In recent years, by reversing and trying to make deliveries less instrumental, by getting closer to nature in general, many benefits are being given to mothers and babies, but new risks arising from new trends are emerging, probably for taking the best of the customs of yesteryear, but outside the natural environment.
A few days ago we commented that giving birth in water could be dangerous if the expulsive is done in immersion, we also know that sleeping with children, what we know as collecting, can be dangerous if it is not done safely and now, researchers from the Hospital 12 de Octubre in Madrid (one of the first to use colecho cribs), warn that Skin-to-skin contact after birth could carry certain risks to the baby's life.
No doubt about the benefits of skin-to-skin contact with the baby
The recommendation of the current protocols for action is that after birth the newborn is put in contact skin with skin on the mother's chest and abdomen. The benefits of this practice are proven and are not questioned at any time, being a measure supported by the Spanish Society of Neonatology, the Initiative for Humanization of Birth Assistance and Breastfeeding UNICEF and the Ministry of Health, Services Social and Equality of Spain. In addition, it is also part of the recommendations of the American Academy of Pediatrics and is in the clinical guides of Australia, Canada and Great Britain.
About the benefits we have talked long and hard in Babies and more. We know that early physical contact with the baby improves breastfeeding, we know that it helps the baby's thermoregulation, we know that it makes the baby have a much less stressful arrival in the world than if they are separated and we know, and it is probably one of the things more important, it helps to bring up the emotional bond between the parents and the baby, necessary for the survival and development of the baby and useful for parents to feel the need to take care of their child and prevent crying, suffering, acting as caregivers at good times and less good times (that having a baby is very hard at many times).
With so much benefit, the logical thing is that the hospitals have been incorporating the measure in a massive way and now there are many centers that do so, putting the baby on the mother during the first hours. The problem is that as a result of this practice they have begun to describe some cases of apnea and sudden deaths at the time of mother-baby contact.
They are said to happen mostly in the first 24 hours, especially in the first two hours and often when the first breastfeeding happens. Children are apparently healthy (so they leave skin in contact with immediate skin), who were born vaginally and without any known risk factor during pregnancy.
Cases have been described in different countries and although a clear frequency cannot yet be established, as it is relatively recent, it is estimated that it could happen in 2.5 to 3.2 of every 100,000 births, with a mortality from 0.8 to 1.8 per 100,000.
What is the cause?
The most important thing, of course, would be to know the cause to prevent it. However, as with sudden infant death syndrome (SIDS), it is not known why it happens. The researchers think that it could be an obstruction of the airway when the child is face down on the mother's chest or when she is breastfeeding, being dangerous because she is so small, that it could also be that they are children who are already born at risk, although Do not manifest at birth or it could be due to an excess of temperature associated with the prone position, as is the case with sudden death syndrome.
All of them are unconfirmed hypotheses, so the only thing that is useful, for the moment, is to know in depth the cases that have occurred to know what are the common events in all of them and try to avoid them, just in case.
Possible risk factors
As it has been seen, in many cases the event happens when the woman was alone with the baby, without a companion, being her first baby and finding herself tired or sleepy after childbirth. It happens especially during skin-to-skin contact or while the baby is nursing, the baby being in the prone position (face down) on the mother's chest and abdomen.
Babies suffer from apnea, stop breathing and some of them die. Many of those who survive are left with serious neurological sequelae, so we are talking about something very serious.
How to prevent it
There are no studies about these events yet. All we have is the documentation of various cases that have helped their authors try to give a series of tips that could be useful to try to prevent them.
The recommendations that have been published, in the absence of more scientific data that can help, are the following:
- Health professionals should know that these episodes exist and should know the risk factors. In this way they can inform and teach the mother and the companion how to prevent the mouth and nose of the newborn from clogging during skin-to-skin contact, while in bed with the mother and when breastfeeding.
- Women, after delivery, should be accompanied at all times by whom they wish, to ensure the safety of the newborn. So the companion can help the mother or, if she is very tired, keep watching the baby even when she is on top of her.
- When the mother is awake, in the first 24 hours above all, she must understand the need to observe the baby's activity and color, and to prevent the obstruction of the nose. In case you are very tired or sleepy, the parent or other adult will be advised to monitor the newborn, or even the father to take the baby for have him in contact skin to skin. If there is no close companion (and the mother very tired or sleepy), the baby will not be left prone on the mother's abdomen or chest, but in a cradle and supine.
- It is recommended that the mother is not distracted (calling or sending messages, etc.) while the baby is in contact with skin or skin or when the child is lying next to her or breastfeeding, especially if she is not accompanied by someone who can Watch the child while she does.
- The mother's ideal position could be semi-incorporated between 30 and 45º, with a pillow under the head. Apparently in this way it is more complicated that there may be complications with the baby.
- What usually happens with the baby is to first make an apnea, then remain hypotonic (no strength, no muscle tone) and finally suffer a change in skin color. Parents should know that before any irregular breathing or color change they must notify quickly.
- Health professionals should also have as protocol the intermittent assessment of the child and the mother, to verify that the child is well, that the mother is watching the child or that a companion is watching him. If the mother is alone, professionals should assume that function if possible, or consider suspending the skin with skin in case the mother is primiparous, is very tired, with sedation, etc.
And from now on, the most necessary thing is to investigate to know the cause of the aforementioned episodes of apnea or sudden death when the baby is with the mother, to treat the cause and eliminate the risk. No one doubts that skin-to-skin contact is beneficial for newborns and therefore it is recommended that it be continued. But as long as the reason for these episodes is unknown, the guidelines are clear: let it be known that this is happening and that mothers and their companions monitor the baby at all times just in case.
