Is it ethical to separate mother and infant just after birth?
Quick medical intervention has been seen as an asset in Labor & Delivery- a mother labors to give birth to an infant and the infant is whisked away. The care an infant receives after being taken away is essential and is part of hospital protocols- APGAR scores, Vitamin K shot, weighing, eye ointment.
The ‘whisking away’ may no longer be deemed ethical. Cochrane Review is a gold standard that is often used to build guidelines and their 2025 systematic review, found the evidence on immediate skin-to-skin to be incontrovertible. A non-profit, the Cochrane Reviews synthesize all studies to date on a particular medical topic. Immediate skin to skin care means less than ten minutes after the infant takes its first breath, the infant, naked except for a diaper, spends at least one hour on the mother’s chest, against her skin.
The 2025 Cochrane Review on ‘skin to skin care (SSC)’ is based upon 69 studies and 7000 mother-infant pairs in high-income countries. This systematic review (and others) find a myriad of probable benefits for an infant who received immediate skin to skin (Kangaroo care) including:
-increased blood glucose levels
-stabilized breathing (cardiorespiratory stabilization)
-controlled body temperature, avoiding hypothermia
-reduced infection
-promotion of exclusive breastfeeding
-decrease in all-cause mortality
This review supports immediate SSC after birth, regardless of mode of birth, for mothers and their healthy full‐term and late preterm infants in middle‐income and high‐income countries.
Though not covered in this Cochrane Review, this finding holds up in low-income countries and even with very low birth weight infants. WHO/UNICEF recommends immediate, uninterrupted skin to skin care (SSC) as the standard of care in Guidelines published in 2022. Immediate SSC for a preterm or low birthweight infant was recommended as a new guideline with strong evidence to support it. The infant should be against the mother’s chest, skin to skin, as a matter of standard procedure, not taken away to a radiant warmer. The exception would be for infants who need advanced cardiopulmonary resuscitation.
In low-income countries, studies have found that “continuous kangaroo mother care initiated immediately after birth in infants with a birth weight between 1.0 and 1.799 kg resulted in a significantly lower risk of neonatal death than the currently recommended initiation of kangaroo mother care after stabilization.” It is recommended that preterm and low birth weight kangaroo care involve prolonging contact beyond the first hour for at least 8 hours per day or as long as possible (up to 24 hours) per day
A study in India showed that a labor ward team was able to increase SSC from 0 minutes to 67 minutes over a period of 20 weeks with no additional resources.
In sum, the evidence is strong enough that the Cochrane Review (and other sources) state that it would no longer be ethical to do a study comparing ‘no SSC’ to ‘SSC.’ The evidence is strong and clear- infants, preterm or full-term benefit from skin to skin. The 2023 “Skin-to-Skin International Guideline expert panel concluded that all mothers and all babies (from 1000 g) should have immediate, continuous, uninterrupted skin-to-skin contact after all types of birth.”
This blog is not intended to be medical advice, but rather summarizes recent peer-reviewed publications.
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