Making skin-to-skin after caesarean the norm

Skin-to-skin contact following birth can have a positive impact on breastfeeding outcomes and cardio-respiratory ...
Skin-to-skin contact following birth can have a positive impact on breastfeeding outcomes and cardio-respiratory stability, as well as decreasing infant crying. 

After a difficult pregnancy, Claire Toose’s planned caesarean went smoothly and she finally laid eyes on her new daughter. “All I wanted was to hold my precious miracle baby close, feel her skin on mine, and never let her go,” she remembers.

But Toose spent the next two hours separated from her baby, in theatre and then recovery. “It was devastating,” she says. “I remember tears rolling down my face as I lay there alone while they sutured and finished the surgery. The theatre staff were lovely, but I had just had a baby and she had been taken away from me.”

When she was finally able to have skin-to-skin time, Toose says it was “precious … but certainly not the same as the immediate skin-to-skin I had with my first daughter”.

The Baby Friendly Health Initiative, developed jointly by the World Health Organization and UNICEF, recommends the initiation of skin-to-skin contact between mother and baby in theatre following a caesarean birth.

Rachel London, manager of the Baby Friendly Health Initiative in Australia, explains that in BFHI-accredited hospitals, the breastfeeding policy must ensure that mother and baby are kept in skin-to-skin contact for at least one hour following birth, unless the mother or baby is severely medically compromised.

However, only one in five Australian hospitals are currently BFHI-accredited. For those who deliver at hospitals that aren’t accredited, skin-to-skin contact following a caesarean isn’t always offered, even when the mother and baby are both well.

“Anecdotally, we know mothers still experience separation from their baby after caesarean in many hospitals in Australia,” says London.

Belinda Millar, whose first baby was delivered by caesarean, says she was heartbroken after being separated from her baby for an hour and a half after delivery. “The nurses told me to relax and rest. Because of the adrenalin there was no way I could rest … I actually was getting quite panicked as I just wanted to see my baby and husband.”

After being together as one for many months, most mums instinctively wish to hold their babies close after birth, and doing this causes a surge of the hormone oxytocin in both mother and baby. This not only has a calming effect, but helps protect mothers against postpartum haemorrhage and makes babies more alert for breastfeeding, says midwife Lois Wattis.

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Other benefits of early skin-to-skin contact are well-documented, with a recent Cochrane Review concluding that it appears to benefit breastfeeding outcomes and cardio-respiratory stability, as well as decreasing infant crying.

Despite the recommendations and clear benefits, there are “unfortunately many policies and hurdles that need to be overcome in both public and private hospitals to allow this simple practice to occur,” says obstetrician Alejandra Izurieta.

The biggest hurdle is staff shortages, she says, which means the one-on-one care required throughout the process is often unavailable. Other reasons relate to comfort; theatres are very cold, and not all mums feel relaxed about being exposed in a recovery room that is shared with other patients.

When Charmer Voller became aware of these policy reasons which would prevent her from having skin-to-skin contact with her baby following caesarean, she had this response: “Not good enough.”

After a traumatic first birth involving three hours of separation from her baby, she was hopeful of a vaginal delivery the second time around. However, with her baby in the breech position as her due date neared, a caesarean was scheduled.

Still determined to make the birth as natural as possible, Voller requested skin-to-skin contact in theatre and non-separation from her baby. This was agreed to in writing by the hospital, despite its policy to the contrary.

On the day of the birth, however, the hospital indicated there was a problem in granting her request. After some negotiating by her doula, Voller was able to have skin-to-skin contact immediately following her caesarean and was separated from her baby for only 30 minutes.

Having her doula present to assert her wishes in theatre involved one big drawback, though: “Only one person could be with me in theatre. My husband sacrificed being there for the birth of his child to ensure I was able to bond with the baby.  This is an amazing gesture and I am so grateful of his support.”

But it seems some hospitals are starting to listen to women who, like Voller, believe the policy reasons for separating healthy mums and babies after caesarean aren’t good enough.

Chris Anley, manager of Women’s Health Services at Norwest Private Hospital in Sydney, says the hospital commenced a trial of skin-to-skin contact and non-separation following caesarean deliveries in mid-March this year, in response to requests from patients. These baby-friendly caesareans are available under certain conditions, she says, and the 18 that have been carried out so far “have gone well”.

To find a Baby Friendly Health Initiative-accredited hospital near you, visit babyfriendly.org.au. 

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