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The Parent Connection: The Importance of Touch by Michele Romano, R.N., B.S.N., C.I.M.I. Late one afternoon, baby boy T. was born by cesarean section. His age was assessed at 32 weeks gestation. His mother had experienced several episodes of preterm labor, which had been halted with tocolytics. Baby boy T.’s mother began to labor again last night and also had a spontaneous rupture of membranes. The medical staff decided to administer betamethasone to assist in maturing the baby’s lungs, and to perform a cesarean section. At delivery, baby boy T. had a spontaneous weak cry with weak muscle tone. He required continuous blow-by of 100% oxygen to maintain a pink color, and chest percussion and suctioning to clear the secretions from his airway. He was identified with banding and footprints, swaddled in warm blankets and a hat and carried to the operating table for a brief meeting with his mother and father. The baby’s color was slightly dusky with nasal flaring and audible grunting. The care the baby required was briefly explained to his parents and then he was transported to the Special Care Nursery(SCN) for care and observation. Once immediate care was given, baby boy T.’s father was able to come to his baby’s bedside. The neonatologist and nursing staff welcomed dad to the SCN and oriented him to the unit and to his baby’s condition. Baby boy T. was asleep on the radiant warmer, on physiologic monitoring equipment and the required respiratory support(nasal prong continuous positive airway pressure(NPCPAP) with 50%FIO2). Looking upon his newborn, dad observed that his respiratory effort was laborious with retractions, grunting and nasal flaring. Heart rate and oxygen saturation was within normal limits. The baby was using a great deal of effort to maintain physiologic stability. It was hard work for him, but if his little body remained organized, he could even conserve energy. Dad requested permission to touch his fragile infant. I nodded that it would be fine and with that okay, he proceeded to stroke his baby’s arm and talk to him. Almost immediately, the baby responded adversely to the stimulation he was receiving. He became restless, irritable and physiologically compromised, by dropping his heart rate to 80 beats per minute and his oxygen saturation to 80%. Dad observed his baby’s reaction, immediately withdrew his touch and appeared concerned. His baby stabilized with an increase in FIO2 to 60% and suctioning and repositioning. I then had an opportunity to reflect on this experience. I gently explained to dad that his baby expends much of his energy breathing and organizing his body to remain stable. I should have shared this important piece of information with dad earlier when I was describing his baby’s condition. I explained that "stroking" and "talking" might be too much external stimulation for his baby to handle now. It is important to touch the baby but let’s offer him an experience he has the ability to take in. With that small, but very essential, piece of information, I began assisting dad with the opportunity to continue bonding and attachment with his newborn. I demonstrated ways to approach his baby and explained that speaking to him would allow the baby to know he is there. Then, I continued to assist dad with touching his baby by showing him how to contain the baby with his hands using a gentle pressure. Hand containment is a nurturing touch that allows baby to feel nested, much like the experience in utero. Baby feels secure, remains organized and appreciates touch they can handle. One hand is usually placed on the baby’s crown, the other hand is placed either on baby’s chest(with baby’s arms flexed over his chest)or on the bottom of baby’s flexed feet or legs. Dad mirrored the demonstration. The baby accepted his touch while maintaining his physiological signs within normal limits. Dad and baby appeared to relax. I suggested to dad that when he wanted to complete this experience, that he should gradually release his pressure and remove both hands together. I took a step back from the radiant warmer to offer some privacy. The impact of educating and supporting parents in the care of their newborn begins on admission. Each family will demonstrate different and individual needs, but connecting parents and infants is an important priority of care. Familiarizing parents with the nursery environment, updating them with information about their baby’s condition and preparing them to touch and nurture their baby facilitates the bonding process. An infant at 32 weeks gestation must sustain internal balance prior to managing any outside stimulus. The infant must "work" at stabilizing his physiologic function by breathing effectively and organizing his behavior. Another appropriate task is to shut out noxious stimuli in order to rest and conserve energy. An infant will provide his parent and caregiver with cues in order to distinguish periods of stability and instability. Cues of an organized or stable state are: heart rate or respiratory rate within normal limits, relaxed flexion of arms and legs, quiet sleep or a state of alertness. Cues defining a stressed or disorganized state are: physiologic instability, finger or toe splaying, a facial grimace or gaze aversion, and yawning or grunting. We must honor each infant as an individual. Each one will share cues unique to himself. A parent will become familiar with the baby’s cues and should be encouraged to care for the infant accordingly. In the story above, it was imperative that dad learn how his baby might react before he begins connecting through touch. Then, he would know that containment, as opposed to stroking, is a more appropriate stimulus for his already compromised infant. Educating parents through experiential learning will assist them in providing their newborn with optimal interactive opportunities. Parents who participate in appropriate infant touch and care will promote bonding and be better prepared discharge. We, as expert nurses, must advocate and facilitate these experiences. Please refer to these websites for more information about touch and parenting. www.internationalmassage.com/tri/
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