Why is skin-to-skin important right after birth?
Skin-to-skin right after birth keeps your newborn warm and calm and helps breastfeeding get started. In trials, babies held bare chest to bare chest were warmer, had higher blood sugar, cried less and were more often breastfeeding months later. For small and early babies, starting it right away saved lives. Do it safely, with someone awake watching.
On this page
What skin-to-skin is
Right after birth, someone decides where your baby spends the first hour. The research answer is on you: bare chest to bare chest, with a blanket over both of you. The usual alternative is a baby wrapped and placed in a cot or under a warmer.
Skin-to-skin works best when it starts straight away and isn't interrupted. WHO's Ten Steps for hospitals put it plainly: immediate and uninterrupted skin-to-skin contact, and help to start breastfeeding as soon as possible. It also fits neatly with waiting at the cord, since your baby can lie on your chest while the cord finishes pulsing.
What the research shows for healthy babies
A Cochrane review pooled trials of early skin-to-skin contact for healthy babies. Compared with babies who were wrapped and placed in a cot or warmer:
- More were still breastfeeding at 1 to 4 months (67% vs 54%).
- More were exclusively breastfeeding at 6 weeks to 6 months (78% vs 52%).
- In one small trial, babies on their mother's skin cried far less.
- Babies on their mother's chest averaged about 0.3°C warmer than babies under the usual covers or warmers.
- Their blood sugar was about 10 mg/dL higher in the first hours.
The evidence is moderate to low quality, but it all points one way: a calmer, warmer baby who feeds better. Your chest works as a heater. Breastfeeding has its own long-term research, and skin-to-skin is one of the easiest ways to give it a good start (see breastfeeding and the baby brain).
One honest note. For healthy full-term babies, skin-to-skin is recommended for warmth, calm, bonding and breastfeeding. Long-term brain benefits have only been studied in babies born early or small.
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Why it matters even more for small and early babies
For small and premature babies, the evidence is the strongest of anything in the first hour. In a WHO trial in Ghana, India, Malawi, Nigeria and Tanzania, 3,211 babies weighing 1.0 to 1.8 kg (about 2¼ to 4 lb) got either "immediate kangaroo care," with skin-to-skin starting right away for a median of almost 17 hours a day, or the usual incubator care first. Deaths in the first 28 days fell from 15.7% to 12.0%. The trial was stopped early because the benefit was clear.
Longer studies of premature babies, in Israel and Colombia, linked kangaroo care to better self-regulation and thinking skills years later. The Israeli study matched babies rather than randomizing them, and the Colombian effects held in the most fragile babies. If your baby goes to the NICU, ask when you can start kangaroo care and do it as much as you're allowed. In a small Israeli study of stable premature babies, a mother softly singing during skin-to-skin went with signs of a calmer nervous system in the baby and less anxiety in the mother. Ask the nurses how quiet to keep it.
How to hold your newborn safely
- Baby on their tummy on your chest, head turned to one side.
- Nose and mouth visible, chin not tucked down onto their chest.
- Blanket over their back, kept below their face.
- Sit propped up rather than lying flat.
- Someone awake should always be watching.
If you feel drowsy, and after labor you probably will, hand the baby to your partner or ask a nurse to place them on their back in the bassinet. If your baby's color turns pale, gray or blue, or they go limp, call a nurse at once.
The same care applies at home. Skin-to-skin is for awake time. Never fall asleep with your baby on a sofa or armchair; the AAP says that setup carries up to 67 times the risk. Sleep belongs on the back, in your baby's own flat, firm sleep space with nothing else in it.
When the mother can't hold the baby yet
After a cesarean. Ask whether your hospital offers skin-to-skin in the operating room once the baby is checked, with the baby on your chest above the drape. In the Cochrane trials, skin-to-skin after a C-section still went with more breastfeeding at 1 to 4 months and better first breastfeeds. More on C-section births.
If you need care first. Your partner can do skin-to-skin until you're ready, with the same safety rules. Here's how partners can do it.
If your baby needs help breathing. Let the team work. Skin-to-skin can start as soon as your baby is stable. A changed first hour is not a failed first hour.
Keep using it after the first hour
Skin-to-skin isn't only for the delivery room. In the first days, it's a handy fix for a baby who is sleepy and won't latch: undress them to the diaper, hold them on your chest, and hand-express a few drops onto the nipple. If you plan to formula-feed, do skin-to-skin too, and give bottles with your baby held close, looking at your face.
Touch is one of the main ways babies feel safe. Holding, cuddling and skin-to-skin are part of how a baby learns the world is a good place. To see how skin-to-skin fits with the cord and the first feed, read about the golden hour.
Do this
- Write "skin-to-skin right after birth, until the first feed" on your birth plan.
- Ask whether your hospital offers skin-to-skin in the operating room if you have a cesarean.
- Name a backup person, usually your partner, for skin-to-skin if you can't hold the baby.
- Hand your baby to someone awake, or place them on their back in the bassinet, the moment you feel drowsy.
- Use skin-to-skin again at home when your baby is too sleepy to latch.
When to ask your doctor
Check with your doctor or midwife first if…
- your baby may be born early or small, so you can plan kangaroo care with the NICU team
- you are planning a cesarean and want to know what your hospital offers in the operating room
- your baby needed help breathing at birth
Call your doctor now if…
- your baby's color turns pale, gray or blue, or they go limp (call a nurse at once)
- your baby has trouble breathing
- your baby is floppy or hard to wake
- your baby under 3 months has a temperature of 100.4°F (38°C) or higher
This page is general information, not medical advice. Every pregnancy and every child is different. Ask your doctor, midwife or pediatrician before changing supplements, diet or care.
Grow a Genius
In the book: Chapter 15: The First Hour
Chapter 15 puts skin-to-skin together with the cord and the first feed, with a partner's checklist for guarding the hour and a plan for when the birth goes differently.
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People also ask
How long should skin-to-skin last after birth?
WHO's Ten Steps call for immediate and uninterrupted skin-to-skin contact. A good plan is to keep your baby on your chest until after the first feed. Left there, many babies rest, then start rooting toward the breast, so give them time. Weighing and the bath can usually wait.
Is skin-to-skin good if I'm formula-feeding?
Yes. The warmth and calm come from the contact, not the milk. Do skin-to-skin in the first hour, then give the first bottle with your baby held close, looking at your face. Keep that closeness for later bottle feeds too: eye contact and your voice are the brain-building part of a feed.
Can I do skin-to-skin after a C-section?
Often, yes. Ask whether your hospital offers skin-to-skin in the operating room, with your baby on your chest above the drape once checked. In the Cochrane trials, skin-to-skin after a C-section still went with more breastfeeding at 1 to 4 months. Your partner can do it until you're ready.
Does skin-to-skin help premature babies?
Strongly. In a WHO trial of 3,211 babies weighing 1.0 to 1.8 kg, starting kangaroo care right away cut deaths in the first 28 days from 15.7% to 12.0%. If your baby is in the NICU, ask when you can start, and do it as much as you're allowed.