Compassionate Beginnings

Often born premature, chronically ill and with unpredictable life struggles facing them, more than 1,100 babies receive care each year at the Alta Bates Summit Medical Center’s NICU in Berkeley, Calif. For nurses, this means not only providing care for the babies, but also helping parents to embrace their roles in spite of their child’s medical situation.

“We’ve found that many parents don’t initially know how to connect with their baby in the NICU,” said Alison Brooks, RNC, MS, CNS, who works in the Alta Bates NICU. “The babies are so vulnerable, and parents are often nervous about holding them.”

Data put to use

In 2002, Alta Bates launched a new program called Compassionate Beginnings, which receives funding from First 5: Every Child Counts and takes a whole-family approach to care in the NICU. Based on touch, one of the baby’s first senses to develop, researchers have found the gentle touch of a parent not only soothes babies, but also can help them grow. Studies at Duke University have confirmed being held and caressed actually helps preemies to grow at a faster pace.

“One of our NICU nurses had taken an infant massage course with Kalena Babeshoff at the Foundation for Healthy Family Living in Sonoma, Calif., and we all noticed how she demonstrated a different and special way of holding preemies,” Brooks said. “While the infant massage skills weren’t appropriate for preemies, Kalena did offer training in touch techniques for infants, and she did a three-day training with our nurses.”

Brooks said one of the most important aspects of the program involves looking at an infant’s nonverbal cues before initiating touch. CB was carefully designed to let babies “learn” about their parents and the environment outside the womb.

“We would never just walk into an adult patient’s room and start taking their blood pressure or touching them without introducing ourselves and asking for permission, so why would we do that with a vulnerable preemie?” Brooks said. “We learned that before you reach into the incubator, it’s important to allow the baby to become aware you’re in their space, and then to put your hands in gently and cradle their feet.”

Learning babies’ signals

Just opening the door of the incubator can prove to be overwhelming for many infants. Some clues a baby is getting overstimulated are desaturation of oxygen and either tachycardia or bradycardia.

CB nurses teach parents how to touch their infant appropriately without overstimulating him or her. Rather than lightly stroking or feather-touching their baby, parents are taught to place a firmly cupped hand on their baby’s legs and then remain still with a firm, constant pressure. Contact may continue for up to 30 minutes, or at times only a few minutes, as tolerated by the infant.

Parents are taught to look for cues such as a baby closing his or her eyes or holding a hand up, both of which can signify the infant is feeling overstimulated. If their baby tolerates touch, parents can try talking to their little one in a gentle voice.

“In addition to providing the baby with much-needed touch from their families, the program also helps to remove the fear many parents feel when interacting with their baby in the NICU,” Brooks said. “And our nurses love the program because they are teaching positive techniques that benefit both the baby and their families.”

Support for parents

When the time comes, Alta Bates nurses teach parents how to hold their babies in a position where they are placed on their parent’s chest receiving skin-to-skin care, while also checking cues regularly to ensure babies aren’t overstimulated.

“All too often, a baby’s experiences with touch in the NICU involve being poked and prodded,” Brooks said. “CB offers a positive way for both nurses and parents to interact with babies and help them thrive.”

Realizing that infant care extends beyond the walls of the medical center, Alta Bates staff added on to the initial CB program, by offering NICU families free infant massage classes after they are discharged and access to speech and occupational therapists to ensure babies are reaching their developmental milestones. A new playgroup also is offered for former NICU babies and their families to further develop the principles learned in CB.

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