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Unveiling a Crucial Barrier to Skin-to-Skin Contact for NICU Parents

Updated: May 2

Do new parents prefer buttons or zippers on their baby’s clothes? 

Most NICU parents prefer neither. 

In a country where one in ten babies are born prematurely and spend time in the NICU, it’s surprising that the baby clothing industry doesn’t have more options for NICU friendly and preemie babywear. 

Oftentimes, babies in the NICU are too fragile for any clothing and spend all their time in an isolette or held skin-to-skin. However, when babies gain weight and strength, clothing is introduced, which can deter parents from prioritizing skin-to-skin contact, also known as Kangaroo Care. According to Stanford Medicine, skin-to-skin contact is one of the most effective ways to help preterm babies heal and thrive, so any barriers to this crucial practice must be addressed by parents, caregivers, and medical professionals. 

Dad practices skin-to-skin in the NICU. Photograph by Quincey Carroll 
Dad practices skin-to-skin in the NICU. Photograph by Quincey Carroll 

Erin Boje, a NICU RN, childbirth educator, and member of our expert panel explains the importance of skin-to-skin contact and why many babies don’t wear clothing at the beginning of their NICU stay.

“In the NICU some babies cannot wear clothing for a few different reasons. If a baby needs close monitoring, then they cannot wear clothing in order for constant assessment of their respiratory patterns, their skin, their abdomen, a wound, or chest tube that they might have. Often in the NICU we are caring for premature babies, and when they are premature we will put them in a humidified environment in their isolette with constant monitoring of their temperature via a probe on their skin. When they are needing such close temperature regulation and monitoring, we keep them undressed in their isolettes or under a radiant warmer. Once they are able to regulate their temperature or have reached a certain weight, then we are able to dress them, but still keep them in their isolettes without the need for constant temperature monitoring. Clothing is a big milestone for NICU babies, and one more step towards being able to discharge home.”

Erin Boje, NICU RN, and newborn care educator
Erin Boje, NICU RN, and newborn care educator

Unfortunately, the design of most baby clothing is not convenient for the NICU setting and can be a burden. Sensitive medical equipment is attached to babies for various reasons, and situating babies and their clothing around cords and machines can be stressful for parents, and undressing NICU babies for skin-to-skin contact is not a simple task. 

The benefits of skin to skin contact are extensive and potentially life-saving. For example, according to Stanford Heath, it regulates babies’ temperature, heart rate, and breathing patterns. It also strengthens the immune system, improves breastfeeding success and weight gain, decreases stress and discomfort, and creates a stronger bond between mother and baby. The benefits, such as improved brain development and parental attachment, are long term and positively impact babies for the rest of their lives, fostering empathy and healthy relationships. 

Due to the critical time that parents need with their babies, skin-to-skin, the medical community and parents should do all they can to reduce barriers. When babies are already naked, this simplifies the task of placing your baby against your chest, bare skin to bare skin.  However, when babies are clothed in traditional baby clothing, this adds an extra step to the process that some parents and nurses would rather skip, forgoing skin-to-skin contact all together. Research from the National Library of Medicine states that even 20 minutes of skin-to-skin contact is beneficial and measurably lowers cortisol levels, the stress hormone, while flooding mom and baby’s body with oxytocin, establishing a more peaceful, loving environment despite the stressful NICU setting. Consider how much of this precious, healing time is missed due to clothing. 

Shelby Wendel, a NICU nurse with over ten years of experience and two of her own NICU babies, agrees that skin-to-skin contact doesn’t occur as frequently when babies are healthy enough to wear clothing. 

“Honestly, I just didn’t think about it. Once the kids were stable and dressed, the importance of skin-to-skin escaped me.  I always held them up on my chest, but if they were clothed I didn’t undress them,” Shelby said. “That's something I’ll be more conscious of as a nurse now to offer to parents with bigger babies once they are dressed.”

Amanda Cunningham also experienced the inconvenience of baby clothing in the NICU. 

“As a mom I feel once we got him dressed we didn’t do much skin-to-skin. Probably the convenience of it all, but something I will definitely change next time!”

Ellie Esry Kongs, another NICU nurse, echoes these sentiments: “I do tend to agree that once a NICU baby gets to the point of wearing clothes, it’s not as convenient for mama to hold skin-to-skin. When we start nursing, I generally feel like we encourage skin-to-skin, but for holding during tube feedings, I don’t think it happens as much.”

Boje shared her perspective of why skin-to-skin contact often decreases as soon as babies are healthy enough to wear clothes. 

“Once NICU babies are able to wear clothes, it does impact the ease of skin-to-skin contact with their parents. We have to keep them constantly dressed to maintain and regulate their temperature, except when they are being assessed or held skin-to-skin with their parents. This can make some parents hesitate to hold babies skin-to-skin. Taking on and off clothing does add an extra layer of stimulation to NICU babies and can definitely deter a parent from wanting to hold them skin-to-skin as often as they might if they were already undressed.”

So, how can we reduce this overlooked barrier and promote more time practicing skin-to-skin contact in the NICU?

Education, advocacy, and more NICU friendly baby clothing. 

Through their thoughtful clothing design, Bonsie Skin to Skin Babywear makes skin-to-skin contact as convenient as possible. Bonsie's products allow for skin-to-skin contact without removing babies’ clothing and for medical attachments to easily be placed on the chest, feet, or hands. Bonsie also regularly shares interviews from medical experts and parents on the benefits of skin-to-skin contact to promote this practice in the hospital and once at home. 

Taylor Leiker, a NICU mom who delivered her son at 31 weeks, regularly practiced skin-to-skin contact with her premature baby. She dressed her son in Bonsie Skin to Skin Babywear while he was in the NICU.

Taylor’s son in the NICU.
Taylor’s son in the NICU.

“Skin-to-skin was so important for us to bond with our baby. Not having to fully undress Wyatt but still perform skin-to-skin was special for both myself and my husband.”

Bonsie’s design is specifically created to accommodate various medical attachments in the NICU. “When Wyatt was in the NICU he had several cords attached to him; traditional onesies or zipper pajamas made it hard because I had to weave the cords through his legs. The other amazing thing about Bonsie's products is that you don’t have to do that, Taylor said. “The NICU nurses loved them!”

In addition to using NICU friendly babywear, parents should advocate for themselves and their babies in the hospital. January Plantage, a NICU mom, prioritized skin-to-skin contact with her daughter every day in the NICU. 

January and her daughter, Mira
January and her daughter, Mira

“Moms are the biggest advocates for their children, especially those of the NICU. I knew how critical skin-to-skin was for my daughter and me. Every day I would visit her, multiple times a day even, I would always ask to do skin-to-skin, even if she was clothed. Eventually the nurses just knew when I walked in, mom would be ready to do skin-to-skin. Advocating and stressing the value it had for both of us made me feel like I was genuinely doing everything I could to make sure we had this time together and all its benefits.”

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