Is It Kin, or Is It Skin? Conclusions About Skin-to-Skin Contact for Low-Birth-Weight Babies

The Huffington Post blogger Jennifer Lauck has done a piece arguing that separation of very young babies from their mothers is traumatic for the babies, and that, therefore, adoption policies need to be changed dramatically (see http://www.huffingtonpost.com/jennifer-lauck/adoption-myth-buster-what_b_822175.html). (And thank you to J.P. for giving me a noodge about this post.) Lauck refers to her own children as evidence for her position, but she also cites a study by the South African physician Nils Bergman (http://www.ncbi.nlm.nih.gov/pubmed/1524427).

The Bergman study took 34 low-birth-weight babies and randomized them to two groups shortly after birth. Half of the babies were randomly assigned to incubator care, the standard method of caring for them. The other babies were placed skin-to-skin with their mothers. The incubator babies did less well in terms of breathing and heart rate and were more likely to experience low body temperatures (which, incidentally, can trigger a cascade of harmful events in LBW or even average babies).

So far, so good. Bergman’s study agrees with much older work that the ordinary isolette is not best-suited for premature or LBW infants. Other researchers, like Tiffany Field, have shown the advantages of devices like water beds or sheepskin pads for these small infants. Human skin-to- skin contact has a whole list of advantageous characteristics—skin is not only warm, but movement of the adult and the baby can make sure that as much of the baby’s skin is kept warm as possible; a human caregiver will shift position from time to time, keeping persistent pressure from being uncomfortable to the baby as it might be if the baby were lying on a firm surface; human voices provide a background of mild stimulation that works better for the baby than quiet; human breathing and heartbeat help entrain the baby’s breathing into appropriate rhythms. It’s all good. But is it about the mother?

Lauck and Bergman both seem convinced that the birthmother is the important factor here. Lauck uses the study to draw conclusions about adoption reform. Bergman says “The cardio-respiratory instability seen in separated infants… is consistent with mammalian ‘protest-despair’ biology, and with ‘hyper-arousal and dissociation’ response patterns described in human infants: newborns should not be separated from their mothers.” In both cases, the conclusion seems to be that the birthmother plays a role that cannot be performed in any other way.

I’m sure most readers will see where I’m going with this. Both Lauck and Bergman are having trouble interpreting confounded variables. They are confusing the effect of skin-to-skin contact with the effect of separation from the birthmother specifically. This confusion is present because Bergman did not design the study to discriminate between experiences of warmth, movement, and good breath and heart patterns, and experiences of being with the mother (what Lauck calls “bonding”). Even more confusingly, Bergman uses terms like “protest-despair” and “dissociation” that imply subjective experiences rather than the objective measures of body temperature, breathing, and heart rate that were actually measured. These terms are especially questionable when applied to low-birth-weight babies who may have had many other developmental problems, as such babies often do. The Bergman study does not support either Lauck’s conclusions, or the implications that the researcher suggests. It’s neither good science nor good policy to jump to conclusions that have little to do with what was studied.

Let me hasten to point out that I am all for whatever makes life more pleasing for both babies and mothers. I spent some time many years ago studying the painful procedures used with pre-term babies and collecting evidence that even babies born at less than 30 weeks’ gestational age showed reactions to pain. In the course of those studies, I reported that procedures were often much longer and more painful than they sounded. (In one case, I observed a heel-stick for a blood sample that took 17 minutes and more than half a dozen sticks to get a few drops of blood.) I noticed that some NICUs were very cautious about keeping things quiet and dimly lighted, and staff spoke in low voices to each other and to the babies. In others, bright lights, loud voices, and constant alarm bells provided exactly the wrong situation for babies trying to live and parents trying to understand and help with medical care. I will always remember seeing a nurse vigorously clean and diaper a pre-term baby with a horrible diaper rash, then perch the agitated baby on her knee and thrust a bottle into her mouth while talking to another adult.

I remain very concerned that babies, full term or pre-term, be treated with as much care as we can manage in all cases, and left primarily to their parents’ care whenever that is possible. There are many reasons why this is beneficial, and some of the reasons gave rise to the British “care-by-parent” pediatric unit several decades ago. But it is not to anyone’s benefit that we exaggerate the role of the birthmother in necessary care or that we draw less-than-warranted conclusions about family relationships, including adoption.