Reduce cost
- Less exposure to infections for baby
- Boost confidence for mum in handling
baby
- Allows mum to feed baby on cue and
establish breastfeeding earlier

31. Question 3
When staff wants to inform a pregnant woman the
benefits of rooming in she needs to tell mother the
following except:
1.Better bonding with her baby
2.She can feed baby any time she wants
3.She learns to recogbaby nize baby’s feeding cues
4.She becomes more confident in handling her baby
5.Baby will be safer with her

32. References
• Keefe M. R. Comparison of neonatal nighttime sleep-wake patterns in nursery versus
rooming-in environments. Nursing Research. 1987;36(3):140–144. [PubMed]
• Keefe M. R. The impact of infant rooming-in on maternal sleep at night. Journal of
Obstetric, Gynecologic, and Neonatal Nursing. 1988;17(2):122–126.
• Flores-Huerta S, Cisneros-Silva I. Mother-infant rooming-in and exclusive breast feeding.
Salud Publica de Mexico. 1997;39(2):110–116. [PubMed]
• O'Connor S, Vietze P. M, Sherrod K, Sandler H. M, Altemeier W. A. Reduced incidence of
parenting inadequacy following rooming-in. Pediatrics. 1980;66(2):176–182. [PubMed]
• Yamauchi Y, Yamanouchi I.Acta Paediatr Scand. 1990 Nov;79(11):1017-22. PMID: 2267917
[PubMed - indexed for MEDLINE]
• Reference: Soetjiningsih and Suraatmaja S. The advantages of rooming-in. Pediatrica
Indonesia,1986, 26:229-23
• Yamauchi Y, Yamanouchi L.Breastfeeding frequency during the first 24 hours after birth in full term
neonates.Paediareics 1990,86(2):171-175