Skin to skin, above all else

I’m sharing below an e-mail conversation with a Midwife/Lactation Consultant from Israel. Gloria

From: Leslie Wolff, Israel

Subject: Lactation Consultants in the labor & delivery room

I was a midwife in the labor/delivery ward for 14 years – and am now a IBCLC for the past four years – working as the coordinator of breastfeeding at my hospital, which means getting to Labor and Delivery also…mostly when the midwives ask me if I can give some help…

I have a few of my own beliefs about breastfeeding immediately after delivery. I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the diad – mother and baby – to recover from the birth experience, is a Win Win situation that requires no effort , there is nothing to “succeed” in – it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast – great..and if not, or the breast is offered and the baby doesn’t GO FOR IT – that’s fine. .I also truly don’t like to give “instructions/ advice” during those first two special hours..I know that proper latching is important, but that mother JUST GAVE BIRTH – I could never see myself “instructing her” – maybe a little helping the baby get the nipple farther into the mouth , maybe a word here or there – there is plenty of time to help her when she is in Postpartum ward – those first two hours after birth seems like a special, quiet , almost holistic time ( having nothing to do with the fact that the baby had a natural or very intervened-with ( is there such a word?) birth, maybe even a C-Section…..I know that babies are “supposed to” “immediately” start breastfeeding beautifully – but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin ,I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth…)

I’m glad that you brought the subject up – because I too am interested in how others ” do it” during that first period after birth labor/delivery ward, and am interested in any comments about what I wrote..

Close to the Heart

Leslie Wolff, Israel


Leslie, may I have permission to put your wise words on my blog. I attend only homebirths and have the same attitude. It’s the skin to skin contact and little (or big) noises of the baby that cause the uterus to contract powerfully post partum. It is a sacred time right after birth that can never be recaptured. When the mother and baby have warmth and privacy they will “discover” each other and fall madly in love. This is the best child protection method both in the short and long term. We are mammals. We must sniff, lick, coo, cuddle, look at and hear our young. In turn, the baby does many “pre-nursing behaviours”-climbing, licking, looking, hearing, sniffing. . . who knows what they are doing because it’s dark and private, remember? How do I know this? Because I had it with my own 2 homebirths. Just like sex, it has to be experienced to be believed. My mission in life is to learn how to take my interference away from the mammatoto. Gloria Lemay, Vancouver, BC

Dear Gloria – it is my honor and pleasure to be quoted on your blog!
Tomorrow I am giving a power point presentation – two lectures – one on Skin to Skin for the Healthy Newborn and the second : Kangaroo Care for the Premature – for nurses and midwives and a few doctors at a breastfeeding course in Tel Aviv ( an acknowledged course for IBCLC). For the first time I am going to take a firm stand on my thoughts about those first two hours , with the support of the feedback I got from you and others.

Linda Smith wrote me, when I mentioned to her that the words of the 4th Step of Baby Friendly put more emphasis on breastfeeding than skin to skin, and I think it should be the opposite):

From Linda Smith: “Take a look at how Step 4 is currently interpreted:

Click to access 9789241594967_eng.pdf

Step 4: Help mothers initiate breastfeeding within a half-hour of birth.
Place all babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers who have chosen to breastfeed to recognize when their babies are ready to breastfeed, offering help if needed. Offer mothers who are HIV positive and have chosen not to breastfeed help in keeping their infants from accessing their breasts.

It’s very clear from this interpretation that getting babies ONTO their mother’s bodies after birth is the point. What they DO once they’re touching mom’s body is up to the baby and mother. Some will latch quickly; others will take longer. Letting the mother & baby follow their instincts is key.
Our role is to STOP INTERFERING.

This is WAY more than your beliefs – the science on this is very clear!
Linda J. Smith, BSE, FACCE, IBCLC, FILCA Bright Future Lactation Resource Centre, Ltd.

So these past letters – yours and others – have come for me just at a perfect time – and I appreciate your feedback very much…

6 thoughts on “Skin to skin, above all else

  1. I remember being “taught” howto breastfeed during that hour. I was exhausted, I would have been happier to sleep, and Abi had a lazy latch, she was probably tired too. So my nipples hurt, then Abi slept for 5 hours, which was nice. I agree the skin to skin is so important, and it is up to the baby to latch.

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  3. It has been my pleasure and joy to await the unfolding and folding of mother and baby – in their time and in their way – as they reach into their new (post-birth) relationship. It is rare that I have something uniquely helpful to offer during this time, as though my expertise is present to oversee their selves and their oneness. That said, I indeed know assistance is at times very helpful with particular situations.

  4. Changes to step 4 are being reinterpreted. See:

    2. Recommendations and Breast Crawl

    WHO and UNICEF BFHI documents’ subtle descriptions of the initiation of breastfeeding are similar to the process of the ‘Breast Crawl’. If interpreted properly and practised in its true spirit, initiation of breastfeeding would naturally follow the ‘Breast Crawl’ pattern.

    By the time the foundation stone of the Baby Friendly Hospital Initiative was laid, the Breast Crawl had already been discovered. This was reflected in the ‘Joint WHO / Unicef Statement’ (1989) as ‘The newborn infant should therefore be cleaned and dried and placed over the mother’s abdomen for her to take and put to her breast.’

    WHO and UNICEF BFHI documents have evolved since ‘Ten Steps to Successful Breastfeeding’ were described in 1989. Though the 4th step remains unchanged, the interpretation has changed with time.

    The initiation of breastfeeding comprises of two components i.e. skin-to-skin contact and suckling. These were discussed and differentiated subsequently (WHO, 1998).

    ‘Early skin-to-skin contact and the opportunity to suckle within the first hour or so after birth are both important. However, contact and suckling are so closely interrelated that most studies reviewed have used the terms interchangeably, and few researchers distinguish clearly between them.

    Optimally, the infant should be left with the mother continuously from birth, and allowed to attach spontaneously to the breast whenever she shows signs of readiness to do so. An arbitrary but practical minimum recommendation is for skin-to-skin contact to start within at most half-an-hour of birth and to continue for at least 30 minutes.’

    Revised BFHI guidelines (UNICEF/WHO, 2006) interpret ‘Step 4’ as ‘Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.’

    The same document further defines the ‘Revised Global Criteria’ for Step Four’ as ‘At least 80% mothers confirm that their babies were placed in skin-to-skin contact with them immediately or within five minutes after birth and that this contact continued for at least an hour, unless there were medically justifiable reasons for delayed contact.’

    The revised criteria have precisely defined the maximum upper limit of the interval between delivery and initiation of breastfeeding as five minutes which is consistent with the recommendation by Klaus and Kennel (2001):’Once it is clear that the baby has good colour and is active and appears normal (usually within 5 minutes), she can go to her mother.’

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