Step Number 4

Skin-to-Skin Contact

Place infants in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their infants are ready to breastfeed, offering them help if needed.

Mom and dad can both practice skin to skin.

Why Step 4?

All mothers and babies should be supported to receive immediate, continuous and safe skin-to-skin care, regardless of feeding method. 

The benefits of skin-to-skin contact includes: 

  • Early establishment of effective breastfeeding
  • Longer duration of breastfeeding
  • Increased exclusive breastfeeding
  • Increased interaction and bonding between the mother and her infant
  • Infant physiologic regulation (e.g. state organization, cardio-respiratory functioning, temperature, blood glucose, etc.)
  • Improved infant health outcomes.


Skin-to-skin after Cesarean birth offers benefits to families by reducing the need to transfer of infants to the NICU for observation. Babies should be placed skin-to-skin with the mother as soon as she is alert and able to safely respond to her baby. Should skin-to-skin contact be interrupted for any reason, it should be resumed as soon as possible. Skin-to-skin contact should be encouraged throughout the hospital stay and post-discharge.

Babies should be placed skin-to-skin with the mother as soon as she is alert and able to safely respond to her baby

Primary Goals of Step 4

  1. Ensure that babies are in skin-to-skin contact with their mothers for at least one hour immediately following birth. 
  2. Help mothers recognize when their babies are ready to breastfeed and offer help, if needed.
  3. Ensure staff observation and implementation of safe skin-to-skin practice with proper education of families.

Ten Step Self-Assessment

Use the Ten Step Self-Assessment to help you evaluate your progress for this step. This self- assessment document does not have to be submitted with application.

Download Step 4 Self-Assessment
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New Applicants

  • Use document checklist (PDF) to ensure appropriate support documentation is included with application.
  • If your current practice does not meet these criteria, review the Ten Step Self-Assessment to assess how your facility might fully implement this step.

View Application and Support Documents

Information for Current Members

Re-Designation Applicants

  • Review your individual Ten Step Scorecard from the last designation for change recommendations.
  • Use the Ten Step Self-Assessment Tool to help plan for step-by-step improvement in any areas needed.
  • Review the Baby Friendly USA, Inc. Guidelines and Evaluation Criteria to view full standard for this step.

Download Baby Friendly Guidelines