Healthy Children Project, Inc.
East Sandwich, MA 02537
Tel: (508) 888-8044

Our Latest Research

Skin to Skin Care in Uganda

The rate of infant mortality worldwide is shocking. Globally 2.6 million children died in the first month of life—approximately 7 000 newborn deaths every day with about 1 million dying on the first day and close to 1 million dying within the next 6 days. Additionally, in 2016, 46% of all under 5 child deaths were among newborn infants, babies in their first 28 days of life (the neonatal period)—up from 40 % in 1990. Globally, neonatal mortality rates are getting worse, when they should be getting better.
As a means to combat these horrifying statistics a team of experts traveled to Uganda to help a small rural hospital implement skin to skin in the first hour after birth. The need for intervention is particularly critical in Uganda. In 2015, neonatal mortality rate for Uganda was 18.7 deaths per 1,000 live births.  
When placed skin to skin with their mothers immediately after birth, many of these deaths can be avoided. New evidence indicates that when compared with newborns who were put to the breast within an hour of birth, the risk of dying in the first 28 days of life is 41 per cent higher for those who initiated 2–23 hours after birth, and 79 per cent higher for those who initiated one day or longer after birth.
To aid in implementing skin to skin in the first hour after birth in Uganda, we have implemented and filmed a video available on YouTube to help understand the 9 instinctive stages that newborns go through during the first hour after birth, and to illustrate for staff, administrators and parents the process for the people of Uganda and sub-Saharan Africa.

Video of Skin to Skin (9 Stages) in Gulu, UGanda also available in Acholi language of Luo

Healthy Children helps with skin to skin in Uganda. This short video shares the work of Healthy Children Project assisting in implementing skin-to-skin contact immediately after birth in Uganda.

Breastfeeding Success Negatively Impacted by Common Labor Medications

Healthy Children Project, Inc. faculty conduct research and consulting throughout the United States and around the world. Our most recent research found that medications used during labor can have a negative effect on breastfeeding. The findings were epublished in Birth: Issues in Perinatal Care, October 2015.

Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin-to-skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes.

A strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth.

For more information:The Association Between Common Labor Drugs and Suckling When Skin-toSkin During the First Hour After Birth

Below is a brief explanatory video about this groundbreaking study.


Skin-to-Skin Algorithm An Implementation Algorithm to Improve Skin-to-Skin Practice in the First Hour after Birth

WileyA new open access article from our Faculty Kajsa Brimdyr and Karin Cadwell, along with colleagues Jeni Stevens and Yuki Takahashi introduces a novel algorithm to analyze the practice of skin to skin in the first hour and highlight opportunities for practice improvement.

We have created editable downloadable versions of the HCP-S2S-IA Algorithm and the Robson's Criteria Form, which have spaces for custom numbers, to aid in implementation. 

HCP-S2S-IA Algorithm Form


Robson's Criteria Form

Robson's Criteria Form


Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding:
Elucidating Physiologic Pathways

Annals of NursingDownstream GraphicAnother new open access article from our Faculty Karin Cadwell and Kajsa Brimdyr seeks to explore physiologic mechanisms affecting breastfeeding outcomes of the commonly administered intrapartum drug, synthetic oxytocin. "Downstream negative effects related to breastfeeding include decreased maternal endogenous oxytocin, increased risk of negative neonatal outcomes, decreased neonatal rest during the first hour with the potential of decreasing the consolidation of memory, decreased neonatal pre-feeding cues, decreased neonatal reflexes associated with breastfeeding, maternal depression, somatic symptoms and anxiety disorders. No positive relationships between the administration of synthetic oxytocin and breastfeeding were found. Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes."


Changing practice in a hospital setting can be difficult – fraught with a list of barriers. A new research methodology, PRECESS, developed by a team of researchers from the US Healthy Children Project, Inc., and piloted by Healthy Children Project, Inc. (USA), Karolinska Intitutet (Sweden), Karolinska Hospital (Sweden), and the Egyptian Lactation Consultant Association (Egypt), uses ethnographic methods combined with hands-on expertise to drive lasting change. PRECESS stands for Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success.

The PRECESS methodology expects sustainable change in a short period of time, only five days. The PRECESS methodology provides an opportunity for clinicians who are experts in the new technique to work in a practical manner side-by-side with the staff of the changing hospital for a limited amount of time. The hospital staff at the changing hospital then have the responsibility to continue the new process. During the time together, the PRECESS team uses video ethnography and interaction analysis, combined with expert education and practical application of the new knowledge, to document the work practice in the hospital; to assist the staff in seeing their own work via interaction analysis, and to identify the barriers and solutions that, by necessity, would be unique to their situation.

Our services can be tailored to your organization. Our experts are available for consulting and keynote speeches.

The Team

Kajsa BrimdyrKajsa Brimdyr, PhD, CLC

Dr. Kajsa Brimdyr is an experienced ethnographer who has worked with health care, municipal and technological businesses, using ethnography to understand and appreciate the work practice of professions, work-flows and services in order to help improve practice. She has conducted research in the United States, Sweden, Latvia, Egypt, and Iceland. Her current research involves using video ethnography and interaction analysis to change practice in hospital settings to improve continuous skin-to-skin for the first hour after cesarean and vaginal births in Egypt and the United States. She, along with Ann-Marie Widstrom and Kristin Svensson, are the producers of the DVD skin-to-skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth. Her newest DVD, the award-winning The Magical Hour: Holding Your Baby for the First Hour After Birth is aimed at parents.

Ann-Marie WidstromAnn-Marie Widström, RN, MTD, Doctor of Medical Science

Dr. Ann-Marie Widström has conducted the foundation research that forms the basis of the 9 stages, and has been instrumental in the research that documents the importance of continuous, uninterrupted skin-to-skin contact in the first hour after birth. She is an associate professor at the Karolinkska Institute in Stockholm, Sweden. She has been a labour ward staff midwife, a lecturer at the Midwifery School in Stockholm,and head of the Department of Nursing including Midwifery Education at Stockholm University College of Health Sciences. She was co-project leader for developing interdisciplinary Centres for Clinical Education at four major hospitals in Stockholm during the merging of the University College and Karolinska Institutet. She has supervised several doctoral candidates at the Karolinska Institutet and published some 50 research articles. Her main research area is the inborn behavior of the newborn infant to find the mother’s breast when held skin-to-skin by the mother immediately after birth. Ann-Marie is also involved in working with teams to apply skin-to-skin under different cultural circumstances in Egypt as well as in USA.

Kristin SvennsonKristin Svensson, RN, Midwife, Doctor of Medical Science

Dr. Kristin Svensson is a midwife specialist in breastfeeding at the Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, and at the Breastfeeding Center at Karolinska University Hospital, Solna. Her doctoral thesis: Practices that Facilitate or Hinder Breastfeeding addressed delivery and maternity practices that can impede breastfeeding and to develop methods to facilitate breastfeeding. Kristin is co-author of a Swedish breastfeeding book and author of breastfeeding chapters in several books. Her research focuses on the use of skin-to-skin in the community for solving difficult breastfeeding problems.


Karin CadwellKarin Cadwell, PhD, RN, FAAN, ANLC, CLC, IBCLC

is a nationally and internationally recognized speaker, researcher and educator. She is a member of the faculty of Healthy Children Project,Inc and convened Baby-Friendly USA, the organization implementing the UNICEF Baby-Friendly Hospital Initiative in the United States. Dr. Cadwell counsels breastfeeding mothers at the Center for Breastfeeding, a community-based lactation clinic on Cape Cod. Dr. Cadwell is a delegate to the U.S. National Breastfeeding Committee. She was a member of the faculty of Union Institute & Universities Bachelor’s, Master’s and PhD degrees in maternal child health-lactation consulting. She was Visiting Professor and chair of the Health Communications Master’s Program at Emerson College (a joint program with Tufts University School of Medicine and Public Health.) She is the author of numerous books and articles including;The Pocket Guide for Lactation Management, Breastfeeding A - Z: Terminology and Telephone Triage, Case Studies in BreastfeedingMaternal and Infant Assessment for Breastfeeding and Human lactation and Reclaiming Breastfeeding for the United States. She has led delegations focusing on Breastfeeding and Human Lactation to China, Sweden, Denmark, Russia, Romania, Latvia, Cuba, Egypt, and Israel. Dr. Cadwell was awarded the designation IBCLC in 1985 for "significant contribution to the field" and has also certified by exam.