NICE has updated its clinical guideline Intrapartum care for healthy women and babies (CG190). This guideline covers the care of healthy women and their babies during labour and immediately after the birth. NICE has reviewed the evidence on the effectiveness of midwife-led continuity models and other models of care and deleted a recommendation about team midwifery.
The Royal College of Obstetrics and Gynaecologists has updated its guideline Monochorionic Twin Pregnancy, Management Green-top Guideline No. 51. The purpose of this guideline is to describe and, if possible, quantify the problems associated with monochorionic placentation and to identify the best evidence to guide clinical care, including routine fetal surveillance and treatment of complications at secondary and tertiary levels.
The World Breastfeeding Trends Initiative UK Working Group has published World Breastfeeding Trends UK Report 2016. The report provides information on breastfeeding trends in the four countries of the UK. The review finds that there are good infant feeding policies and programmes in place, but that these are scattered. England in particular is lacking in leadership and has support services that have declined in recent years. The report includes a ‘scorecard’ for each UK country, rating them out of 10 on a variety of indicators.
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews2016, Issue 11. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub4
Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother’s arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother’s bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a ‘sensitive period’ for programming future physiology and behavior.
Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.