Tag Archives: premature infant

The Importance of Skin-to-Skin Contact

By Jack Newman, MD, & Teresa Pitman

Editor Rita Brhel doing Kangaroo Care with her premature daughterWe now have a multitude of studies that show mothers and babies should be together, skin-to-skin (baby naked, not wrapped in a blanket), the baby’s neck extended slightly so his head is in “sniffing position,” immediately after birth – and they should spend as much time together skin-to-skin as possible in the days that follow. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and normal, and the baby’s blood sugar levels are better.

Not only that – skin-to-skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s and studies show that the baby is much more likely to adjust to his new world, metabolically speaking, when he is skin-to-skin with the mother than if he is in that incubator.

We now know that this is true not only for the baby born at term and in good health but also for the premature baby. Skin-to-skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin-to-skin, and this helps reduce their need for oxygen and keeps them more stable in other ways as well.

From the point of view of breastfeeding, babies who are kept skin-to-skin with the mother immediately after birth for at least an hour are more likely to latch on without any help, and they are more likely to latch on well, especially if the mother did not receive medication during labor or birth. Putting mother and baby skin-to-skin can also be a valuable first step in solving any breastfeeding difficulties they are having.

There is no reason that the vast majority of babies cannot be skin-to-skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence. Of course, there is also no reason a baby cannot be back skin-to-skin with the mother immediately after the hospital routines are done.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, usually in response to the baby’s behaviors showing some interest in going to the breast, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other’s company. The mother and baby should not be left alone, however, especially if the mother has received medication. It is important that not only the mother’s partner but also a nurse, midwife, doula, or physician stay with them – occasionally, some babies do need medical help and someone qualified should be there “just in case.”

The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin-to-skin contact can also be done after Cesarean section, even while the mother is getting stitched up, unless there are medical reasons that prevent it.

Studies have shown that even premature babies as small as 1200 grams (2 pounds 10 ounces) are more stable metabolically, including the level of their blood sugars, and breathe better if they are skin-to-skin immediately after birth. The need for an intravenous infusion, oxygen therapy, or a nasogastric tube, for example, or all the preceding, does not preclude skin-to-skin contact. Skin-to-skin contact is quite compatible with other measures taken to keep the baby healthy.

Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin-to-skin with the mother immediately after birth. Indeed, in the premature baby, as in the full-term baby, skin-to-skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin-to-skin contact is still good and important for the baby and the mother for all the other reasons mentioned.

I have heard of a few cases where a mother had planned not to breastfeed but was still urged by hospital staff to hold her baby skin-to-skin. After doing this for a short period of time and seeing her baby gravitate to her breast, these mothers decided to breastfeed after all. The effects of this simple technique are powerful! In fact, one could say that skin-to-skin contact is even more important if the mother does not breastfeed so that the mother and baby have this special opportunity to “fall in love with each other.”

The Case for Skin-to-Skin Contact Between Mother and Baby, Whether Full-term or Premature
In summary, skin-to-skin contact immediately after birth that lasts for at least an hour has the several positive effects. These babies:

  • Are more likely to latch on, and to latch on well.
  • Have more stable and normal skin temperatures.
  • Have more stable and normal heart rates and blood pressures.
  • Have high blood sugars.
  • Are less likely to cry.
  • Are more likely to breastfeed exclusively longer.

Excerpted from The Latch and Other Keys to Breastfeeding Success by Newman, J., and Pitman, T. (2006) Amarillo, TX: Hale Publishing. (pp. 9-12) www.ibreastfeeding.com

The Story of Rachel

By Rita Brhel, editor of The Attached Family publications



Editor’s Note:

This birth story goes along with the article of how I came to Attachment Parenting through my premature daughter’s birth. Find the article, “AP from a Preemie Mom’s Perspective,” in the “Your AP Stories” section of TheAttachedFamily.com or by clicking here.


As my second trimester came to a close at the end of May, with the summer promising to be very hot, I began to wonder how big I would get and how exactly I’d be able to do my busy, active journalism job as my pregnancy progressed. While I was starting to get a little nervous about my due date, August 13, and was sad that I’d miss my usual summer activities of water-skiing and canoeing, I still felt good. Besides some swelling in my ankles, the pregnancy seemed to be going along just fine.

The morning of Tuesday, June 6, everything changed. Pregnancy was no longer nearly as fun or as full of promise for a healthy baby. I woke up at 5:30 a.m. in a pool of blood. My first thought was that I had lost the baby, but as soon as I stood up, I felt a kick. I couldn’t grasp that she was still alive when it was clear from the blood that things were not at all OK.

Fifteen minutes later, my husband Mike had driven me to the clinic in Hartington, Nebraska — only 10 miles away, but the ride seemed like an eternity. The doctor hooked me up to the ultrasound and contraction reader, found the baby’s heartbeat and said everything was going to be OK. However, I would need to go to the hospital to stop the labor that had begun. I was also given the first of two painful steroid shots to quicken my baby’s lung maturity.

Because I was only 30 weeks along in my pregnancy, it was decided that I would need to go to the Avera McKennan Hospital in Sioux Falls, South Dakota, a hospital that specializes in high-risk pregnancies and has a Level III Neonatal Intensive Care Unit, or NICU, a nursery that is able to handle the youngest and sickest babies, basically any baby born before 32 weeks gestation. It was a long ambulance ride up there, one and a half hours away from Hartington. Mike followed the ambulance in the car; I distracted myself from the contractions that were coming every 10 minutes by chatting with the paramedics.

Once I got to the hospital, the perinatalogist determined that I had a placental abruption, a dangerous complication in which the placenta prematurely separates from the uterus, causing the mother to hemorrhage and the baby’s oxygen and nutrient supply to diminish. I also had effaced nearly 100 percent, signaling that labor had been going on silently for longer than just that morning, most likely caused by an incompetent, or weak, cervix. Luckily, dilation had not begun, I was stable, the baby showed no signs of distress and my water had not broken. There was hope.

I was placed on strict bed rest — not even able to go to the bathroom, shut the curtains, or turn on the TV — and put on a powerful dose of magnesium sulfate, a drug that effectively stopped labor but left my body wrecked. The first dose of medicine, put through my I.V., felt like fire running through my veins. I was extremely weak and dizzy, and had to be on oxygen. My heart rate, blood pressure, blood-oxygen levels, urine output and temperature were checked every hour by the nurse; my medicine level checked every four hours by a blood draw; and I could only eat a liquid diet. I still cannot eat Jello to this day. But it worked; I had stopped bleeding and I felt less than four contractions an hour, not enough to cause labor to progress.

The ultimate goal was to delay labor long enough so that my baby wouldn’t be born until the steroids had time to work, at least 24 hours past the second injection. The hope would be that I could stay on bed rest at the hospital until at least 32 weeks, when the survival rate of premature babies jumps up to about 98 percent and complications were less likely and less severe. The survival rate for a 30-weeker was 90 percent but complications were more common and their severity higher.

At one point during my hospital stay, a neonatalogist visited my bedside to give me an overview of the NICU. I had no idea was he was trying to tell me — I thought the drugs would work, the pregnancy would last until my baby was term, my baby wouldn’t need any sort of NICU care. I had never even heard of the NICU before then, and when he asked me if I had any questions, I just stared at him blankly … even though my mind was racing with them.

Thursday, June 8, was the day of truth … in my mind. That was the day I was to be taken off the magnesium sulfate and put on the pill form of procardia, a drug created for heart patients, with the hope that it would keep labor-progressing contractions at bay. Unfortunately, Mike had to return to work on Friday, so I begged for my dad to come and stay with me, instead.

Thursday was a good day. Friday was not. My contractions came back early Friday morning, June 9, with all the intensity they had on Tuesday. At 11 a.m. Friday, I was put back on a magnesium sulfate I.V. with a double dose of the procardia pill and an injection of terbutaline, another anti-labor drug that gave me the shakes. I braved each contraction, with the help of my dad and a nurse as my coaches since I had never been through childbirth classes, with the expectation that the drugs would work. But when the perinatalogist checked my cervix at about 3 p.m., he found that I was 7 centimeters dilated and far beyond the point of halting labor. I had also started hemorrhaging again, and birth was the only sure way that neither me nor my baby would die. It was devastating to hear the doctors say there was nothing more they could do to stop labor and that my baby’s well-being was left to fate.

I was immediately wheeled down to the next floor to prepare for delivery. I was given an epidural, not only for my pain relief and to help keep me and my baby calm, but also to ensure that an emergency C-section would be possible. If the baby showed any signs of distress, it was expected that I would undergo a C-section immediately.

Mike got to the hospital just as soon as the anesthesia started working, but although he had missed most of the labor, he was right in on the action during birth. My time to push came so quickly that he didn’t even have time to scrub in. Wearing a pair of shorts and a sweaty shirt, he helped hold my leg and my hand, telling me how great of a job I was doing.

I had been pushing for 40 minutes when we ran into a snag. The baby was starting to show signs of distress, a slowing heart rate. I was put back on oxygen to help my baby out, but the doctor advised me he’d have to help her out in his own way. He decided to try an episiotomy, but said that if the baby didn’t come out with one pushing cycle, we’d have to do a C-section. After all that work, and especially an episiotomy already done, I did not want that C-section. And, luckily, I didn’t have to have one.

At 10:17 p.m., a little girl with blond hair was born measuring 16 inches long and weighing three pounds, seven ounces, about a pound more than the neonatalogists were hoping.

AP from a Preemie Mom’s Perspective

By Rita Brhel, managing editor and attachment parenting resource leader (API)

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

Rita doing Kangaroo Care with Rachel
Rita doing Kangaroo Care with Rachel

It was a big day for me, my husband, and my daughter. In mid-January, seven months after Rachel was born, when she had reached 18 1/2 pounds and 26 inches long, her pulmonologist told us she was ready to come off the cardio/respirations apnea monitor that had been a constant part of her life since she left the hospital five months earlier. I was nervous, but her doctor told me that it was OK – in all his many years of practice, he had never seen a healthier looking preemie than Rachel.

It was a great compliment. My daughter was born in June at 30 weeks gestation, due to a significant placental abruption, a serious pregnancy complication in which the placenta prematurely separates from the uterus. Weighing three and one-half pounds and measuring 16 inches long, Rachel was nearly three months early.

A Traumatic Start

I had been planning a drug-free childbirth, but what I got was anything but easy, natural, and beautiful. It was traumatic for me, both emotionally and physically. I had been in the hospital for four days after hemorrhaging, and I was being treated with several anti-labor drugs, one of which (magnesium sulfate) left me so weak that I required oxygen. I was given an epidural in case I needed a C-section, and I had an episiotomy that became a fourth-degree tear and later acquired an infection. This was not the childbirth of my birth plan. Continue reading AP from a Preemie Mom’s Perspective

Small Blessings: A Father Recalls His Preemie Daughter’s Birth

By Mike Brhel

**Originally published in the Summer 2007 Secondary Attachments issue of The Journal of API

Mike and Rachel
Mike and Rachel

My wife and I had always wanted a family. We had tried for a child during the first few years of our marriage, but nothing ever happened. We decided to leave it up to God; He would give us a child when the time was right. That time came in December of 2005, confirmed by those two distinct lines.

I was thrilled to become a father and could hardly contain my excitement. This made it extremely difficult to wait to tell friends and family the good news until we were sure that the pregnancy would go to term. After a slight scare in the first trimester, everything was going as expected.

On the morning of June 6, everything changed. Continue reading Small Blessings: A Father Recalls His Preemie Daughter’s Birth