8 REASONS WHY “TUMMY TIME” SHOULD BE STARTED AT BIRTH

Doctors, midwives, nurses and doulas highly encourage parents to start tummy time right after birth. But…they don’t call it “tummy time”, they call it something different, and it’s actually one of the most beneficial things you can do to help your baby get their best start in life.

Tummy time isn’t just placing your baby on the ground or on the floor with their stomachs facing down.

It can be done many different ways including on a pillow, rolled towels, on an exercise ball, across your lap, or by holding them in your arms with their tummy down instead of holding them on their back.

But…

what’s the best way to do tummy time with a newborn?

The best way for a newborn to do tummy time is on your bare chest.

This way of doing tummy time is called “skin to skin” (aka- kangaroo care), and it’s done by placing your baby’s bare tummy down in the middle of your bare chest, with their head to one side and their hands up by their head. They’re only wearing a diaper, and they may have a blanket placed over their back. It’s usually done in a reclining position, but it can also be done sitting up or lying down. It can be done on mom or dad, a sibling, or anyone else the parents feel comfortable with.

The American Academy of Pediatrics (AAP) recommends to wait until after your baby is home from the hospital to start the “traditional” tummy time where they’re placed on their tummy on a firm surface, like the floor.

But, they only say that because hospitals don’t allow babies to be placed on their tummies on a hard surface unless they’re hooked up to a heart monitor in the newborn ICU.

However,

the AAP does recommend that placing baby on their tummy to do skin to skin, should not only be started immediately after birth in the hospital, but it should also be done as often as possible, and for as long as possible.

In addition, it can be done safely even while your baby is asleep.

So, why is this way of doing tummy time superior to all other ways?

And why does The American Academy of Pediatrics, obstetricians, neonatologists, pediatricians, midwives, doulas and labor and delivery/postpartum nurses all agree that placing babies on their tummy skin-to-skin should be started immediately?

Here’s 8 convincing reasons why we feel that way.

1. IT HELPS BABIES REGULATE THEIR VITAL SIGNS

It’s crazy, but true.

Here’s a great example of a true story:

A baby was born healthy. They were assessed by nurses, and then swaddled in a blanket. Many family members were in the room and they were taking turns holding the baby.

During the nurses next assessment, baby was breathing too fast, and showing some signs of respiratory distress, like flaring their nostrils, and having intercostal retractions. Baby was also starting to “grunt”, which can sound like they’re sighing when they exhale.

At this time, the nurse took the baby over to a radiant warmer that’s in the room so they could better assess baby and give them some oxygen, if needed.

After about 15 minutes the baby was not improving. The healthcare team decided that the baby needed to be transferred to the Newborn Intensive Care Unit for a higher level of care.

One of the nurses took the baby off the warmer and placed them tummy down onto the mother’s bare chest skin-to-skin so the mother could have a few minutes with her baby before they were taken away to the ICU.

And guess what happened while baby was lying there on mom’s chest?

The baby’s breathing slowed down, the oxygen level in their blood improved, and their signs of respiratory distress disappeared.

It was like magic.

The newborn was minutes away from being admitted to the ICU, and all it took for that to be avoided in this case was to simply place the baby on their tummy skin-to-skin with mom.

That’s not to say that placing the baby skin-to-skin will resolve all cases of respiratory distress.

But, if the baby is stable enough, it’s definitely worth a try before more invasive interventions are introduced.

Studies have proven that skin-to-skin helps stabilize other vital signs too.

Babies heart rates are more stable,

their blood pressure is lower,

they’re able to stay warmer,

and their blood sugar level is higher after they’ve been placed skin to skin.

Another study investigated the impact that skin to skin has on low body temperature in newborns during the first 48 hours of life.

32% of the babies who were just wrapped in a blanket and did not do skin to skin got too cold, compared to only 4% of babies who were placed skin to skin.

A likely reason for this is due to an amazing phenomenon known as “thermal synchrony”. This is when the temperature of a mother’s chest will decrease if her baby is too hot, and it will increase if her baby is too cold.

Thanks to extensive studies like these, evidence based practice and clinical based observations, the medical community is embracing skin to skin as a standard of care.

For example, after vaginal births, babies without medical problems are immediately placed on their mother’s chest before the umbilical cord is even cut. And sometimes babies born by c-section are even placed skin to skin on mom’s chest even before the surgeons are done sewing her back up.

Skin to skin is becoming more and more accepted as a safe treatment to help temperature stability, heart and lung function, and blood sugar levels.

There is indisputable evidence that skin to skin benefits the health of the baby, and therefore every healthcare provider should be as encouraging and supportive as possible. If a baby is cold, has borderline low blood sugar, borderline low oxygen levels, or is breathing fast, they should definitely try skin to skin before they think of doing more invasive procedures.

2. IT HELPS BABIES SLEEP BETTER (But, they’re on their tummy. I’ve been told they can only sleep on their backs)

The American Academy of Pediatrics stands firm that babies must be placed to sleep on their backs in order to reduce the risk of Sudden Infant Death Syndrome (aka- SIDS).

Their “Back-to-Sleep” campaign in the 1990s encouraged parents to switch from having their baby sleep on their stomachs, to their backs.

Following the initiation of this program, the rate of SIDS deaths went down by 50%.

FIFTY. PERCENT.

Needless to say, the “Back-to-Sleep” campaign saved countless of lives.

YET,

read here where the American Academy of Pediatrics recently stated that:

“Skin-to-skin care is recommended, regardless of feeding or delivery method, immediately following birth for at least an hour as soon as the mother is medically stable and awake.”

The American Academy of Pediatrics- Safe Infant Sleeping Environment Report

You would think with their hard stance on only putting babies to sleep on their backs, that they would not encourage placing babies on their tummies skin-to-skin, because obviously babies are going to fall asleep that way.

But, no where do they recommend that babies should NOT sleep in this position.

And no where do they recommend to remove your baby from your chest if they fall asleep.

And no where do they state that babies who sleep on their tummies skin-to-skin are unsafe.

SO,

go forth!

And feel comfortable allowing your baby to sleep on their stomachs in the skin-to-skin position!

However, it’s VERY important to understand that your baby sleeping skin-to-skin is safe, but it can be done in a way that quickly makes it unsafe.

So, be sure to follow these rules:

1. Make sure your baby’s face is to the side, and their mouth and nose are not covered.
2. Make sure you’re fully awake if you’re alone.

It’s highly recommended that you do not do skin to skin if you’re left alone with baby and you’re overly tired, or if you’re on pain killers or other medications that make you drowsy. Babies have died from slipping into a position that kinks or obstructs their airway, and from slipping out of position (even slightly) and suffocating in bedding.

You’re obviously going to be much more in tune with baby and their position and breathing while you’re awake.

It’s safe to sleep with baby on your chest if someone else is awake in the room to keep their eyes on you and baby.

It’s no surprise that most newborns sleep the best on their tummies skin to skin,

and for good reason.

First off, they sleep better because they don’t wake themselves up as much.

A common reason they’ll wake themselves up is from their startle reflex. When they’re on their stomachs they don’t do it because their arms are cuddled against your chest.

But an even bigger reason why newborns sleep so well on their tummy is because it’s the most safe, familiar place they know.

Your warmth, your smell, your voice, the gentle up and down motion of your breathing, and the sound of your heartbeat reminds them of being in the womb: their home for the past nine months.

They’ve been born into a strange new world, and your chest is the only place that reminds them of being back in the comfort of home.

3. IT HELPS TO DECREASE PAIN FROM POKES

When my newborn patients have to have a blood draw or are going to be poked with the Vitamin K injection or the Hepatitis B vaccine, or have their blood drawn, I always prefer baby to be skin to skin, if possible.

This is not only due to the research I have read, but also from what I’ve witnessed over the years.

Babies just cope better when they’re skin to skin.

They show less signs of pain when I assess them using the Neonatal Infant Pain Scale (aka- NIPS) compared to babies who are not skin to skin.

Twenty-five studies showed that skin to skin reduces pain in newborns during invasive procedures.

Two of those studies compared the mother doing skin to skin to other people doing it, and there was no difference.

This should highly encourage anyone: dad, partner, siblings, family, and close friends to participate in doing skin to skin. Especially if mom’s not feeling well, or if she’s exhausted, which I assure you, she probably is.

If someone wants to help and hold baby, but doesn’t feel comfortable exposing their chest, they can also simply place baby’s tummy down on the middle of their clothed chest.

It’s like doing skin to skin, but without being skin to skin!

Baby will still be very soothed by their heartbeat, warmth, and respirations.

4. IT HELPS WITH DIGESTION & PREVENTS GAS

Your baby’s food, whether it’s breastmilk or formula is new to their digestive system, and for this reason it’s common for newborns to have gas.

The build up of gas can cause their tummies to hurt and feel crampy, which will cause them to cry.

A sign that they’re having gas pains is when all of their needs have been met (i.e.- their diaper is dry, they have been fed, they are being held, etc), but they are still crying.

If they’re having gas pains their cry is usually high-pitched, inconsolable, and they often will lift their knees up towards their bellies.

One way to help prevent gas in your newborn is to make sure you’re burping them after each feeding AND also after they have a big cry.

Try to burp them after each feeding whether they’re bottle fed OR breastfed. Breastfed babies can also swallow air while they’re nursing.

Also, babies swallow a lot of air while crying, so definitely try to burp them after they have a cry.

The pats you’re giving on your baby’s back while they’re either being help upright over your shoulder or in a sitting position on your lap will help air bubbles (aka- gas!) come up to the top of their stomach, which will then be burped out, sparing them from the air bubbles going further into their digestive tract and causing cramping and a tummy ache.

How long should you try to burp your baby for? Try to burp your baby for about 10-20 seconds. That’s usually a sufficient amount of time for a build up of air to come out. The patting can be broken up with giving a rub with gentle pressure from the bottom of their back up to the top of their back to help excess air come out. Not all babies will burp every time, and that’s ok! You should always try though!

In addition to burping them, another way to help prevent gas is to place them on their tummies skin to skin. But, how does placing your baby on their tummy in the skin to skin position help with gas?

It’s because air rises. The skin to skin position with tummy down will naturally help baby get gas up and out, instead of being forced by peristalsis deeper into their digestive tract which may result in discomfort, pain, irritability and crying.

In addition, skin to skin will also help prevent your baby from spitting up, especially if they’re placed in this position for at least 30 minutes after a feeding.

5. THEY WILL CRY LESS

Why do babies who are doing skin to skin cry less?

Countless studies have shown that babies cry less if placed on their tummy skin to skin, and this is most likely due to what we have already discussed.

• Their vital signs prove that they feel calmer
• They sleep better
• They cope with pain better
• They have less gas

6. IT HELPS WITH BONDING (not just with mom)

One word:

Hormones!

According to this study, and many more like it, the hormone “oxytocin” is released while doing skin to skin. Oxytocin increases feelings of well-being and reduces stress, and it’s also responsible for helping us fall in love, that’s why it has been dubbed the “love hormone”. Oxytocin is released in baby and whomever is providing the skin to skin care. It definitely goes both ways!

And it’s being released like crazy while doing skin to skin! So, much so that it should also be called the “bonding hormone”.

If dads and partners are worried that they won’t be able to bond since they’re not the mother or since they’re not breastfeeding…

hello, skin to skin!

Skin to skin has be proven to increase maternal and paternal sensitivity, responsiveness, and connectivity to their baby.

Mom, dads, and partners who do skin to skin have increased confidence and report feeling more relaxed, which ultimately leads to a stronger bond since stress can interfere with bonding.

The American Academy of Pediatrics reported on a study where mother’s stress levels were lowered substantially after doing skin to skin for one hour.

That leads us to the question, exactly how long should you do skin to skin to have it be the most beneficial?

This study found that the length of time didn’t matter, and there was no clear benefit from doing skin to skin for more than one hour, compared to less than one hour.

So, the standard of practice should be to shoot for one hour, but don’t get too worried if it’s less.

And what if you can’t do skin to skin immediately? It’s ok. The same study reported that there was no difference between starting skin to skin immediately (less than 10 minutes after birth) versus starting it more than 10 minutes after birth. However, starting skin to skin immediately after birth did show evidence that supported more successful breastfeeding.

7. IT ENCOURAGES BREASTFEEDING & MILK PRODUCTION (if that’s mom’s preference)

Babies are hardwired to find food for their survival.

Have you ever heard of the “breast crawl”?

When a newborn is placed on their tummy skin-to-skin they will actually “crawl” or even throw themselves towards the nipple. Even when placed on a male.

I have seen this time and time again!

All I can think is…

survivalism and nature are at work!

This study among many others show that immediate or early skin to skin promotes breastfeeding.

Babies who did skin-to-skin had better breastfeeding outcomes.

For example, they were more likely to have a good first breast-feeding, and they breastfed, in general, for longer, by about 1-2 months.

With that said, the fact that skin to skin helps with breastfeeding and milk production (due to increased oxytocin release) should NOT discourage bottle feeding parents from doing skin to skin.

According to the American Academy of Pediatrics, skin to skin should absolutely still be done with formula fed babies.

If you’re the mother who’s formula feeding, be sure to still do skin to skin, but wear a tight sports bra to help prevent nipple stimulation which may cause your milk to come in.

8. IT HELPS BABY GET USED TO BEING ON THEIR TUMMY (well, why does that matter?)

Why should you care if baby likes being on their tummy or not?

Two reasons:

1.) Being on their tummy helps strengthen the muscles in their neck and upper body, which is important later on for their motor development and for helping them meet important milestones such as learning how to roll over and crawl.

2.) Being on their tummy helps prevent a condition called plagiocephaly, also known as “flat head syndrome”.

Since so many babies are being placed on their backs to sleep, plagiocephaly is becoming more and more common.

It’s when a flat spot develops on the skull from lying in one position (like their back) for too long.

In addition to not having an evenly round head shape, if not treated as they grow older plagiocephaly may also result in an asymmetrical face, and may cause jaw misalignment.

Treatment usually begins around four to six months old and may require a the baby to wear a helmet that will help mold the baby’s head back to being round.

However, due to the shape of the head being fully formed by two years old, the cranial helmet therapy must be done by then or else the treatment will not work.

Parents can easily avoid plagiocephaly by starting skin to skin right away to help their baby get used to being on their tummy.

When parents complain that their baby doesn’t like being on their tummy it’s usually because their baby was not exposed to enough skin to skin right after birth and beyond, so being positioned on their tummy feels foreign to them.

WHAT IF YOU CAN’T START “TUMMY TIME” RIGHT AWAY?

Study, after study, after study, has proven that “tummy time”, in the form of skin to skin, should be started immediately after birth.

I hope that the eight reasons I explained here in this post helped to convince you that placing your baby on their tummy skin-to-skin on your chest has powerful benefits for your baby, and yourself, regardless if your baby was born vaginally or by c-section, or if your baby is breastfed or bottle-fed.

However, if your baby didn’t or doesn’t have the chance to do skin to skin right after birth due to medical issues, or if they’re in the NICU,

it’s ok!

My mom didn’t do skin to skin with me. And your parents most likely didn’t do it with you either.

The benefits of doing skin to skin was not known at the time, and therefore it was not encouraged like it is today, but we all still turned out pretty awesome!

Even though babies are physiologically programed for skin to skin, and it has been proven to have amazing benefits to help your baby adjust to life outside of the womb, your baby will ultimately be fine if they didn’t do skin to skin right after birth.

With that said, you can still start skin to skin any time after birth, we’re talkin’ months down the road, and still reap some benefits.

It’s never too late to start giving more physical comfort and love to your baby.

Evidence supports that doing tummy time skin-to-skin should be a normal practice for all babies if they are medically stable enough to do so.

And while skin to skin has amazing benefits, do you know what’s the MOST important thing you can do for your baby?

It’s just to love them,

gaze into their eyes,

talk to them,

feed them,

and keep them warm and safe.

If your baby is being loved and their needs are being met, they will surely thrive, regardless.

“Tummy time” in the skin-to-skin position, can just be icing on the cake.

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Disclaimer:
The content that I share on Purely Postpartum is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. I encourage you to always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.