Touch is as necessary to the human body as food yet it seems our culture trains us to develop different tolerance levels of tactile contact and stimulation. Some cultures are characterized with a "Do Not Touch Me" way of life with minimal touch even between family members; whereas others embrace and kiss so often that it embarrasses other nontactile people. Anthropologist Margaret Mead studied tribal societies all over the world. She found that those societies that withheld touch in infancy were the most aggressive, warring people; while those who practiced infant massage and carried their babies allowing for constant physical contact where non-aggressive, gentle people in which warfare was not practiced.
Research suggests that massage can stimulate nerves in the brain that facilitate absorption of food, resulting in faster weight gain. It can also lower stress hormones which aids in immune function. Touch therapy has also shown to help premature babies thrive, asthmatic children improve respiratory function, and sleepless fussy babies fall asleep more easily. And if nothing else, infant massage can certainly improve infant-parent interactions and bonding.
Healthcare providers of today may be surprised to learn the history of touch in the United State. Many nursing text books in the late 1800's stated that they baby "should never be rocked nor hushed on the nurse's neck. In 1894 Dr. Luther Hold, a professor of Pediatrics at Cornell University published a child rearing guide called "The Care and Feeding of Children: A Catechism for the Use of Mothers and Children's Nurses". In it Holt wrote that rocking a baby is not necessary, and that it was "a habit easily acquired, but hard to break and a very useless and sometimes injurious one". He also recommended bottlefeeding, that parents should not pick up a child, no matter how long it cries, and that the child should be fed only at 4 hour intervals. In 1928 John Broadus Watson, a professor of psychology at John Hopkins University stated in his book "Psychological Care of Infant and Child" that sentimentality was to be avoided because any show of love or close physical contact made the child too dependent upon its parents. One should aim for independence and self reliance; one must not spoil children with affection.
It was not until 1957 that Dr. Harry Harlow performed his landmark experiment on touch using monkeys. His research help changed thinking about mother infant attachment. The study established that it was touch, not food that promoted attachment behavior. Those monkeys deprived of maternal touch exhibited abnormal self stimulating behaviors, such as thumb sucking and rocking. He concluded only the sense of touch created the secure base "necessary for normal development." Developmental psychologists agree that infants are natural learners and given a warm, loving environment will extract what they need to thrive. This secure base of a strong infant-parent bond enables babies to develop to their full capacity physically, mentally, and spiritually.
As health care providers working with new parents it is important to remind them that you cannot spoil an infant in the first few months of their life as they are learning to trust their care givers. Give your students permission to indulge in touching their babies-there is no better, more intimate gift as that of infant massage. Infant massage enriches the parents as well as the baby and will continue to enhance their relationship for years to come! The attached handouts give parents step by step instructions on infant massage and instructions on doing a skin test first to ensure that baby is not allergic to the oil used for the massage.
Field, T.(2003) Touch. Cambridge, MA: the MIT Press
McClure, V. (2000) Infant massage, a handbook for loving parents. New York, NY: Bantam Books
Maternal-child nurses learn the value of maternal-infant bonding early on in their education. When we complete our maternal –child rotation we commit to providing this for our patients because we know this is the “right thing to do”. Research has taught us the value of skin-to-skin contact immediately after birth and the value of kangaroo care in the NICU, however in the daily practice of a labor and delivery nurse and NICU nurse, many obstacles occur to prevent or delay these practices. In a perfect world the nurse is able to stay with her patient immediately after birth, teach her about the benefits of skin-to-skin contact and other bonding opportunities and facilitate a positive first breastfeeding session. Nurses are often receiving another patient assignment at this time, called to other emergencies, phone calls, interruptions etc and all interfere with our plan. Nurses become frustrated with not being able to provide the care they would like and the patient looses out when these “windows of opportunity” are closed.
Maternal –child nurses need to problem solve these issues and come up with viable solutions to insure that opportunities for family bonding will occur. Suggestions to improve:
In the LDR:
• Prioritize keeping one to one nursing care in the first hour after delivery
• Utilize OB techs/nursing Assistant to assist with placing baby skin-to-skin
• Empower the patient’s support people to assist with this after birth—discuss in early labor and create a plan for after the birth
• If available, utilize a lactation consultant to see the patient during the recovery period to assist with this process
• Communicate with nursery and mother-baby nursing team the status of bonding
In the Mother-Baby Unit:
• Include frequent skin-to-skin during plan of care—discuss with patient and family members early in post-partum and again at discharge
• Teach patients and family members other ways to bond with their baby; infant massage, singing, reading, eye contact, use of a baby carrier/sling, and making eye contact at close range
• Catch the “teachable moments” to include bonding teaching and demonstrate!
• Educate about postpartum depression’s effect on bonding—identify at-risk patients and provide a resource for assistance
• Empower you ancillary staff to assist you with this process
In the NICU:
• Early teaching about bonding—empower parents to be available to bond during visits to the NICU
• Include bonding in the Plan of Care
• Involve the parents with as much care as possible, as soon as possible
• Coordinate care with Lactation Services
• Discharge teaching to include ways to bond at home
• Utilize ancillary services, i.e. social services, physical therapy, occupational therapy in discharge planning
Maternity Unit Associates:
• Plan to educate nursing assistants, float personnel and unit clerks of the importance of family bonding
• Have nursing staff identify your units barriers to this process and ways to improve bonding opportunities
Providing early bonding opportunities for families will continue to meet challenges in the hospital setting. Take inventory in your unit to view first-hand how your unit is doing today!
Merenstein & Gardeners handbook of neonatal intensive care / [edited by] Sandra L. Gardner…[et al].-7th ed.p.j.cm.