_edited.jpg)
The Importance of Skin-to-Skin Contact: 2025 Cochrane Review
- Elise Armoiry et Marie-Xavier Laporte
- May 13
- 4 min read
This Cochrane review presents the most up-to-date evidence on immediate or early skin-to-skin contact between mothers and their healthy newborns, drawing on 69 randomised trials including more than 7,000 mother-infant dyads across diverse settings (low- and high-income countries, vaginal and caesarean births, term and late preterm newborns).
It demonstrates that skin-to-skin contact, initiated within the first 10 minutes after birth or within the first 24 hours, is not merely a comfort measure, but a key intervention for both the breastfeeding trajectory and the newborn's physiological adaptation to extrauterine life. The data thus confirm and reinforce international recommendations (WHO/UNICEF, Baby-Friendly Hospital Initiative) in favour of immediate, continuous, and uninterrupted skin-to-skin contact as the standard of care, rather than an optional practice.
Effects of Skin-to-Skin Contact on Breastfeeding
The most robust finding of this review concerns exclusive breastfeeding. Mothers who receive immediate or early skin-to-skin contact are significantly more likely to breastfeed exclusively at hospital discharge and up to one month postpartum, with a relative increase of approximately one third compared to standard care without systematic skin-to-skin. This effect persists beyond the first month: between six weeks and six months, exclusive breastfeeding rates remain significantly higher in skin-to-skin groups, despite heterogeneity across studies due to context and varying definitions of exclusivity.
For lactation consultants, these results confirm that skin-to-skin contact is not merely a subjective 'facilitator', but a measurable lever for extending the duration of exclusive breastfeeding, with a level of certainty rated as 'moderate' by the authors. Very early initiation (within the first hour) appears particularly strategic: it takes place within the sensitive period during which the newborn's innate behaviours (orientation, crawling, familiarisation, first feed) unfold spontaneously when the dyad remains together without interruption.
Effects on Newborn Physiology
Beyond breastfeeding, the review documents significant physiological effects for the infant. Compared to standard care (separation, incubator placement, immediate clothing), skin-to-skin contact improves thermoregulation: axillary temperature is slightly higher in skin-to-skin infants during the first hours, even though the observed mean difference (approximately 0.3°C) is considered clinically modest in isolation. The thermal benefit nonetheless remains important in environments where prevention of hypothermia is a concern, particularly in low-resource settings.
Skin-to-skin contact is associated with higher blood glucose levels between 75 and 180 minutes after birth, reflecting better metabolic stability and reduced energy stress in the newborn. Two small trials also suggest improved cardiorespiratory stabilisation (higher SCRIP score), although these data remain of low certainty due to small sample sizes and the way in which scores were aggregated. For lactation consultants, these physiological findings reinforce the clinical case: promoting skin-to-skin contact not only supports the first feed, but also helps the infant adapt more effectively on a respiratory, thermal, and metabolic level.
Maternal Effects and Limitations of the Evidence
The authors also explored maternal variables such as the duration of placental delivery (third stage of labour) and postpartum blood loss.
The results suggest that skin-to-skin contact probably does not clinically meaningfully alter the time to placental expulsion, and that the impact on the quantity of blood loss remains highly uncertain, given the small number of studies, heterogeneity, and low methodological quality.
There is, however, no signal of increased maternal risk associated with immediate skin-to-skin contact, including after caesarean section, which is reassuring for clinical practice.
The review also highlights frequent methodological limitations: the impossibility of double-blinding for teams and mothers, sometimes vague descriptions of skin-to-skin protocols (duration, interruptions, positioning), the modest size of many trials, and variations in definitions of exclusive breastfeeding. Despite these limitations, the body of evidence remains consistent: across diverse settings (32 studies in high-income countries, 25 in upper-middle-income countries, and 12 in lower-middle-income countries), immediate or early skin-to-skin contact appears beneficial or neutral — never harmful — for healthy mother-infant dyads.
Practical Implications for Lactation Consultants
For lactation consultants, this review reinforces several key messages to communicate to clinical teams and families.
First, immediate skin-to-skin contact (within the first 10 minutes), continuous and without unnecessary interruptions until after the first feed, should be presented as the standard of care regardless of the mode of delivery, provided the mother and infant are clinically stable. The role of support is then to protect this 'bubble': minimising non-urgent procedures, adapting delivery room and operating theatre protocols, and training teams to carry out necessary care directly on the mother's chest rather than at a distance.
Furthermore, lactation consultants can draw on the findings of this review to advocate with institutions:
skin-to-skin contact requires virtually no additional material resources, yet improves exclusive breastfeeding, a major public health objective, and optimises immediate neonatal adaptation. Finally, the authors note that, given the accumulated level of evidence and WHO/UNICEF recommendations, it is becoming ethically difficult to justify continuing to randomise dyads to systematic mother-infant separation. The focus of future research will instead be on the optimal 'dose' of skin-to-skin contact, specific situations (analgesia, anaesthesia, late prematurity, complex caesarean sections), and longer-term effects on health and the mother-infant relationship.
REVIEW REFERENCE:
Comments