Skin-to-skin contact is
*SAFE* - BUT DO SAFELY
Everything we do must be done safely – skin-to-skin contact is the safest for any baby - but must be done safely – TECHNIQUE matters.
Health professionals have over many years developed safe techniques and methods for keeping babies alive in incubators. These techniques are routine and almost automatic, and we don’t think too much about them. Doing things safely applies to everything we do: whether we cross the street (wait for green man), drive a car (seatbelt, check the mirror), or prepare food. We do these things safely by automation and routine. When we teach a child to cross the street, or an adolescent to drive, then we have to remind ourselves of the details.
When we now start putting babies on their mothers and fathers instead of into incubators, we have to remind ourselves of some details. In fact, we have to figure them out, because nobody did this before. For a late preterm infant (LPI) with little technology needed, this is relatively straightforward. For the smaller infant with a great deal of technology, this can be more complex. Experience from all parts of the world shows that soon the techniques become routine and “normal”.
There are some basic principles for SAFE TECHNIQUE , along with much detail. (See details for KangaCarrier)
1 The airway must be protected. Even a full term infant may experience obstructive apnea, more so smaller babies. The chin should be kept horizontal to the body, the neck flexed slightly less than the sniffing position taught in adult CPR. For prolonged care, this position should be secured by a cloth or band. The secured position should be maintained while the infant is sleeping.
2 The position should be flexed (fetal position) with maximal skin-to-skin contact.
3 The baby should be covered - of mother is comfortably clothed, the baby is warm enough. To achieve this for prolonged periods of time, most units have found some sort of garment necessary. KC (as in the USA) that is practiced just for an hour, usually suggests any garment that covers the baby, without fixation of the head. There is an element of risk if the airway is not secured.
4 BREATHING in very small neonates should be primarily diaphragmatic. The position should therefore be such that the abdomen can breathe without work against a soft or hollow spot (mother’s cleavage, or her epigastric hollow). The baby should also be upright to allow gravity assist to the diaphragmatic breathing
5 PROTECT SLEEP ! Mostmodern care ignores whether baby is asleep or awake. Sleep is necessary for brain development. Parents can tell – purely by the skin-to-skin contact – whether their infants are awake or asleep, they may need some help in realizing this. They become “sleep monitors”, directing any care that is needed to the end of a sleep cycle. This is about one hour, routine care and observations and drugs can almost always wait a while for this.
6 FEEDING should only be done when the baby is awake … and at the breast. This requires loosening any garment, which then also allows for eye to eye contact and other communication between parent and baby. Feeding at the breast helps the baby with smell and other sensory signals that prepare the stomach to digest the milk better, as well as support earlier initiation of breastfeeding. . The baby then is able to integrate sensory inputs of sociality and feeding during its next sleep cycle.
7 MONITORING should always be maintained, and parents taught to understand what is measured, and how to respond to problems.
8 PARENTS should be encouraged to be fully involved in the care of their infants, from the earliest stages. Many NICU’s have restrictive policies on visiting and parental involvement, these are not evidence based. Parents in the NICU are essential for good outcomes.
9 TECHNOLOGY - as much as is needed - should be added. This may require innovation and inventiveness to adapt existing technology not designed for use in skin-to-skin contact.
Ther KangaCarrier was developed in a situation where there were no incubators - and therefore had to be absolutely safe. It was subsequently used as the technique for SSC in a randomised controlled trial, which trial showed that low birth weight newborns stabilised much better in SSC than incubator