A nonprofit publication of the Kentucky Center for Public Service Journalism

UK Children’s Hospital nurses utilize ‘Kangaroo Care’ to protect bond between mother, new born


By Elizabeth Adams
Special to KyForward

With her tiny body too vulnerable to withstand the world outside her mother’s womb, infant Emma Lewis continued to grow and develop inside an incubator during the first four days of her life.

But the life-preserving incubator at Kentucky Children’s Hospital Neonatal Intensive Care Unit (NICU) also separated Emma from her mother’s nurturing touch, which plays an important role in comforting and strengthening newborns. Those days were emotionally grueling for parents Katie and D.J. Lewis, who feared they were missing out on a critical time of bonding with their baby.

“I just always thought I’d have a picture-perfect delivery,” Katie Lewis said. “That I will get to hold her, and all the family will come and see her and hold her.”

Bonding was especially important for D.J. Lewis, a sergeant in the U.S. Army. At the time of Emma’s birth, Lewis was preparing for a yearlong deployment to Kuwait in September. He couldn’t wait for IV lines and monitors to disappear to begin the bonding process with their daughter (UK Now Photo)

Bonding was especially important for D.J. Lewis, a sergeant in the U.S. Army. At the time of Emma’s birth, Lewis was preparing for a yearlong deployment to Kuwait in September. He couldn’t wait for IV lines and monitors to disappear to begin the bonding process with their daughter (UK Now Photo)

Halfway through Katie’s pregnancy, a serious and rare complication expedited Emma’s delivery, making Katie’s vision of a perfect birth impossible. Obstetricians at St. Joseph East diagnosed Lewis with HELLP syndrome, a life-threatening variation of preeclampsia that causes a depletion of red blood cells and liver failure in the mother. As symptoms worsened, Katie’s brain swelled and liver started to fail. Because the only way to stop the progression of HELLP syndrome is through delivery, doctors sent Lewis to UK HealthCare where an obstetrics teams delivered baby Emma via emergency cesarean section at 26 weeks gestational age.

One-pound, 15-ounce Emma arrived on July 13, 2015, attached to intravenous lines, beeping monitors and a breathing ventilator to support her underdeveloped lungs. The neonatal care team watched Emma closely because of the risk of brain bleed, and monitored her red blood cell count and bacterial infections. While the team focused on giving Emma the best chance for survival and recovery, they did not neglect the essential function of maternal and paternal bonding during her stay in the NICU. Even in cases involving the earliest born and weakest babies, the NICU nursing staff attempts to accommodate maternal-paternal bonding with families through postponed Kangaroo Care.

In 2015, three Kentucky Children’s Hospital nurses, LaQuinta Bailey, Tara Hunt and Lisa McGee, received special training to facilitate Kangaroo Care for parents whose baby required treatment in the NICU. A standard method for initiating the maternal-infant bonding process of skin-to-skin contact, Kangaroo Care is typically conducted immediately after birth by placing the baby on the mother’s chest.

Skin-to-skin contact soothes infants under stress, stimulates the nervous system, regulates an infant’s heart rate, and improves weight gain, among other benefits for mothers and babies. In the busy NICU environment, where intravenous lines, incubator isolation, heart monitors, and feeding tubes complicate the process, nurses must work within their environment and parameters to engage families in bonding practices.

Lisa McGee, a NICU clinical nurse specialist, said the additional expertise has prepared KCH nurses to help families navigate the challenges of implementing Kangaroo Care hours, days or even weeks after birth.

“There is a lot of science behind Kangaroo Care,” McGee said. “Actually, the biggest thing it does is to decrease stress in the baby, and it helps parasympathetic nervous system to come into play, so that the baby calms down.”

Katie Lewis recalls nurses in the operating room encouraging her to look at Emma immediately after the cesarean delivery. Because Emma required immediate placement in an incubator, the medical team couldn’t spare any time for maternal bonding. Instead, the nurses initiated paternal bonding with D.J. Lewis after birth by allowing the new dad to touch Emma as she was relocated to an incubator.

A day later, Katie recovered from surgery and reunited with Emma, who was still inside the incubator. After four days passed, the eager parents were able to hold Emma outside the incubator for the first time. During this interaction, nurses helped initiate skin-to-skin contact by setting Emma on the chests of her parents.

At first, the couple held Emma for increments of an hour and a half because getting the baby in and out of the incubator frequently was a risk. Emma relied on the warmth of her parents’ bodies to retain heat, calories and body temperature. As Emma gained strength, the nursing staff gradually introduced the parents to new bonding opportunities, such as giving Emma a bath, pushing her food through a feeding tube, giving her a bottle of Katie’s breast milk and reading her books.

Bonding was especially important for D.J. Lewis, a sergeant in the U.S. Army. At the time of Emma’s birth, Lewis was preparing for a yearlong deployment to Kuwait in September. He couldn’t wait for IV lines and monitors to disappear to begin the bonding process with their daughter.

D.J. and Emma bond in the hospital shortly after her birth (UK Now Photo)

D.J. and Emma bond in the hospital shortly after her birth (UK Now Photo)

“He loved it,” Katie Lewis said of D.J.’s role in paternal bonding. “He would just fall asleep with her and rub her head and read books.”

Katie Lewis said the NICU nurses encouraged and affirmed the parents in interacting with their fragile child. The nurses shifted equipment and rearranged areas in the NICU pods to accommodate peaceful Kangaroo Care time for the family, even in the middle of the night. As Emma’s chances of survival increased with each day, the nurses transitioned the responsibility of care to the parents. The parents learned the baby’s signals indicating breathing problems or a loss of body heat.

“None of them made me feel like I didn’t know what I was doing,” Katie Lewis said of the nursing staff. “They would help reposition us, they would move the incubator — to make us feel as at home as possible.”

By the time Emma was ready to leave the hospital in September, Katie Lewis felt terrified but also excited.

“When we got home, I sat on my couch and I held her and I cried because it’s such an exciting feeling,” Katie Lewis said. “To be able to reach that milestone and go home for good was a very exciting feeling.”

More NICU nurses will receive formal training to become certified Kangaroo Care Caregivers. McGee said low birth weight infants received Kangaroo Care in about 45 percent of cases, with efforts underway to increase the number of families benefiting from Kangaroo Care.

And paternal bonding was worth the extra effort for D.J. Lewis, who came home to visit his family in November. Emma had no trouble snuggling and sleeping on her dad’s chest after his time away.

Elizabeth Adams writes for UK Now. Contact her at elizabethadams@uky.edu


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