In the NICU, parental well-being can help babies thrive. The health of infants is intertwined with the health of their parents. When an infant is born prematurely, their physical features are complete, yet the ways in which their systems and organs function are not. Infant development is a dynamic process dependent upon internal and external factors and a nurturing environment. While premature infants are at risk of many complications, disabilities, and diseases, there are strategies that offer protection. For example, the benefits of skin-to-skin care (also known as kangaroo care) highlight how parental and infant health are interconnected and related to how we experience life.

A meta-analysis looked at studies in 9 countries, including the US, with an aim to describe parental experiences in providing skin-to-skin care to their infants in the NICU. The main theme describes skin-to-skin care as a restorative experience. Parents expressed a unique sense of joy and connection when they held their baby skin-to-skin. Mothers described a sense of calmness accompanied by less feelings of guilt and fear. Providing skin-to-skin care helps parents bond with their baby.

The Womb World

The sense of touch is the first sense to develop, last to leave us and a powerful memory cue. The absence of relational touch can result in significant growth, developmental, and behavioral deficits. In the intrauterine environment, most is regulated by mom’s rhythms. The mother develops a history of movement patterns, sounds, smells and tastes from the intrauterine environment.  The infant also recognizes the redundancy of her voice and body sounds along with others in the home.  This is important as families presence in the NICU becomes vital to their infant as they provide skin to skin.  This continues a familiar relationship to the infant in an unfamiliar NICU.

Benefits of STS

Evidence reveals that STS provides autonomic, physiologic, behavioral, and sensory benefits to the infant. Let’s explore these benefits.


When a parent holds a baby semi-upright or prone, it lower the diaphragm, increasing tidal volumes optimizing ventilation and oxygenation.

Pain & Stress

STS is supportive during painful procedures by decreasing mean heart rate, cry time and behavioral response, improving saturations and decreasing hemodynamic and brain changes.

Thermal Regulation

There is a statistically significant reduction in hypothermia with maternal/infant dyad STS

Other advantages are immunity & intestinal microbiome benefits.  STS supports healthy microbiome development, showing a decrease in NEC, improved digestion and intestinal function. It also improves overall survival by decreasing infections, pneumonia, and inflammatory response.

Maternal Benefits

  • Evidence reveals an ↑ in Milk production, ↑ Initiation of breastmilk/breastfeeding, ↑ Exclusivity in breastfeeding, and ↑ duration in breastfeeding
  • A decrease in post-partum depression after STS intervention has been noted and may lessen maternal depression

Parental Benefits:

Cortisol levels have been studied in premature infants, mother and fathers as a sign of physiological  stress. Stable premature infants held STS have shown reductions in cortisol levels by 60% compared with infants in an incubator. One study found that infants and mothers had a greater reduction in salivary cortisol than mothers in the control group after STS. Another study revealed ↓ maternal/paternal anxiety and dissatisfaction, better maternal/paternal attachment and more positive interactions with their infant. Fathers scored lower on a stress sub-scale compared to the control. They concluded that frequent STS decreases infants’ cortisol reactivity in response to handling, improves the concordance between mothers’ and infants’ salivary cortisol levels, and decreases fathers’ experiences of stress. The effects lasted longer in fathers after STS and was associated with increasing paternal confidence. When fathers are more involved in caring for their infants, they experience stronger hormonal and neurobiological changes than when uninvolved.

Another important aspect of STS is its accessibility. It is a low-cost intervention carrying lasting gains for infants and families that can have significant implications for public health policy.

Barrier to parents providing STS

From a healthcare perspective, concerns are linked to safety, specifically security of IV lines, and fear of unplanned extubation. To overcome barriers to STS, NICU teams need education highlighting the knowledge and skills needed to provide STS safely. The lack of standard guidelines and inconsistency in STS practice may contribute to this barrier. One study doubled STS practice by creating a pathway for earlier and more frequent integration. Families can help us put safety guidelines in place as they more than anyone want to protect their baby. STS is an intervention that is behavior driven and involves many facets. Success requires more frequency and stakeholder commitment. Health care teams are critical for implementation

View from Her

There’s no other area of healthcare where we have an impact in how a human being will become a relational being. How crazy is that and what a responsibility. I read 3 statements from parents from a STS article when I first started in the NICU almost 40 years ago. It left an imprint on my practice.

  • “For the 1st time I felt like I was doing something no one else could”
  • “It was the 1st time I felt sure I was his mother & the nurses were not”
  • “This was the 1st time I knew my baby was mine”

Sometimes it doesn’t matter that we provide our best technology, medical and nursing care. Babies born at the earliest of gestations are at risk for outcomes that will be challenging all of their life. What a child experiences at 3, 13, and 23 may be because they were born prematurely.  Infants thrive because they have a parents who know them, listen to them and respond to their need. Any opportunity to encourage parents to provide STS is one more opportunity to build history and lay the foundation for attachment and other physiologic benefits. The strength and resiliency of families in the NICU is beyond anything we can explain. They make us better human beings for watching and experiencing their strength.