There’s an image many of us have in our heads of “the perfect birth”—that final push, crying with joy, and a plump newborn is gently placed into mom’s waiting arms. Chest-to-chest and skin-to-skin, they feel each other’s warmth and comfort, and fall in love at first sight.
But that dreamy watercolor scene, which has been shown to us again and again in advertisements, social media posts, and even doctor’s office pamphlets, isn’t the reality for so many families. And for mothers who unexpectedly deliver preterm or have complications during labor—birth and the moments, days, and months following can even be traumatic.
These moms first meet their tiny babies through the walls of an incubator, obscured by scary tubes and beeping machines. And it can be hard for a parent in these circumstances to feel emotionally connected, or to even feel like they play any role in their baby’s life or survival.
For a long time, the overwhelming consensus was that mothers had little influence over their newborns’ brains and bodies. Because of this, Neonatal Intensive Care Units (NICUs), especially in resource rich countries, became heavily machine dependent. But over the last thirty years, moms (and dads and other family members) have been plugged back into the equation of their baby’s health, thanks in large part to Kangaroo Care.
The Benefits of Kangaroo Care
Kangaroo Care was first introduced to the NICU in Colombia, South America, in the 1970s. Hospitals there had a limited supply of incubators and were experiencing a high preterm infant mortality rate. And so they strapped at-risk babies to their mother’s chests from minute one (picture a kangaroo joey in mama’s pouch), hoping to recreate the warmth and co-regulation of the womb. And it overwhelmingly worked.
That’s because a baby, even one born at term, is unable to regulate its own physiology. It can’t keep its little body warm, or feed itself. It needs sensory inputs, such as mom’s smell, warmth, touch, and milk. There are many wonders built into our genetics, but it takes nurturing to activate and shape these genes. For example: it’s these sensory inputs that connect the baby’s amygdala (emotional brain center) to its frontal lobe (social brain center), which means that our socioemotional behavior isn’t predetermined, it’s conditioned.
And the health benefits of Kangaroo Care are overwhelming. It has been found to reduce instances of infection, hypothermia and pain; it regulates blood sugar and improves sleep, neurodevelopment, and cardiorespiratory stability. When Kangaroo Care is used exclusively (with moms alternating responsibility with other family members), it tends to shorten a baby’s stay in the NICU.
Due to its well-documented successes, many NICUs around the world have begun to incorporate some form of Kangaroo Care into their standard of care.
Emotional Expression Increases the Benefits of Kangaroo Care
At the Nurture Science Program we have a term—autonomic emotional connection—for what immediately happens between a mother and baby after an uninterrupted birth. During pregnancy, mom and baby share continuous sensory and emotional inputs, and after birth, these inputs continue through touch, cooing, kisses, and warm, teary greetings. These interactions sync up their bodies, so they can listen and respond to each other, now face to face.
Mom quickly becomes a place of calm for her baby, and baby a place of calm for her. And our bodies need to be in a state of calm to develop, function well, and thrive. Autonomic emotional connection isn’t just about survival, it’s about improving health outcomes and quality of life.
When we developed and tested Family Nurture Intervention (FNI) in NICU, we sought to reestablish this autonomic emotional connection by facilitating sensory and emotional inputs between mom and baby as quickly as possible. This meant that even when a baby was too fragile to be removed from their isolette, mom was laying her hands on her baby’s torso and stimulating calming pressure receptors. She was smelling a scent cloth that had been placed under her baby’s head, which helped her breasts produce more milk. And baby was smelling one that had been worn in mom’s bra, which was calming to its brand new nervous system. And finally, when it was safe to do so, mom was doing skin-to-skin Kangaroo Care with her baby.
But facilitating sensory engagement wasn’t enough. Not when the fear and stress of the NICU had made these new moms shut down their emotions. It is hard to form an autonomic emotional connection, without the emotional exchange part.
It’s a cycle. So many new moms in this situation are scared their baby won’t survive, so they don’t want to get too emotionally invested. They are also angry at themselves, consumed by guilt, and worried that tears of any kind will make their baby worse, and will make the medical staff think of them as problematic. But young babies respond to emotion—both positive and negative—and not to neutral voices or faces. The stronger the mother’s emotion, the longer the baby will look at her.
And we wanted these babies to respond to their mothers—to look at her, and listen to her. Because we knew this would trigger a mother’s response to her baby. It’s a give-and-take, which is vital to survival.
We’ve seen plenty of moms practicing Kangaroo Care where both mom and baby seem to be in separate worlds. And it’s not mom’s fault. She’s been told she will just “feel like a mom” right away. So she’s confused that she doesn’t, and sad that her baby won’t seem to look at her. And it becomes easier to pick up her phone, which is very distracting and built to gratify her.
During FNI, Nurture Specialists helped moms access and share their emotions with their babies during all of the sensory activities listed above. They provided mothers with emotional infant-directed prompts, such as “talk to your baby about what you were expecting, and how different this is (maybe you’re scared they won’t be okay, or are upset that this happened sooner than you wanted it to; maybe you feel like no one could possibly understand what you’re going through).”
These prompts helped mothers practice this high level of emotional expression. It also helped them work through any negative emotions they had that were blocking the positive emotions waiting underneath. Like a bottle that had been stopped up, these moms often needed to cry in order to let their joy and love flow.
There was one mother in our trial who admitted that after every visit in the NICU with her baby, she would go home and sob her eyes out. But this release of emotions at home wasn’t helping her connect with her baby. “This is like putting an emotional Grand Canyon between you,” explained Martha G. Welch MD, director of NSP. “The more you keep your emotions bottled up, the wider that divide gets. When you express them, you can close the gap and reach each other.”
And so the mom finally shared her feelings while with her baby and, to her utter joy and amazement, he oriented towards her for the first time! At the same time, his oxygen saturation went up and he was able to get off respiratory support. Soon, he was allowed to go home.
From that moment on, this mom felt that she’d done something for her child. Through heart-to-heart and gut-to-gut communication, she had positively affected his health, and that gave her the confidence to keep building autonomic emotional connection with her baby—so they could both grow healthier and happier, together.
Autonomic emotional connection is beneficial for all moms and babies, whether preterm or full term. And sharing emotions while skin-to-skin is a great way to facilitate it. Emotional expression can also be hugely beneficial for lifelong emotional health and resilience—by sharing these big emotions and moving through them together, a mother can teach her child how to live with, express, and work through their big feelings, in a healthy, productive way.
Advances in neonatal medicine have been incredible over the past thirty years, but it is important for all moms (and dads) to know: nothing can replace you. You are medicine for your baby!
Let’s take care of each other,
Martha G. Welch