The Cleveland Clinic study found that uninterrupted skin-to-skin bonding time between mothers and newborns increased exclusive breastfeeding rates. 

Newborn Asian Baby Bath Blue Pale
Credit: A3pfamily/Shutterstock

January 23, 2019

Bathing newborns soon after birth has been the standard of care for generations, but a new study from Cleveland Clinic Hillcrest Hospital may change that. The study, published in The Journal of Obstetric, Gynecological and Neonatal Nursing found that by delaying newborns first bath, in-hospital exclusive breastfeeding (no formula supplementation) rates jumped from 59.8% to 68.2%. Exclusive breastfeeding in the hospital increases the probability that baby will receive breastmilk at home which has longterm benefits for both baby and mother.

Typically newborns are placed in skin-to-skin contact with their mothers immediately after birth. If born via surgical birth or cesarean section, skin-to-skin contact is initiated as soon as its safe for the mother. This skin-to-skin contact is then interrupted within the first hour after birth to allow hospital staff to complete Baby's first bath. The study came about after Heather DiCioccio, DNP, RNC-MNN, a nursing professional development specialist for the Mother/Baby Unit at Cleveland Clinic Hillcrest Hospital, noticed that several mothers requested to delay their newborns' first bath so they could have uninterrupted skin-to-skin bonding time.

The Clinic looked at nearly 1,000 healthy mothers—448 who had their babies bathed shortly after birth and 548 who delayed the first bath. Not only did the study find that exclusive breastfeeding rates increased among those who delayed baths, but those mothers were also more likely to be discharged with a feeding plan that was exclusive to, or at least included breast milk.

DiCioccio explained that there were probably several factors at work to increase breastfeeding success including skin-to-skin contact, the similarity in smell between the amniotic fluid and the breast, which may encourage babies to latch, and the temperature of the babies. Babies who were bathed after the 12-hour window were more likely to have a warmer body temperature than the babies bathed earlier, leading researchers to hypothesize that the warmer babies may have been more alert and less tired at the breast while trying to nurse.

"Mothers who keep their infants close to them are more likely to recognize early feeding cues in the infant and get the infant to the breast in a timely way for feeding," explains Jennifer DiPace, M.D., medical director of the newborn nursery at NewYork-Presbyterian Komansky Children's Hospital and Weill Cornell Medicine. "Sufficient maternal milk production is dependent upon regular stimulation of the breasts; mothers who skip/miss feedings, especially in the first few days of life, may have inadequate milk supply and need to rely on formula supplementation for their baby." The more skin-to-skin contact in the first days after birth, the more likely mother/baby pairs are to develop successful breastfeeding.

Early initiation of breastfeeding, or breastfeeding in the first hour of life, is recommended by multiple expert organizations including the World Health Organization (WHO), adds Dr. DiPace. "The reason for this recommendation is that evidence shows that babies who are fed early are more likely to be exclusively breastfed later in infancy."

The Cleveland Clinic decided to push first bathing for 12 hours after birth and this study may motivate other hospitals to implement more baby-friendly, breastfeeding-friendly policies. "It is no longer accepted practice to interrupt skin-to-skin bonding for anything other than medical reasons related to the care of the mother or baby," says Ben Horton, M.D., an Ob-Gyn in Charlotte, North Carolina. "Hopefully, the additional benefit seen in this study will serve as a further impetus to develop process changes at facilities that do not currently offer immediate skin-to-skin bonding."