See also Emma’s story and Justin’s experience photos.

Sitting or lying down

Your baby only needs a tiny nappy and cap. Wash your hands well every time you come to your baby. Use plain soap without any perfumes. Mum, take off your bra but keep your shirt on, it is easiest if you have one that buttons down the front. Put your baby inside, against your skin. Sit in a chair with cushions so you can lean back a bit and be comfortable. It is best for your baby if you are half lying, half sitting. The angle of 30-40 degrees helps her breathing. Place your baby on your chest facing you with her legs curled up in the foetal position. This is best for her hips. Put her tiny hands near her face for self-soothing. She has been doing that for months in the womb already. You can hold your hands underneath and behind her. Cover her and yourself. Your body will automatically warm up if your baby is cold or will cool down if your baby is hot. You might find that you start to sweat, don’t worry, that is normal. If it is cold in the room, you may want to put a small cap on her head, as most of the body heat is lost through the head, and for a tiny baby, loss of heat means lots of calories lost which she should be using to grow. Make sure that all materials are pure cotton as her skin is extremely sensitive. You may cry with relief as you hold her – that is normal. You will feel full of wonder to be able to hold your tiny baby, and know that you are giving her the best, just by being who you are, her mother! Tears are deeply healing and release oxytocin which will make you calmer and therefore your baby calmer too. Mums, tears will also help your milk production. Dads can cry too, and often feel fearful as their tiny prem seems so very fragile. Sit there for at least an hour, sleep or read a book or just enjoy your baby. Your baby can be held in skin-to-skin contact as long as you want, for part or all 24 hours per day. It is important for your baby to go through a full sleep-wake cycle which is usually about 60 minutes as a minimum to get the full benefits of SSC, and to get her biological systems stabilised. For a tiny prem, their body systems will not be mature enough to stabilise themselves, so mothers chest helps them to settle in to a sleep-cycling and feeding rhythm. You give closeness and security to your child. Positive feelings for your child strengthen as you care for your baby and closeness helps you to interpret your baby’s unique small signals, for example when the baby is ready to breastfeed, or she is tired or stressed. Being held contained skin to skin and secure is the best thing for her physical, brain and emotional health. For the first hour of life she can be loose. Her biology wants to be free to crawl to your breast. After the first hour, and if you want to sleep she needs to be secured. The baby does not have neck control, and you want to prevent “obstructive apnoea”, a closed airway stopping her breathing. So it is important to secure the head firmly. To do this, place the baby on your chest as above. The baby’s head should be turned to the side with the head tilted slightly up, (sniffing position) so that the airway is protected. Take a fine weave cotton wrap and fold it under her chin and ear and around your back so she is tied firmly to your chest bone. There are many types of wrap-around shirts or ties for making skin-to-skin contact easier to do. Examples are the KangaCarrier or Thari, find the one that suits you best.

Walking around

For the first six hours in skin-to-skin contact, the baby is stabilising its heart and lungs. During this time it is best to stay at a leaning angle, sitting or lying down. When the baby is stable enough, it can be more comfortable for the mother to get up and move around in the wards in the Kangaroo position. If there are monitors connected, keep them on while standing up the first time to confirm stability. Ifyour baby is connected to machines, you can only move as far as the leads allow. Soon you will be able to get up and move around with your baby tied to your chest. You can make tea or a meal, read or write, or talk to friends.

Sleep

You can sleep together with your premature baby in the Kangaroo position, as long as your baby’s airway is stabilized and she is held safely in the wrap. You as parent can lie on your back or on your side with head slightly raised. Your baby is used to being held tightly in the womb and feels safer when she is contained. If you want to sleep with her next to you in the bed, she should have her own small bed or nest. The doctor will decide if the premature needs technical monitoring while she is sleeping. A baby in quiet sleep should never be disturbed. When she starts to wake up or wriggle, you can loosen the tie and feed her. Change her nappy and spend time looking at her and talking to her. When she is awake the nurses can do the tests they need to do on her. Then tie her on firmly again so that she can sleep. It is important for your baby to go through a full sleep-wake cycle which is usually about 60 – 90 minutes as a minimum to get the benefits of skin-to-skin contact. As parents you can take it in turns to have your child in skin-to-skin contact. For twins get Dad to carry one twin skin to skin, or granny, aunt etc, but for best effects before breastfeeding it would need to be Mum. . If you want to do continuous skin-to-skin contact it will also work to ask a relative or close friend to take turns in holding the baby in skin-to-skin contact. Important: If you need to leave the ward, the child can be left warmly wrapped in a bed only if she is able to maintain a stable body temperature on her own The staff can give you advice, and are there to support you and teach you according to the specific needs of your baby. The nurses will help you to transfer the baby onto your chest, especially in the case of the baby needing respirators, monitors etc. These cables and tubes can be taped together to make it easier to work with.