The Sacred Hour

Uninterrupted Skin-to-Skin Contact Immediately After Birth

Raylene Phillips MD, IBCLC, FAAP

Disclosures

NAINR. 2013;13(2):67-72. 

In This Article

Skin-to-Skin Contact Protects From the Negative Effects of Separation

Babies are born ready to interact with mother. If a newborn has not been exposed to excessive medication, its alert awareness and intense focus on its mother's face is obvious to all who are present. Until the moment the cord is cut, a mother and her baby are literally a single biological organism. Until several months after birth, mother and baby remain a single "psychobiological organism." The experience of an infant who is separated from the mother is graphically described by Gallager. "Mother and offspring live in a biological state that has much in common with addiction. When they are parted, the infant does not just miss its mother. It experiences a physical and psychological withdrawal from a host of her sensory stimuli not unlike the plight of a heroin addict who goes 'cold turkey."' (p 13)[7]

From a baby's perspective, separation is life threatening! The universal response of baby mammals to separation from the mother is biphasic; first protest, then despair. The initial response to separation from the mother is to protest with loud cries and intense activity. This is an instinctive response to being outside the newborn's "natural habitat," the place of warmth, nutrition and safety. Loud cries and intense activity are protests designed to bring the newborn's plight to the mother's attention so she can bring the newborn back into contact with her body, providing rescue from cold, starvation, potential harm, or even death.

While this is readily seen in the animal world, the same instinctive response is also clearly seen in newborn human infants. When the crying behavior of human infants who are separated from their mothers is compared to those who are skin to skin with their mothers, it has been found that separated infants have 10 times the number of cries and 40 times the duration of crying.[8] Because separation is the cultural norm in the developed world and newborn crying is so common, many see it as normal behavior, yet frantic crying is not good for newborns. It impairs lung functioning, increases intra-cranial pressure, jeopardizes the closure of the foramen ovale, and increases stress hormones.

If separation continues for a prolonged period, the newborn mammal's response is "despair". The baby's cries eventually stop, intense activity ceases and the infant becomes still — the baby gives up. This is also an instinctive behavior to avoid attracting attention from potential predators. All systems slow down for prolonged survival. Temperature drops, heart rate decreases and metabolism slows down. Hypothermia, bradycardia, and hypoglycemia are all common complications of newborns that are separated from their mothers even in Special Care Nurseries. Short periods of separation resulting in protest is not thought to be harmful to the developing brain, but repetitive and prolonged separation resulting in "despair" has been well documented as harmful with lifelong consequences.

This was such a concern in primate research that a document was published in 2002 entitled, "The Welfare of Non-human Primates used in Research: Report of the Scientific Committee on Animal Health and Animal Welfare" in which the biphasic response of "protest" and "despair" to maternal–infant separation was described, including the physiological disturbance in the regulation of heart rate, body temperature, sleep patterns, cortisol secretion and the immune system. This document recommended that research primates not be separated from mothers for 6–18 months, depending on the species of monkey. Monkeys raised in isolation from their mothers invariably became deeply depressed within a few days and remained socially withdrawn. They often became pathologically violent in adolescence and thus unfit for research.[9]

Hundreds of experiments in animal research have documented the negative effects of maternal–infant separation. In many studies designed to explore the effects of stress on various organ systems, separation of newborns from their mothers produces enough stress to see profound and often permanent changes in the organ system being studied that persist to adulthood. One such study examined the separation of piglets from their mothers on days 3–11 for only 2 hours per day. On days 12 and 56 the piglets' weight, behaviors, immune system, hormonal, and brain parameters were measured. Results showed decreased weight gain and activity levels, increased corticotrophin releasing hormone activation in the hypothalamus, higher plasma levels of cortisol, increased glucocorticoid receptors, suppression of the immune function and higher interleukin concentration in the limbic area.[10]

A more recent study examined mare–foal attachment and the bonding and social development of foals during the first year of life, corresponding to the developmental period from birth to adolescence in humans.[11] Foals that had experienced human handling for 1 hour after birth while being gently restrained from contact with their mothers (who remained in close proximity) showed the same biphasic response to separation as seen in primates. They first struggled valiantly, trembled and had increased respirations (protest), then became motionless but maintained high tone (freeze/despair). After 1 hour when they were released, there was a delay in the first standing and first suckling. Many had inappropriate suckling patterns, making sucking motions in the air or toward their human handler and chewing on the teat. All foals eventually learned to suckle and were raised with their mothers in the same pasture as were the foals that had not been handled for the first hour after birth. Experimental foals showed clear signs of insecure attachment by staying closer to their mothers, playing less with their peers, and showing less curiosity in exploring novel objects in the pasture. More disturbingly, they were also more aggressive towards the other foals. All foals were weaned at 7 months with a temporary separation from their mothers. The experimental foals were less adaptable to the change, producing stress vocalizations for 4 compared to 2 days. All foals were reunited with their mothers after weaning and then permanently separated at 1 year. The experimental foals continued to keep more distance from their peers and showed more aggressive behaviors during adolescence and adulthood.[11]

Stanley Graven, MD, a developmental neonatologist cautions, "It is a serious mistake for professionals who provide care for neonates to assume that the principles derived from careful animal studies do not apply to human infants. The risk of suppression or disruption of needed neural process…is very significant and potentially lasts a lifetime." (p 210).[12]

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