A Comprehensive Evidence-excerpts for Med Approved 4-11-2015

A Comprehensive Evidence-Based Review of Skin-to-Skin (Kangaroo) Care with Fullterm Infants


Susan M. Ludington-Hoe, R.N., CNM, Ph.D., FAAN


Barbara Morrison, R.N., CNM, FNP, Ph.D.


Gene Cranston Anderson, R.N., Ph.D., FAAN


This report has been supported in part by NIH-NINR 5RO1 NR04926 and NIH-NINR RO3 NR08587 to the first author and a Case Western Reserve University Frances Payne Bolton School of Nursing Research Incentive Grant to the second author.



Kangaroo Care (KC), skin-to-skin chest-to-chest contact between an infant and his/her parent, has been shown to be beneficial for preterm and Fullterm infants.  The infant and mother must have full skin-to-skin contact, without any clothing or materials being present in the ventral are (no bras are allowed!) because fabric in the ventral area will impeded all brain-mediated responses to KC (Kress, Minati, Ferraro, & Critchley, 2011).  Evidence regarding KC’s effects (physiological, psychosocial, behavioral, and breastfeeding outcomes) on Fullterm infants and their mothers and fathers was reviewed according to KC nomenclature that characterizes KC by its “starting” time.  This comprehensive review covers 39 years of research and includes all types of studies, from qualitative through meta-analysis.  Based on the evidence presented, anticipated outcomes and recommendations for practice conclude the review.




The new Maternity Care Practices in Infant Nutrition and Care (MPINC) criteria published by the Centers for Disease (CDC) Control and Prevention in the United States describe skin-to-skin contact (SSC) as a supportive hospital practice and mandate beginning SSC with the mother immediately after birth to improve breastfeeding outcomes (Centers for Disease Control and Prevention, 2009a, 2009b). Thus health professionals are eager to learn more about the evidence supporting the use of SSC.  Another name for SSC is Kangaroo Care (KC), defined as skin-to-skin, chest-to-chest contact between infants and their mothers and fathers. The use of KC with preterm infants has become common because its safety and benefits for these infants and their parents have been established through meta-analyses (Conde-Agudelo, Diaz-Rosello, & Belizan, 2000, 2003, 2007; Ludington-Hoe & Dorsey, 1998; Mori, Khanna, Pledge, & Nakayama, 2010).



  1. Have the mother provide continuous KC until discharge. Mother and infant should remain in KC as much as possible throughout the postpartum stay for improved interactions, development, and breastfeeding (Kent et al., 2012;Vasquez & Berg, 2012).  Continue KC as much as possible throughout the first three months of life (Chalmers, O’Brien, & Boscoe, 2009) and use KC as a FIRST intervention for breastfeeding problems (Vazquez & Berg, 2012).   Remember, Kangaroo Care is the newborn’s playground (Winberg, 2005).  Kangaroo Care’s continual use throughout the mother’s day can be accomplished using a tube top, slings, or wraps to position the infant near the breast while maintaining maternal modesty as the mother conducts routine postpartal activities.  Commercial wraps and tops are available (Kangaroo Care increases oxytocin release in both mother and infant.  Oxytocin, in turn, facilitates breastfeeding, bonding, maternal relaxation, uterine contractions, and minization of stress (Dordevic et al., 2008; Uvnas -Moberg, 2003; Uvnas-Moberg et al., 2005). Suckling maintains development of the anterior pituitary’s prolactin-secreting cells even when estrogen drops at birth – a condition that threatens prolactin cell integrity.  Suckling also induces prolactin surges in maternal blood, supporting normal lactation (Uvnas-Moberg, 1999; Uvnas-Moberg, 2003).  The colostrum delivered with the initial sucks is rich in T and B lymphocytes, enhancing infant immunity.  5.  Keep the infant in KC at least until the first suckling at the breast has been accomplished. Also, sending the infant to the observation nursery at any time during postpartum is detrimental because once the infant is in the nursery, treatments, physical assessments, and screenings get clustered together and result in prolonged separation from the mother (Vazquez & Berg, 2012). Conducting these procedures at the mother’s bedside is the best practice.
Labor and Delivery

Wearing The Second Skin Swaddle Is The Perfect Way to Welcome your Baby into the World

Provides coverage during labor and Delivery. After your baby is born he will be dried, diapered and placed on your chest. He will then be covered with the Swaddle Section to keep him warm and secure. The Womb like Enclosure will comfort him as he hears your heart beat and the sound of your voice. Learn More

Hands Free Hold

Step-by-step instructions on using the swaddle

Click below to learn all the steps on how to properly use your swaddle to effectively hold your baby skin-to-skin. Learn More

For Dad's

Great Shirt for Dad to Hold and Bond With His Precious Gift

Skin to Skin Contact the first weeks of life have been proven to be a life changing event for you and your newborn. It is also great for Mom to have a break.

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The Second Skin Swaddle “patent pending” For Post Partum Wear Allows You to be Discreet While You Safely Hold your Baby In Skin to Skin Contact

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Moderate Hold

There are two identical sections to the Second Skin Swaddle. A Single Section is used for Labor and Delivery a second section is added for the moderate hold. The design and flexibility of the Swaddle provides all that is needed for Labor/ Delivery and Postpartum while mom is in bed.

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