Overselling the benefits of skin-to-skin … and ignoring the risks

Woman with long nose isolated on grey wall background. Liar concept.

Pediatrician Clay Jones has a great piece today on The Scientific Parent, Recent Reports of Skin-to-Skin Benefits Fail to Mention Key Infant Safety Risks:

The Kangaroo Mother Care concept was introduced in the the late ’70s in developing countries as an alternative solution to incubators, where access to them and more complex healthcare for infants was limited…

…[Y]ou need to know that the reduced risk of death has really only been found in babies born with low birth weight…


[pullquote align=”right” cite=”” link=”” color=”#96712D” class=”” size=””]Practices beneficial for premature babies extended to term babies despite a lack of evidence? Where have we heard that before?[/pullquote]

There are risks. The media reports I saw had flawed conclusions, overlooking that these practices can put babies at risk of neurologic injury and even death.

Dr. Jones is talking about Sudden Unexpected Postnatal Collapse (SUPC):

This happens in the first week of life when a low-risk (healthy) newborn suddenly and unexpectedly has difficulty breathing, which can lead to their heart stopping. In the U.S. and Canada, we typically refer to this as early SIDS and sudden unexpected early neonatal death (SUEND). The outcome is frequently tragic, and half of the children affected die, with many of the remaining newborns are disabled in some fundamental way.

I’ve written about this problem before in association with the so called “Baby Friendly” Hospital Initiative designed to promote breastfeeding, in Is the Baby Friendly Hospital Initiative really the Baby Deadly Hospital Initiative? In it I discussed the paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards published in 2014 in the Journal of Perinatology.

We know that bed sharing (co-sleeping) can be deadly for babies, and the risk is highest when mothers are impaired by drugs or alcohol

The author reported 15 deaths and 2 near deaths:

In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.

So the benefits of skin-to-skin are being completely oversold and the risks and downsides completely ignored.

That sounds familiar. Where have we heard about practices beneficial for premature babies extended to term babies despite a lack of evidence? Where have we heard about benefits being oversold and risks or downsides completely ignored?

I remember! The exact same thing has happened with breastfeeding and delayed cord clamping. All three share remarkably similarities.

1. A practice found to be beneficial for premature infants is extended to term infants in the absence of any scientific effort to support it.

As Dr. Jones notes, skin-to-skin care was found to be beneficial for premature infants who need help regulating body temperature. There were no studies that showed the same benefits for term infants who don’t have trouble regulating body temperature.

Breastfeeding has been found to prevent necrotizing enterocolitis (NEC), a deadly complication of prematurity, but has no similar life saving benefits for term infants.

Delayed cord clamping has been found to prevent anemia of prematurity, but does not prevent anemia in term infants.

2. The practice is promoted and popularized by allied health professionals like midwives and lactation consultants.

3. The practice is promoted in a dual effort to demonize conventional medical practice and promote alternative medical claims.

4. The practices are examples of unreflective defiance so prominent in midwifery theory.

The midwife who first promoted delayed cord clamping did so because she believed it prevented learning disabilities. That was obviously untrue but other midwives picked it up and made the rationale more plausible but still unsupported by scientific evidence.

5. The risks and the burdens are ignored.

This is especially true in the case of breastfeeding. Approximately 5% of mothers cannot make enough breastmilk to fully support a term infant. This can result in dehydration, brain damage and death. Nonetheless lactation consultants continue to promote the utter fiction that there is “no such thing” as not enough breastmilk.

Breastfeeding can be painful, inconvenient and burdensome for mothers … but who cares about mothers? Their needs are rendered invisible and considered meaningless.

6. Even deadly dangers are ignored.

We know that co-sleeping increases the risk of infant death. We know that prone sleeping also increases the risk of infant death. We know that the risk is higher when women have taken sedative medications. We know that soft bedding also increases the risk. Yet lactivists and lactation consultants encourage co-sleeping and prone sleeping next to or on top of sedated mothers enveloped in soft bedding to “promote” breastfeeding … and there’s no solid evidence that it has any impact on breastfeeding rates.

Has anyone ever said: “I stopped breastfeeding because if I had to get up anyway to put the baby back in the crib I might as well bottle feed”?

7. White hat bias

White hat bias is bias toward what are perceived to be righteous ends. Formula companies have committed egregious crimes in the developing world. White hat bias is bias against formula in a righteous effort to punish the manufacturer.

The desire to believe that “natural” is always better than technological is another form of white hat bias.

Midwives and lactation consultants have their own form of white hat bias. In an ongoing effort to demonize any technology that they cannot provide, they are heavily biased toward practices or procedures that they can provide.

In the final analysis, only careful scrutiny of scientific evidence should guide clinical recommendations … NOT intuition; NOT wishful thinking; NOT the desire to promote midwifery or lactation consultants; NOT a desire to promote breastfeeding; NOT white hat bias.

Women who pride themselves on taking a cynical view of doctors and industry products need to expand their cynicism to midwives and lactation consultants and their products.

Otherwise babies will continue to die completely preventable deaths because their mothers never received complete and honest information about minimal (or even non-existent) benefits or complete and honest information about deadly risks.