Over the years, we have seen understanding of the importance of immediate skin-to-skin after birth. We know for the birther and the baby there are significant benefits.
We know skin-to-skin assists with bonding, establishing breastfeeding, and more.
However, if there are benefits to skin-to-skin, are there risks associated with interrupting skin-to-skin?
As doulas, being familiar with normal physiological birth, including immediately after birth, helps you provide parents with information. Part of your role as a doula is to provide evidenced-based information so your clients can make fully informed decisions.
Skin-to-Skin Interruption
A 2015 study found birthers who did not have immediate skin-to-skin contact and breastfeeding attempts within the first 30 minutes after birth were twice as likely to experience one type of serious birth complication.
Study Finds Double The Risk Of Postpartum Hemorrhage
Birthers who did not have skin-to-skin and breastfeeding initiation immediately after birth were found to be twice as likely to experience postpartum hemorrhage (PPH) compared to those who did have skin-to-skin and breastfeeding initiation.
As a doula, it is easy to see why skin-to-skin is an important part of physiological birth process.
We know that PPH is a serious birth complication. While all birthers experience some blood loss, a PPH is when 500mL or more is lost after birth. In some cases, this is the result of placental complications, previous anemia, or the result of interventions.
However, this 2015 study suggests some cases are the result of a lack of naturally release oxytocin. The hormone oxytocin is responsible for contractions during labor but also after birth. Oxytocin aids in the placenta expelling and the uterus clamping down.
Why Does Skin-To-Skin Reduce PPH Risk?
Birth is a complex hormonal process. Oxytocin is the most well-known hormone as it triggers the uterus to contract.
People release oxytocin when they feel good. This includes when we have skin-to-skin contact – such as breastfeeding. Latching triggers the body to release oxytocin to cause the letdown reflex. Therefore, early breastfeeding, and not only skin-to-skin, aids in reducing PPH.
Oxytocin plays a significant role after birth by:
- Making the uterus contraction to cause the placenta to detach and be expelled
- Causing contractions to help the uterus shrink and clamp down to reduce blood flow where the placenta was attached
- Encourages bonding through feelings of euphoria
- Triggers the milk letdown reflex
As doulas, we know that prolonged third stage can increase the risk of bleeding. We also know there is a risk of PPH during the entire postpartum period while healing. Helping clients understand the importance of immediate skin-to-skin can be an important part of preparing them for birth.
Why is This Study Important?
There are times when providers need to separate a birthing parent and baby. This can be for the health of either party – but this is often an exception and not the rule.
When we saw a cultural shift from birthing in the home to birthing in the hospital, we saw an increase in separation. Hospitals whisking away babies for weight checks and newborn exams became a norm. Babies spent most of the time in the nursery so birthing parents could rest and recover.
What providers thought would be beneficial – allowing extra rest after birth – turned out to interfere with a natural transition for both the birthing person and baby. Allowing rest IS important. However, it should not be done at the expense of immediate skin-to-skin contact.
We now know that interfering with the birth process, including the third stage, and immediately postpartum, comes with risks.
The body and our babies work together during the birth process. They provide each other with necessary hormones to make the transition safe.
When birthers and babies are not able to practice skin-to-skin we interfere with the natural release of oxytocin. While the birth itself might be finished, oxytocin still needs to flow to ensure the uterus clamps down. Oxytocin’s job is not complete just because baby is out.
The Significance
This study is significant because it could reduce the need for active management in low-risk births in low-risk settings. The study found immediate skin-to-skin had the greatest impact in low-risk women.
Active management does have a role in safe birth. It is when providers give synthetic oxytocin to aid in placenta expulsion and the uterus clamping down. Providers use active management to reduce the risk of PPH. This can be a routine practice in some facilities regardless of risk status. While active management is a great tool to reduce the risk of PPH, some birthers prefer to avoid unnecessary intervention.
Providing clients with information about the benefits of skin-to-skin to reduce PPH gives them the information to make informed decision when talking to care providers.
What If Separation Is Necessary?
In some situations, separation occurs because medical intervention is necessary. For example, in the case of premature birth. However, providers can safely delay routine exams and weight checks until after immediate skin-to-skin. Anything which a provider cannot safely delay they can do on or near the parent. This obviously excludes cases of serious medical complications.
Knowing the importance of oxytocin, when medically necessary separation occurs, providers will opt for active management. While not identical to natural oxytocin, synthetic oxytocin, known as Pitocin, will reduce the risk of PPH. When separation occurs, providers routinely give Pitocin.
Fortunately, we are seeing a rise in immediate skin-to-skin. As doulas, we hope this will continue to be an expected norm for routine birth. The more modern obstetrics learns about birth, the more we are seeing how interfering with birth is not without risk.
It is important we weight the benefits and risks of each birth option. As doulas, we equip our clients with the tools and support to make these decisions.
While we are seeing a rise in immediate skin-to-skin, perhaps it will become the expected norm for the safety of mothers and not only a social trend. The more we learn about birth the more we realize just how intricately designed the birth process is and interference is not without risk.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...