Written by Mindy Morris, DNP, NNP-BC, CNS, C-ELBW and Liz Drake, MN, NNP, CNS, RNC-NIC, C-ELBW, EngageGrowThrive

In the NICU, parental well-being can help babies thrive. The health of infants is intertwined with the health of their parents. When an infant is born prematurely, their physical features are complete, yet the ways in which their systems and organs function are not. Infant development is a dynamic process dependent upon internal and external factors and a nurturing environment. While premature infants are at risk of many complications, disabilities, and diseases, there are strategies that offer protection. For example, the benefits of skin-to-skin care (also known as kangaroo care) highlight how parental and infant health are interconnected and related to how we experience life.

A meta-analysis looked at studies in 9 countries, including the US, with an aim to describe parental experiences in providing skin-to-skin care to their infants in the NICU. The main theme describes skin-to-skin care as a restorative experience. Parents expressed a unique sense of joy and connection when they held their baby skin-to-skin. Mothers described a sense of calmness accompanied by less feelings of guilt and fear. Providing skin-to-skin care helps parents bond with their babies.

The Womb World

The sense of touch is the first sense to develop and a powerful memory cue. Relational, nurturing touch can help foster an infant’s overall health, growth, and development. In the intrauterine environment, the infant is engulfed with connection and begins to recognize the rhythm and sound of the mother’s voice. This need for sustained connection and touch is why a family’s presence in the NICU is so beneficial for the infant. Parents who can provide skin-to-skin care, breast milk, and read or talk to their infant, are helping to develop this reciprocal, familiar relationship, which is so important since the NICU is so unfamiliar to both the infant and parents.

Benefits of Skin-to-Skin Care

Research shows that skin-to-skin care provides autonomic, physiologic, behavioral, and sensory benefits to the infant. Let’s explore these benefits.

Respiratory

When a parent holds a baby semi-upright or prone, it lowers the diaphragm, increasing tidal volumes, optimizing ventilation and oxygenation. Infants can breathe easier during skin-to-skin care!

Pain & Stress

Skin-to-skin care can help an infant during painful procedures by decreasing mean heart rate, cry time, and behavioral response, improving saturations, and decreasing hemodynamic and brain changes. Skin-to-skin care is comforting!

Thermal Regulation

There is a statistically significant reduction in hypothermia with maternal-infant dyad skin-to-skin care.

Other advantages are immunity & intestinal microbiome benefits. Skin-to-skin care supports healthy microbiome development, showing a decrease in NEC, improved digestion, and intestinal function. It also improves overall survival by decreasing infections, pneumonia, and inflammatory response.

Skin-to-skin care promotes an infant’s overall health and stability in the NICU!

Maternal Benefits to Skin-to-Skin Care

Research shows skin-to-skin care can increase milk production, increase initiation of breastmilk/breastfeeding, increase exclusivity in breastfeeding, and increase the duration of breastfeeding. Moreover, skin-to-skin care can help decrease post-partum depression and maternal depression.

Parental Benefits to Skin-to-Skin Care

Cortisol levels have been studied in premature infants and their parents as a sign of physiological stress. Stable premature infants held skin-to-skin have shown reductions in cortisol levels by 60% compared with infants in an incubator. One study found that infants and mothers had a greater reduction in salivary cortisol after skin-to-skin care compared with mothers in the control group. Another study revealed lower maternal/paternal anxiety and dissatisfaction, better maternal/paternal attachment, and more positive interactions with their infant. They concluded that frequent skin-to-skin care decreases infants’ cortisol reactivity, improves the concordance between mothers’ and infants’ salivary cortisol levels, and decreases fathers’ stress.

Skin-to-skin care is an accessible, low-cost intervention with lasting gains for infants and families that can have significant implications for public health policy.

Barriers to Skin-to-Skin Care

From a healthcare perspective, there are a few safety concerns including the security of IV lines, and the fear of unplanned extubation. To overcome these barriers, NICU teams should understand how to provide skin-to-skin care safely. Standard guidelines and consistency in skin-to-skin care practice would help to promote and encourage skin-to-skin care in all NICUs. Families are deeply committed to their child’s health and safety, and thus should be integrated in the process of developing any guidelines.

National policies and laws that prioritize the well-being of families are needed and essential to skin-to-skin care in the NICU. Families cannot provide this vital intervention to their baby in the NICU if the family cannot be physically present at the bedside or when the family’s basic needs are not met. 

Skin-to-skin care takes practice and parents must receive hands-on support and encouragement from the healthcare team. Families need to know they are the most important member of their child’s healthcare team. Healthcare providers can demonstrate this truth by supporting, mentoring, and coaching families into providing skin-to-skin care for their babies.

Conclusion

In the NICU, we can shape a child’s development for the rest of their life. Caring for infants is a huge privilege and responsibility for both parents and providers.

These quotes from NICU parents highlight the power of skin-to-skin care:

• “For the 1st time I felt like I was doing something no one else could do for my baby”
  
• “It was the 1st time I felt sure I was his mother & the nurses were not”
  
• “This was the 1st time I knew my baby was mine”

Sometimes the best technology, medical and nursing care are not enough. Babies born at the earliest of gestations are at risk of lifelong complications. A premature birth can affect the child’s development and life experience from childhood, adolescence, and adulthood. Human connection, bonding, and nurturing touch in the NICU help to cultivate healthier outcomes for parents and babies. Skin-to-skin care helps to amplify the strength and resiliency of our NICU families and babies.

Infants are more likely to thrive when they have a loved one at the bedside who is responsive to their cues and nurtures their need for connection. NICUs should encourage families and give them every opportunity to provide skin-to-skin care because it promotes bonding, lays the foundation for attachment, and offers countless benefits to parents and infants.

References

Anderzan-Carlsson Agneta., et al. “Parental experiences of providing skin-to-skin care
to their newborn infant: A qualitative meta-synthesis, Int K Qual Stud Health Well-being (2014):
9: 10.3402/qhw.v9.24907.

Chan, Grace, et al. “Kangaroo mother care: a systematic review of barriers and
enablers.” Bull World Health Organ 94  (2016): 130-141.

Choudhary, Mukesh, et al. “To study the effect of Kangaroo Mother Care on pain
response in preterm neonates and to determine the behavioral and physiological
responses to painful stimuli in preterm neonates: a study from western Rajasthan.” The
Journal of Maternal-Fetal & Neonatal Medicine 29.5 (2016): 826-831.

Conde‐Agudelo, Agustin, and Jose Díaz‐Rossello, “Kangaroo mother care to reduce
morbidity and mortality in low birthweight infants. Cochrane Database of Systematic
Reviews, 8 (2016): 1-122 https://doi.org/10.1002/14651858.CD002771.pub4.

Mishra, Pravakar, et al. “Effect of Kangaroo Mother Care on the breastfeeding,
morbidity, and mortality of very low birth weight neonates: A prospective observational
study.” Indian Journal of Child Health 4.3 (2017): 379-382.

Mörelius, Evalotte, et al. “A randomised trial of continuous skin-to-skin contact after
preterm birth and the effects on salivary cortisol, parental stress, depression, and
breastfeeding.” Early human development 91.1 (2015): 63-70.

Pineda Roberta, et al. “Parent participation in the neonatal intensive care unit:
Predictors and relationships to neurobehavior and developmental outcomes”. 117
(2018): 32-38.