Woman lying in hospital bed holding her newborn baby in her arms

Scientific Article

Covid-19: Skin-to-Skin Recommendations

Zoe Watson

From the very first moments following birth, skin-to-skin contact between mother and baby has been proven to have significant, long lasting benefits both physically and psychologically.1
Skin to skin contact has been shown to ease the transition from being in utero to newborn baby in the first hours of an infant’s life. This precious time is so powerful that it has a long term and lasting impact on baby’s ongoing development for the future.

What are the benefits of skin-to-skin contact?

  • Calms and relaxes both mother and baby
  • Helps baby to regulate their heart rate and breathing
  • Facilitates a smooth transition from fetal to newborn life
  • Encourages an interest in feeding
  • Regulates infant’s body temperature
  • Enables colonization of baby’s skin with the mother’s friendly bacteria, which provides protection against infection
  • Stimulates the release of hormones to support breastfeeding and bonding2

Additional benefits of skin to skin contact with babies in the Neonatal Intensive Care Unit

In the instance where an infant has been referred to the Neonatal Intensive Care Unit, recent studies demonstrate that skin-to-skin contact is a cost-effective, high-impact intervention that reduces mortality and morbidity in preterm infants.3 Early and uninterrupted skin-to-skin contact and kangaroo mother care significantly improves neonatal survival rates and reduces morbidity.4 

The additional benefits to an infant in a neonatal unit include:

  • Improving oxygen saturation levels
  • Encouraging pre-feeding behavior
  • Reducing cortisol levels, particularly following a painful procedure
  • Assisting growth
  • Potentially reducing total time spent in hospital
Furthermore, if mother expresses breastmilk following a period of skin-to-skin contact, her milk volume can subsequently increase and the milk expressed contains very specific antibodies that are beneficial to baby.2 

The COVID-19 effect on skin to skin contact 

The first case of COVID-19 was identified in December 2019 and following its exponential spread, the World Health Organization declared a global pandemic in March 2020.5

During the rise of COVID-19 there was limited knowledge about the virus and its effects on the general population. Even less was known about its influence on pregnant women and infants.6 Due to the lack of evidence and the novelty of the pandemic, a challenge arose following the birth of a baby to a mother who tested positive for COVID-19. Should skin-to-skin still be encouraged based on its known benefits? Or, should it be stopped in light of the unknown effects of neonatal transmission of COVID-19 from mother to baby?

Initially, a majority of hospitals did not recommend keeping mothers who tested positive for COVID-19 together with their newborns. However, this guidance was based on fear of the unknown rather than evidence gained from previous viral epidemics.7 In fact, research suggests that when a mother had suspected or confirmed COVID-19 and was separated from her baby, it resulted in a lack of skin-to-skin bonding which put the babies at an even higher risk of health complications.8

Sadly, these disruptions of keeping mothers close to their babies after birth which facilitates skin-to-skin and early initiation of breastfeeding, may already be widespread. A systematic review of 20 clinical guidelines from 17 countries found that one third recommended separation of a mother and her newborn if the mother has confirmed or suspected COVID-19. The report suggests that this is “severely affecting the quality of care given to small and sick newborns, resulting in unnecessary suffering and deaths.”9

But there is hope. It is estimated that by keeping mothers and babies together, even given the current global pandemic, more than 125,000 infant lives could be saved.8

The World Health Organization recommendation

In light of the most recent scientific evidence surrounding mothers, babies and skin-to-skin contact during the COVID-19 pandemic, the World Health Organization’s recommendations could not be clearer- skin-to-skin contact is indeed best practice.10 In a recent study, of 80,000 Chinese patients symptomatic of COVID-19, only 6 cases of neonates born to COVID-infected mothers were reported. This signifies a low transmission rate between mother and newborn. In the instances where the neonates tested positive for COVD-19, all infected babies made a full recovery without the need for intubation.11 It is, therefore, with the release of emerging research supporting skin-to-skin contact between mother and baby in the first few moments of life, that the guidance from the World Health Organization has been affirmed as the gold standard practice: “Mothers and infants should be enabled to remain together and practice skin-to-skin contact, kangaroo mother care and to remain together and to practice rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”10

Zoe Watson

Midwife & Adult Nurse

Zoe is a registered nurse and midwife with over 10 years of post-registration experience. Zoe has worked in a variety of settings from a specialist homebirth team to a high-risk delivery suite and, most recently, at a community birth center. Zoe is passionate about maintaining her professional development to enhance the support she provides to families in her care. She has successfully completed courses in neonatal life support, perineal surgical skills, managing acutely ill adults and has recently qualified as a hypnobirthing teacher. 

1Phillips, R. (2013). Uninterrupted Skin-to-Skin Contact Immediately After Birth. Newborn and Infant Nursing Reviews. 13 (2), 67 - 72.
2Unicef. (2020). Skin-to-skin contact. Available: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/. Last accessed 15th April 2021.
3World Health Organization, UNICEF. 2014. Every Newborn: an action plan to end preventable deaths. Geneva: World Health Organization.
4World Health Organization. 2015. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: World Health Organization.
5World Health Organization. (2020). Listings of WHO’s response to COVID-19. Available: https://www.who.int/news/item/29-06-2020-covidtimeline. Last accessed 12th April 2021.
6Williams J, Namazova-Baranova L, Weber M, Vural M, Mestrovic J, Carrasco-Sanz A, Breda J, Berdzulli N and Pettoelle-Mantovani M. (2020). The Importance of Continuing Breastfeeding during Coronavirus Disease-2019: In Support of the World Health Organization Statement on Breastfeeding during the Pandemic. European Paediatric Association. 223 (1), 234 - 236.
7Vu Hoang D, Cashin J, Gribble K, Marinelli K & Mathisen R. (2020). Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health 8Organization recommendations. BMJ Nutrition, Prevention & Health. 3 (1), 339 - 350.
World Health Organization. (2021). New research highlights risks of separating newborns from mothers during COVID-19 pandemic. Available: https://www.who.int/news/item/16-03-2021-new-research-highlights-risks-of-separating-newborns-from-mothers-during-covid-19-pandemic. Last accessed 29th April 2021.
9Minckas N, Medvedev M, Adejuyigbe E, Brotherton H, Chellani H, Estifanos A et al. (2021). Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection. The Lancet. 33 (1), 1-8.
10World Health Organization (2020a). Clinical management of severe acute respiratory infections (SARI) when COVID-19 disease is suspected. Available at: https://apps.who.int/iris/bitstream/handle/10665/331446/WHO-2019-nCoV-clinical-2020.4-eng.pdf . Last accessed 28th April 2020.
11Ma X, Zhu J and Du L. (2020). Neonatal Management During the Coronavirus Disease (COVID-19) Outbreak: The Chinese Experience. Neoreviews. 21 (5), 293 - 297.