Skin-to-skin contact after birth is important - but it's best to hold 'the golden hour' in perspective

Be ready to enjoy abundant skin-to-skin contact and frequent flexible offers of the breast after your baby is born

In the hospital setting immediately after the birth, whether it was vaginal or by caesarian section, your midwives will help you lie back against the pillows, with your baby's bare little body resting, tummy down, upon the skin of your own exposed chest or tummy.

Your newborn is a tiny little mammal. When you are laid back with her secured against you by gravity, in skin-to-skin contact, her breastfeeding reflexes switch on. But skin-to-skin contact also stabilises her body temperature and glucose levels and keeps her dialed down. Skin-to-skin contact increases the chances of breastfeeding success long-term.

Normal is, however, a very diverse human condition. Not all babies want to take the breast in that first hour. What matters is that baby is offered the opportunity to be up close to your body and breast. Another loving person can offer skin-to-skin contact, too, whether a father or other mother or parent of non-binary gender or loving carer.

And even when there are disruptions, such as sedation due to medications used with birth, or a traumatic birth experience, your newborn's biological drive to breastfeed is ancient and powerful and hardwired for months to come. The two of you just need ample opportunities to experiment together and work things out, calling on the help of breastfeeding support professionals if problems arise.

You and your baby are a complex adaptive system, which is - from an evolutionary perspective - incredibly resilient. You can find out about yourself and your breastfeeding baby as a biological system here and here.

If things don't go quite to plan at the beginning, which is often the way, then you just need to know how to do a repair, how to patiently call upon this inbuilt and ancestral resilience. That's what we're aiming to do in Possums Breastfeeding & Lactation.

It doesn't help to feel under pressure in the first few hours after birth

Some might tell you to hand express in the first hour after birth unless baby has breastfed 'well'. You might hear that the 'golden hour' after birth is essential for not only skin-to-skin contact but also colostral removal. Some might advise you to offer the breast frequently in those first hours but also to hand express and offer colostrum as 'dessert from a spoon'.

To my mind, it's not necessary to hand express your colostrum in the first hour after birth, and I worry that being put under pressure to do so may even be unkind.

This is because you, your baby, and your breasts aren't at all like machines, which work well to rules and algorithms. We don't want to put pressure on that first, numinous, liminal, vulnerable hour of your baby's life, when you may be in shock or feeling numb or in pain, when the baby is adapting and orienting to the strangeness of this world.

I hope that you're able to relax back on the bed after the extraordinary work of giving birth (although relax isn't always the right word for resting and recovering after the extreme physical and emotional demands of giving birth), and let life wash through you as you meet this new little human that you made.

It's great to offer skin-to-skin opportunity at least every couple of hours or even continuously, with the help of others, throughout the first 24 hours of your baby's life in this world. But just do what feels enjoyable and sensible and easy enough! There's no 'right' way, actually, as long as baby has lots of physical closeness near your breasts, as well as against the bodies of others.

You might snuggle your baby up but not fuss so much with having both your own body and baby's body completely bare. Feeling as though you both have to have skin exposed, especially when it's cold, can make it all feel too complicated! Best to do lots of snuggling up, even if you're not exactly skin-on-skin.

You could express milk in the first hour after birth of course, if you want to and it feels comfortable enough and no-fuss. If baby is affected by anaesthetic medications and sleepy, or if baby has a medical condition, some women hand express immediately in the hope of improving their chance of a good milk supply.

But to my mind, keeping the baby close to you, and knowing how to avoid nipple damage and how to set up pain-free transfer of the colostrum when baby does suckle is what matters most in the first hours after your baby is born.

We don't need everything to be ideal at the beginning for breastfeeding to succeed

Normal is a very diverse human condition, and each baby's needs are different. Striving for an ideal at the very beginning can even spoil what is best for you and your baby's breastfeeding success long term, because too much pressure is placed on you and the baby to make it happen.

We don't need everything to be ideal to succeed. We just need enough to go right, enough of the time. That's the nature of complex biological systems, which are resilient. You can find out why you and your baby are a biological system here.

Setting up your breastfeeding relationship is about workability, not perfection. Breastfeeding is often much more resilient than you hear, even though it's also true that not all women can breastfeed. We can usually retrieve supply even if the baby hasn't been removing milk as often as you might have wished in the first few days, as long as the two main things that undermine happy and easy breastfeeding in our society are addressed.

These are

• Nipple and breast tissue drag, so very often not identified, and

• Frequent and flexible offers of the breasts - even if baby is only on the breast for fairly short periods of time.

Often everything else is blamed, when these two most important problems have not been properly dealt with.

Selected references

Moore ER, Brimdyr K, Blair A. Immediate or early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2025(10):Art. No.: CD003519. DOI: 003510.001002/14651858.CD14003519.pub14651855.

Schafer R, Watson Genna C. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery and Women's Health. 2015;60:546-553.