383,979 babies were born prematurely in the United States in 2021, according to March of Dimes, which is a little over 10% of live births. To support the many parents of premature babies and spread education during Prematurity Awareness Month, we’re sharing encouragement from experts and parents on best facilitating a life-saving practice: skin-to-skin contact.
One of the simplest and most effective ways you can help your premature baby thrive is by practicing skin-to-skin contact, also known as kangaroo care. To practice skin-to-skin contact, hold your baby against your chest, bare skin to bare skin. For optimal results, keep your baby snuggled against your chest for as long as you can, but positive results can be seen and measured from just a few minutes together. This special bonding time works wonders for all babies, and is particularly crucial for premature babies. In fact, research shows that increased frequency of skin-to-skin contact can reduce the days on oxygen and ventilation, as well as shorten the NICU stay.
According to Sanford Health, skin-to-skin contact:
Regulates your baby’s temperature, heart rate, and breathing patterns
Strengthens the immune system
Improves breastfeeding success by increasing mom’s milk supply, forming a stronger bond between mom and baby, and boosting the release of oxytocin
Helps baby absorb and digest nutrients
Decreases stress for parents and baby, resulting in less crying and discomfort
Improves your baby’s weight gain and growth
Improves brain development and parental attachment, which has long-term benefits into adulthood
Helps your baby conserve energy so they can focus on learning instead of surviving
Fosters empathy and strengthens positive relationships
Improves sleep duration and quality
Benefits for Mom:
Allows for the sharing of good bacteria between mom and baby
Initiates and encourages breastfeeding
Helps baby attach to caregivers if breastfeeding is not an option
Lowers cortisone levels, the stress hormone
Builds mom’s milk supply
Increases levels of oxytocin in mom and baby, also known as the “love” hormone
Promotes healing for mom by slowing postpartum bleeding and encouraging uterine contractions
Lowers mom's risk of postpartum depression
We interviewed several experts and parents to get advice on how to get the most out of skin-to-skin time while in the NICU.
Educate yourself
Knowing the many benefits of skin-to-skin contact will motivate you to make this time a priority with your baby.
Erin Boje, a NICU registered nurse and newborn care educator, shared her expertise on the importance of skin-to-skin contact: “As a NICU nurse I have seen first-hand the amazing benefits of skin-to-skin contact, and the miraculous impact it can have on both premature babies and healthy newborns alike.
“One of my favorite benefits to talk about with parents is the immune-boosting benefit of skin-to-skin contact. When mothers hold their babies skin to skin, in both sick and well babies, the mother’s skin colonizes the baby's skin with “good” bacteria to fight off infection. The mother’s skin absorbs information about what antibodies to produce in their breastmilk to protect their baby based on what specific bacteria is present on the baby's skin. I think this is amazing! It is just one more thing to show us that much of the mother/baby dyad is unseen and often overlooked."
"Keeping babies close to their mothers is one of the fastest ways to heal a sick baby, or help a premature baby to grow and thrive."
“When premature babies get ample skin to skin contact with their mothers throughout their time in the NICU, the benefits are incredible. These babies grow and thrive in miraculous ways. Their nervous systems are regulated, mothers produce the right antibodies in their breastmilk to protect and boost their baby’s immune systems, baby’s heart rates, blood pressures, blood sugars, and respiratory rates are regulated, and their digestion is more optimal to tolerate their feedings, and in turn to grow and thrive.”
Get your partner involved
Skin-to-skin contact is tremendously beneficial for dads and other caregivers too. This is a great way for partners to be actively involved in their baby’s care and spend meaningful time together, all while aiding in crucial developmental processes.
“It’s important for dads or partners to know that skin-to-skin isn’t just for mom,” Lauren Brown, RN, BSN, RNC-NIC said.
According to The National Library of Medicine, “New fathers have been shown not only to develop close emotional ties with their child three days postpartum, but also to invest and sustain a strong interest in him or her during this period. Consequently, skin-to-skin contact may help decrease parental anxiety and enhance the dependency relationship. More frequent interaction with his infant may indicate that a father is providing increased levels of positive parenting behavior as measured by the five facets: sensory stimulation, physical care, warmth, nurturing, and fathering.”
Wear skin-to-skin friendly clothing and be mindful of fragrances
Wear clothing to the NICU that is skin-to-skin friendly. Zip up sweatshirts with a low cut tank top underneath, oversized flannels, a cozy robe, or open sweater are great options to snuggle skin-to-skin. Whatever you wear, just make sure your baby has access to your bare chest to correctly practice skin-to-skin contact. Button up shirts or zip up hoodies also work well for dads. “We did skin to skin every day in the NICU as much as we could. I made sure to wear shirts or dresses that were easy to tuck my daughter inside,” Kati Asher said, a NICU mom who delivered her daughter at 30 weeks.
While your baby is adjusting to their new surroundings and bonding with you, it's best to limit strong scents: “Be mindful of synthetic fragrances, scents, or products you use on your skin. You want your baby to bond with you, to smell the comforting smell of your skin and your body. Your little one already knows your scent; it’s best to keep your products clean and simple, especially while holding your premature baby since they can be more sensitive to synthetic fragrances and chemicals,” Boje said.
Get preemie and NICU friendly baby clothes
Taylor Leiker, a NICU mom who delivered her son at 31 weeks, regularly practiced skin-to-skin contact with her premature baby. She recommends that all parents, especially with premature babies or NICU babies, try Bonsie Skin to Skin Babywear to easily practice skin-to-skin without the hassle of undressing your baby.
“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. Plus, he just looks really cute in Bonsies too!”
Bonsie’s unique design is also 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 Bonsies are that you don’t have to do that. The NICU nurses loved them!”
Advocate for yourself and your baby
Many preemie parents feel intimidated by all of the cords and machines in the NICU, as well as their baby’s fragile condition. This can make them feel hesitant to hold their baby. If your baby is stable enough for skin-to-skin contact, ask the NICU nurses for assistance in navigating the medical equipment until you feel comfortable picking up your baby.
“At first, I needed help from the nurses to get my daughter out and snuggle her in. There was one nurse who took the time to show me and support me so I would feel confident getting her out myself. After I knew that, she believed I could handle it myself and I believed I could too.”
Remember that no one knows your baby like you do. You spend every day with your baby, watching the monitor and learning how your little one communicates. Nurses are the medical experts, but you are your baby’s expert, which is why open dialogue between nurses, doctors, and parents is so crucial to best assist premature babies. Babies in the NICU are in the safest place possible and monitored 24/7, but what they crave most is close contact with you, so don’t miss opportunities to advocate for yourself and your baby and hold your tiny miracle close.
“I often have to remind parents that they’re the parents, they know their little one best and providing care such as diaper changes and temperature checks before skin-to-skin helps them feel at home with the baby and makes them feel like they’re the parents again,”
Brown said.
Coordinate with NICU nurses
NICU nurses are there to help you and your baby. They want you to practice skin-to-skin contact and bond with your baby. Ask them questions, ask them for help holding your baby, ask them for advice, and don’t hesitate to express any concerns. They are there to help you! Let them know your plans to practice skin-to-skin so they can best facilitate it.
“My advice would be to first chat with the nurse to find a great time to do skin-to-skin so mama and baby can stay tucked in tight for a while. Oftentimes they need to cluster care to support the baby, so coming at care times is usually best,” Brown said.
Boje echoed Brown’s advice, highlighting the importance of sleep: “Sleep and rest are so important for babies, but especially premature or NICU babies. When they rest and sleep they are growing, developing, and healing. It’s best to plan to hold them during the times your nurse will be waking them to care for them, that way the stimulation of getting them out of their isolettes or beds to be held will happen during their wakeful time.”
If your baby then falls back asleep in your arms, that’s beneficial too because contact naps contribute to deeper, more restful sleep.
Make yourself comfortable first
The longer you practice skin-to-skin contact, the more you’ll see and feel the benefits for you and your baby. So if you can, settle in for the long haul.
Boje and Brown both advised parents to use the restroom first, have a drink and a snack close by, your phone, a book or calming music, and anything else to help them to be comfortable while you practice skin-to-skin contact. Remember that this time is beneficial for you both.
Breastfeed or pump during or after
Many premature babies are not ready to eat on their own, but for moms who are able to breast pump or breastfeed their babies, this is a great time to do so. Skin-to-skin contact triggers the release of oxytocin, which signals your body that it’s time to make more milk. Closeness to you will also signal your baby’s natural instinct to nurse or eat. Again, this is depending on your unique situation and your baby’s medical condition and abilities.
We asked Summer Friedmann, IBCLC and founder of Done Naturally about nursing and pumping in the NICU: “Pumping while doing kangaroo care: RNs and I used to get the littles all tucked into and under their pumping bra, tubes and monitors attached and all, then help them situate the pump into their breasts to pump while holding. It boosts their oxytocin, which helps them collect more milk. It’s also best to pump after hold times because milk yield is higher after holding because of the oxytocin.”
Talk, read, or sing to your baby during this special time
Your baby is comforted and familiar with the sound of your voice. While you're snuggling, you can talk to your baby about your day, read to your baby, or sing to your baby. This will only amplify your experience and soothe you both. “I loved singing to my daughter. We called her Marshmallow during the pregnancy. I would sing to her, You are my sunshine and change the ‘sunshine’ to ‘marshmallow.’ I still sing it to her and it calms her. I loved how she would melt into me and relax her little hands on my chest,” Asher said.
Do your best to relax
Sanford Health states that in the NICU, “a baby has more stress and emotional needs. Ongoing tests, noises and procedures are very different from the quiet, warm womb the baby has known. Being able to hold these babies skin-to-skin – even with monitors attached and/or equipment attached to them – still has been shown to help them relax and be more content.”
To make the most of your skin-to-skin contact, Boje recommends parents try to enjoy the time together: “Soak up the time for you to bond with your baby. Keep those times low pressure, relaxing, and calm. Allow yourself to just be present with your baby. Let go of the worries, the to-do lists, and stress during that precious hour. That time is sacred and should be whatever you want it to be! If you want to read a book during that time, great! If you want to just put your feet up and snuggle in with your baby, do that. If you want to listen to quiet, calming music that you love during that time, that’s great too! Try to keep the environment in the room calm and quiet to nurture your growing baby while she snuggles with you.”
There are many ways you can make the most out of your time practicing skin-to-skin contact. The goal is that you establish this practice as a daily part of your routine and make it peaceful. If you can slow down and relax, you can actually feel the oxytocin flooding your body, helping you both to bond. This miraculous time together will benefit you both in the long-run, and nurture a relationship full of empathy and understanding, while hopefully quieting some of the stress caused by the NICU.
“Those times when I got to be so close to her helped make it less about what we're missing by her being in the NICU,” Asher said.
Remember that skin-to-skin contact has lasting benefits, and this important practice should be continued daily once at home as well.