Each year, an estimated 15 million babies are born preterm, that is before 37 weeks of pregnancy are completed. Of those 15 millions, 1.1 million will die within their first year of life due to complications related to their preterm birth.

Many think of preterm birth as being an issue exclusive to developing nations, but it is also a significant problem for developed countries. The United States has one of the highest prematurity rates in the world. Dr. Craig Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s Hospital, and a study author, says that, “Getting people and funders and policymakers to understand that is a huge burden.”  The U.S. has half a million preterm babies each year, and in its annual “premature birth report card,” the March of Dimes gave the U.S. a “C” for its efforts in reducing prematurity.

Researches also agree that we still have a lot to learn when it comes to the causes of preterm births. Chris Howson, vice president for global programs at the March of Dimes and a preterm birth researcher and study author, shares that “We don’t know the cause of 50% of all preterm births, and we still don’t fully understand the causes and mechanisms behind the other half.”

What research does  show is that there are five interventions that have been shown to reduce the preterm birth rates.

1. Discouraging elective C-sections and labor inductions unless there’s a compelling medical reason.
2. Reducing the number of embryos transferred during fertility treatment.
3. Supporting pregnant women to give up smoking.
4. Providing women with high-risk pregnancies with progesterone supplementation.
5. Performing cervical cerclage, a minor surgical procedure, on pregnant women with short cervixes.

In 2012, WHO and its partners published the Lancet report, Born Too Soon: The Global Action Report on Preterm Birth, which presents the first country-by-country estimates of preterm birth. This report is a joint effort of nearly 50 international, regional and national organizations, led by the March of Dimes, The Partnership for Maternal, Newborn & Child Health, Save the Children and the World Health Organization in support of the Every Woman Every Child effort, led by UN Secretary-General Ban Ki-moon. The report details more than 30 new and expanded commitments to prevention of preterm birth and to the care of preterm babies. (You can see the more than 200 commitments here: www.everywomaneverychild.org.)

Based upon these findings of this report, the  WHO has also committed to the following specific actions:

• to work with countries to improve the availability and quality of data on preterm births;
• to provide updated analyses of global preterm birth levels and trends every 3 to 5 years;
• to work with partners to research the causes of preterm birth, and test effectiveness and delivery approaches for interventions to prevent preterm birth and treat babies that are born preterm;
• to regularly update clinical guidelines for the management of pregnancy and mothers with preterm labour or at risk of preterm birth, and those on the care of preterm babies, including Kangaroo Mother Care, feeding babies with low birth weight, treating infections and respiratory problems, and home-based follow-up care; and
• to develop tools to improve health workers’ skills and assess the quality of care provided to preterm babies.

So while global NGOs and researchers continue their dedicated work in the discovery of the causes of preterm birth, as well as creating preventative interventions, companies like Boba Family continue their grassroots efforts in the communities where we live and raise our families. Like the WHO, Boba Family advocates for research-based Kangaroo Mother Care as an incredibly effective, life-saving arm of preterm baby care. Kangaroo Mother Care keeps preterm babies and mothers together, so that a mother can be the primary source of physical and emotional comfort for her baby within the extended care of the medical system.

For both preterm and full-term babies, Kangaroo Mother Care:

Not only is the preemie’s body temperature regulated, his respiration is regulated too.  So is his heart rate.  Not too slow, not to fast.  Just right.  There is less chance the baby will stop breathing (apneic episodes) and the mother is more likely to let down her milk.  There is more milk. And the baby is more likely to nurse longer.  He will digest it better.  He will cry less, and sleep more, and be less stressed.  His immune system will be stronger.  And with those conserved calories, he will grow.  And he will leave the hospital sooner. And he will thrive.  These extensive health benefits of KMC are backed by science.

Unfortunately, knowledge does not equal implementation.  When the NICU staff doesn’t include mothers in the equation, they are not prioritizing giving the baby the highest impact care possible.  The incubator is meant to mimic the womb, but the mother’s chest, as a holding place, is far superior to the static incubator.  Have you heard of thermal synchrony?  Incubators can’t pull that off.

Mothers are tuned by evolution to provide a safe holding place after birth for their babies’ continued growth. When you place a baby upright on his mother’s chest, skin to skin, nutrition, protection, warmth and proximity are all taken care of.  This is just what preemies need to stabilize and focus on healing, development and growth.

The latest KMC study compares to the standard care a preemie would typically receive in a hospital setting.  The findings are moving.  They found an incredible 51 percent reduction in neonatal mortality (from preterm complications) when…

• stabilized babies weighing 2000g/~<4lbs received KMC (on their mother’s chests)
• KMC was in a hospital setting
• KMC was implemented within the first week of birth

The effects of adding mother to the equation are powerful.  Baby+Mother= 500,000 more preemies surviving every year.

The findings suggest that up to half a million newborn deaths due to preterm birth complications could be prevented each year if Kangaroo Mother Care were available for all preterm babies.

Sure, it may seem like wishful thinking to imagine the microenvironment (even if it is thermostatically controlled) of a mother’s chest replacing the high-tech incubator.  We are a techy society.  In this instance we have research coming from low income countries that can teach us a thing or two.  We do have a love affair with the incubator and the controlled environment it seemingly provides.  Of course a mother needs to rest too and continuous skin-to-skin contact may be too much to ask of mothers in high-income countries.  Nonetheless, KMC should be presented to the parents of a preterm infant as the most effective care.  Without say, it should be made available as a choice.  It could have a major impact if implemented at scale.

As Dr Joy Lawn says,

“No matter if babies are born in Lilongwe, London or Los Angeles, preterm babies need extra care to survive. Kangaroo Mother Care is low-cost and feasible, and we now have proof it is one of the most highly effective ways to give more babies the chance to survive and thrive.”

We cannot ignore the facts.

I leave you with this video where my friend Angela shares her story of moving from outsider to playing an active role in her preemie son’s recovery. Kangaroo Mother Care is her secret.  She will inspire you with her grace.

Click here to view the video on YouTube.

She named her son “Levi”- meaning “we are one”.  They are amazing together.

Six weeks out of the year about 40 horses run wild in the open space behind my house. While attempting to lure them close to the barbed wire with carrots and long green grass, I met two ten year old twin boys and their mother. After complementing me on my three kids, she went on to tell me that she had always envisioned having a big family. However she was definitely “done” having kids after her experience with the twins. I invited her over. She told me her story. How they were born premature. How she couldn’t hold them for the first month of their lives. How she would never go through such a traumatic experience again.

I did a little research on parental anxiety in the Neonatal Intensive Care Unit (NICU).  She certainly is not alone.

It is hard to be at ease in the NICU. Here are some factors that explain why:

1.  Your baby’s position, or appearance, or behavior in the incubator- The skin tone, size and position of your baby may be unexpected. He may be breathing irregularly, and may be either moving restlessly, crying or still and expressionless.  If he is sad or is crying, it may be disturbing and even debilitating to watch.
2. The equipment, the hum of machines, and the sounds of intensive care-The tubes and machines used for your baby may be both intimidating and overwhelming. There may be constant noise, beeping, or other babies crying. Other stressed parents that are visiting their little ones can make for a tense and upsetting atmosphere.
3. The hustle and bustle of the technicians and nurses- Sometimes the nurses may go about a procedure pretty hastily without explaining what they are doing. Sometimes the medical jargon may be over your head. Information concerning your baby may even be conflicting which can be incredibly frustrating.
4. The actual physical separation of you and your baby- You can’t feed your baby or hold her when you want to. You don’t have a chance to intervene when your baby cries or seems distressed. You feel powerless over the progress of your baby. Essentially you have not had the time to develop a relationship as the mother/infant dyad has been torn apart.

Hospitals are endeavoring to ease parental anxiety in NICUs by making them as peaceful an environment as possible. The staff is trained to hustle less, to be very sympathetic, and to educate and thoroughly explain the procedures and the progress of the baby to the parents.

Hospitals hope to support parents and reduce anxiety and depression through…

• Organized support groups
• Individual development care programs
• Classes that teach emotional coping skills and problem solving methods
• Buddy programs
• Psychotherapy
• Journal writing
• Improved communication between staff and parents

These efforts to ease parental anxiety are definitely a step in the right direction. They are certainly right about one thing: interventions to support parents during the care of their preterm infant in the NICU will most likely improve outcomes for both parent and baby.

Here’s the deal. Classes and improvements in communication help. But, offering out coping mechanisms is not as powerful as encouraging parents to step up and play an active role in their baby’s care.  Kangaroo Care supports parents and allows them to play an active role in the care of their preterm infants. This high impact care should be prioritized, not only for the crucial health benefits of the baby but also because it empowers parents.

Kangaroo Care is engaging; It brings mom and baby (or dad and baby) together.  It cuts down the distance. Parents feel close to their babies. It fosters attachment and a sense of confidence.  Attachment inspires nurturing behaviors. Nurturing behaviors support the growth and development of the baby. It’s good for all involved.

When a mother experiences Kangaroo Care, this loving touch from her baby, she knows that she is doing something incredible for her baby that no stranger can do. She feels that her baby recognizes her voice and who she is. She is comforted by her baby’s relaxation, and witnessing his surrender into deep sleep. She becomes confident that her baby is taken care of and may survive.  She feels like she is in control. Kangaroo Care strengthens the emotional bond between babies and their parents.

Kangaroo Care can be a positive way to shut the door on what has been a trying and traumatic experience. 

To reduce anxiety, hospitals should support parents during the care of their preterm infant. By educating, integrating and facilitating Kangaroo Care, they will be promoting a high impact care that brings mom and her baby together, and is supportive and therapeutic to both.

Kangaroo Care eases parental anxiety.

Kangaroo Care is empowering.

Kangaroo Care is healing to both babies and parents.

I wish that the mother I met, who told me her story, had been more empowered. I wish that she felt more in control and was able to feel closer to her boys while they were in their incubators in the NICU. I wish this empowerment  and emotional connection for all parents of preterm infants.

Foot pressed against the glass, this preemie is seeking out the familiar feeling of containment.

I remember when I was still involved in print advertising with our graphic designer in Miami.  The copywriter tried to come up with some slogan for our full page ad. I remember coming up with, “Sleepy Wrap, the best place after the womb”.

We all know that babies crave the familiar containment and pressure of the womb.  Upright on mama’s chest in a baby wrap certainly mimics that womblike environment.  While in utero, babies push their little elbows, knees, feet, and shoulders against the walls of the womb; this helps the baby’s muscles develop and get stronger.  As baby gets bigger and there is less room and he has more opportunities to flex his body, making muscles even stronger. When babies are born, they are in flexion, and almost impossible to straighten out.

A preemie who is born before he had a chance to develop good muscle tone may not be able to hold his body together.  He may lay flat on his back like a little star.   In the NICU they often create woolen or fleece nests for the babies, to contain their little bodies and help them stay in a flexed position.  Again, mimicking the womb.

Did you know that preemies not only crave containment but they actively seek it out?  When reading Ashley Montague’s book on touch, I remember one story in particular where the preemie in the incubator would scoot, with a series of tiny movements to the corner of the incubator.  When the nurse in the NICU would see him scrunched up on one side, she would move him back to the center of the incubator so he wouldn’t lose any heat from his body touching the wall. And then he would scoot again. Preemies actually feel safer against a boundary.

Practicing Kangaroo Care, and wrapping your flexed preemie skin to skin offers optimal positioning, crucial health benefits, and it connects the two of you.  Your baby is flexed, enveloped, protected and safe.  Surely it is the”best place after the womb”.

When it’s time for your baby to go back into the incubator, remember that keeping your baby in the flexed position-

• May enable your baby to breathe more easily
• May help regulate heart beat
• Promotes more uninterrupted sleeping because of improved breathing and overall improved comfort
• Reduces and helps alleviate the symptoms associated with gastric reflux
• Filters extrasensory input by decreasing your baby’s perception of environmental events
• Prevents your baby from acting out his startle reflex- which uses up his energy/calories
• Cuts and buffers some of the sounds around him
• Helps your baby develop normal posture and movement
• Provides your baby a feeling of security