Tommy's PregnancyHub

Your role in caring for your premature baby

Your role in caring for your baby in the unit is very important for both your and your baby’s wellbeing. Your healthcare team will support you with this.

Your role in the neonatal unit

As your baby’s parent, you are not classed as a visitor to the baby unit. You are partners in care alongside the healthcare professionals looking after your baby. 

Your baby needs you more than anyone or anything else. You are welcome to come and go from the unit at any time of the day or night. It is important that you’re not separated from your baby unnecessarily, for example during medical rounds.

In some units, parents might be asked to leave the room under certain circumstances. For example, if staff are having confidential conversations with other parents about their babies or during a handover to other staff. But your healthcare team will do everything they can to make sure that you can stay with them as much as possible. 

At first, many parents feel too intimidated by the medical environment or by the size of their baby to try to provide baby care. Your healthcare team are there to support you. They will show you how to care for your baby, which will help you increase your confidence. 

If you have other children, some baby units allow the baby’s older brothers and sisters to help with their care too. Speak to the unit staff about their rules for visitors. 

There are lots of ways you can help your baby while they’re in the baby unit. This includes the following:    

  • looking after your baby’s daily needs, such as feeding them, bathing and changing their nappy – Bliss has more tips for changing your premature baby’s nappy
  • expressing your milk – breast milk is important for premature babies and even if you don’t plan to breastfeed, expressing milk for the first few feeds can help protect your baby from infection
  • using still touch (touching your baby with a still, resting hand) and skin-to-skin contact, which can help you bond – skin-to-skin contact also helps babies grow and reduces both of your stress levels. Find out more about kangaroo care.
  • reading, singing or talking to them – when your baby was growing inside the womb, they got to know your voice and the voices of all their close family, so talking to your baby will calm and reassure them
  • being close to them and hearing your voice – this will release a hormone called oxytocin, which is important for your baby’s brain development 
  • comforting and reassuring your baby during medical procedures by holding them, touching them or talking to them. 

Don’t be afraid to ask the staff questions, such as what medication is my baby on? What breathing support does my baby need and why? Having the answers to these types of questions may help you make informed decisions about your baby’s care. Be involved with as much, or as little, as you feel comfortable with.

When you’re looking after your baby, take your time and talk to them, telling them exactly what you are doing. Your baby knows your voice and this will reassure them. As you spend more time with your baby, you will begin to really get to know them, learn how to comfort them and pick up on how they are feeling. Trust your instincts and let the hospital staff know if you notice anything that you are concerned about. Remember that you know your baby better than anyone else. 

“If you are not happy with something speak to the doctors and nurses. You are all a team working together for your baby, it is important to have good communication.”

Jen

Making decisions about your baby’s care

The neonatal team must include you when talking about your baby and support you when decisions need to be made. It may help to be there and talk with the doctors during their rounds. If you cannot be there for ward round or there is more you would like to discuss with the medical team, you can ask for a separate meeting.

The health professionals need to get your written consent (permission) for operations and some other procedures. 

If you’re not on the unit and your baby is unwell, urgent decisions might be made quickly to make sure your baby gets the best care. This may also happen if there is an unexpected change in your baby’s condition. The team should talk to you about these decisions as soon as possible.

How do I know what my baby’s needs are?

Babies communicate in their own way all the time. As your baby grows, they will become more able to react to their environment and you will find it easier to understand what your baby needs. For example:   

  • if they open their eyes, move their tongue and put their hands in their mouth they may be hungry
  • if their face or body tenses up, they may be in discomfort
  • if their face is relaxed and their eyes are open, they are probably comfortable.

Over time, you will develop a sense of how your baby reacts to different situations. For example, some babies might not like having their nappy changed, while others might like it.

Comforting your baby during medical procedures

Your baby is likely to need regular tests and procedures, which may cause them some discomfort. The healthcare team may give them pain relief medicine for some procedures but there are also things you can do before and during procedures to help reduce discomfort. For example:     

  • talking or singing to your baby
  • breastfeeding or giving milk feeds
  • feeding your baby a sugar solution (speak to your healthcare team about this)
  • skin-to-skin (kangaroo) care
  • swaddling your baby or containment holding (the staff can show you how to do this). 

“It’s also okay if you feel that you can’t be there or physically cannot be there for medical procedures. Some of them are very upsetting and it is not always helpful for baby or parents if there is a lot of distress. I felt huge guilt that I couldn't manage to be there when my son had blood tests etc, especially if Daddy couldn't be there either. The NICU team were great and reassured me. We often discussed what I thought may be the best thing to help soothe baby and I would then go to read to him afterwards.”

Andrea

How the healthcare team will help

The healthcare team will also be looking out for signs of how your baby is feeling. They will try to fit treatment and care around your baby’s needs, for example by:  

  • grouping tests and treatments together so your baby has time to rest 
  • soothing your baby, for example, by swaddling or encouraging sucking
  • carrying out tests, such as blood tests, in ways that cause the least possible distress or pain
  • keeping noise and bright light in the baby unit to a minimum.

You can help the healthcare team by telling them what you have learnt about your baby’s likes and dislikes.

Worrying about hurting your baby

Many parents worry about accidentally hurting their baby when their healthcare team encourages them to help as they can seem very fragile. This is normal. 

To begin with, you might be worried about holding your baby if they are very small or ill. But your touch and care will help with their recovery and growth. Your role as part of the team caring for your baby is the most important one.  

The healthcare team will help you take an active role in your baby's care, for example, by showing you how to feed and wash your baby, change their nappy and comfort them. You will get more confident as you get used to touching and holding your baby.

If you’re worried or do not feel ready, that’s okay. Take things at your own pace and talk to the healthcare team about how you feel. You can read more about your role in caring for your baby and building a bond. 

“The first time I helped with my daughter’s care I was shaking like a leaf. The nurse was by my side the whole time and gave me the support and encouragement I needed. It was the best feeling being able to do something for my little girl and each time after that got slightly easier.”

Jen

Bonding with your premature baby

Building a bond with your baby can take time, especially when they are born early. Don’t worry if you don't feel a connection with your baby at first. Try to take each day as it comes.

The usual process of bonding can be suddenly interrupted when your baby is born prematurely. Both you and your baby may need time to recover from the birth before you can start to feel close. 

It can be difficult to bond when your baby is in an incubator and you can’t pick them up or cuddle them. You may feel detached or helpless. Taking an active role in caring for your baby can help you bond. The healthcare team will support you to do as much as you feel comfortable with and can help you build your confidence.

It’s natural to feel many and conflicting emotions after having a premature baby. You may be worried about your baby’s health or feel that you won’t be able to care for them. Some parents feel angry, sad or guilty about their birth. Others may feel frightened of getting too close to their baby in case anything happens. Try not to keep your feelings to yourself. Talking to someone you trust in the healthcare team will allow them to offer you help and support. 

"I found it really hard to bond with my baby initially. I loved him but in an abstract way. It was lots of sessions of kangaroo care, reading to him and taking an active role in his care that helped build that bond. It took a long time for me to realise it was okay that I didn't have the film-worthy instant bond."

Andrea

What can help me bond with my baby?

You may not be able to cuddle your baby as much as you would like, but there are other things you can do to connect with them. This is really important for both parents. These include: 

  • Holding your baby. Even if you are not able to pick your baby up, they may find it comforting to hold your finger.
  • Touching your baby. This can be reassuring for your baby. Do it smoothly and gently, but firmly enough not to tickle.
  • Using your voice. Your baby will know your voice from when they were inside the womb, so hearing you gently sing and talk will be comforting for them.
  • Massaging your baby. Once their condition is stable, massage can help you feel closer to your baby.  
  • Kangaroo care – Skin-to-skin contact is a great way of bonding with your baby. 

Some units use cotton bonding hearts, squares of fabric or similar that you keep one tucked into your top to pick up your scent and place the other with your baby, swapping these over can soothe your baby and help you both feel closer.

Gently does it

These activities may seem very gentle to you as an adult, but just a minute or two may be enough to make your premature baby feel tired. Watch them carefully to see how they respond and stop if you can see they’re getting tired or upset. Avoid noisy toys such as rattles at this stage.

Some babies may not like to be patted or stroked. Sometimes a cuddle or a still hand placed on their back or head can be more comforting. Let your baby guide you so you learn what they like and don’t like. 

There may be times when your baby doesn’t want to be touched, maybe because they’re uncomfortable, not feeling well or tired. You can still comfort your baby by placing your hands near them so they can smell you and by calmly talking or singing to them. 

You can read more about bonding with your baby once they have left the baby unit

How do I wash my baby?

Premature babies have thin, delicate skin so frequent washing can do more harm than good. Avoid using soaps and creams, which can upset the balance of natural oils in their skin. It’s best to just use warm water at first.  

Very premature babies

If your baby is very premature or unwell, you may not be able to give them a bath or sponge wash. Instead, the healthcare team will show you how you can work together to keep your baby clean. For example, you could cuddle and comfort your baby while the nurse uses warm water to gently clean around your baby’s eyes, ears, neck, armpits and in between their fingers and toes.  

Bathing your baby

Once your baby’s health is stable, you may be able to give them a bath. The healthcare team will help you decide when your baby is ready for this. 

Swaddling your baby in a blanket or towel while you gently bathe them will help them feel secure and strengthen the bond between you.  The nurse can show you how to do this. You can use a thermometer to check that the water is 37°c. 
Limiting baths to no more than 2 or 3 a week will help prevent your baby’s skin from drying out. 

Top and tail

In between baths, you can use cotton wool and water to clean your baby’s face, neck and bottom.  

Snuggle them dry

Babies get cold very easily so it’s important to get them warm and dry quickly. Always wash them in a warm, draught-free place and have a towel ready to wrap them in and dry them afterwards. 

Let your baby lead the way

Try to let your baby guide you when you’re thinking about when and how to wash them. If they’re asleep, you will probably want to wait until they’re awake. If they’re uncomfortable, you could give them a quick top and tail rather than a bath. This will help them learn to enjoy bath time. 

Looking after yourself

To be able to look after your baby, you need to look after yourself too. Try to rest or take some time out where possible, even if it’s just going for  short walk.  

Eating and drinking healthy foods and getting sleep will help you keep energy levels up. If you are breastfeeding or expressing, this can also help with the flow of breast milk. 

It’s also important you are on the maternity ward for any medical review you might need for yourself, any medication you might need (especially pain relief) or to attend any appointments you have with your midwife. 

EFCNI, Pallás-Alonso C et al. (2018) European Standards of Care for Newborn Health: Parental involvement. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/parental-involvement/

Macdonald S, Johnson G (2017) Maye’s Midwifery 15th edition. Elsevier, London.

Chapman V, Charles C (2018) The Midwife’s Labour and Birth Handbook 4th ed. Wiley-Blackwell, Oxford.

NICE (2019) Specialist neonatal respiratory care for babies born preterm. NICE guideline 124. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng124 

Unicef (2016) You and your baby. Supporting love and nurture on the neonatal unit. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2015/08/neonatal_leaflet_online.pdf
  
Unicef (2016) Guidance for neonatal units. http://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2015/12/Guidance-for-neonatal-units.pdf 

Carey S (2018) Clinical Guideline: Developmental Care. NHS East of England Neonatal ODN. http://www.nnuh.nhs.uk/publication/download/developmental-care-management-of 

NHS Greater Glasgow & Clyde. Neonatal pain guideline. https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/neonatology/neonatal-pain-guideline/ (Page last reviewed: 10/7/2019. Next review due: 1/9/2021.)

Stevens B et al. (2016) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub5.

Johnston C et al. (2017) Skin‐to‐skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD008435. DOI: 10.1002/14651858.CD008435.pub3.

EFCNI, Kuhn P et al (2018) European Standards of Care for Newborn Health: Supportive sensory environment. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/supportive-sensory-environment/ 
  
EFCNI, Montirosso R et al. (2018) European Standards of Care for Newborn Health: Support for parental-infant bonding. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/support-parental-infant-bonding/

Brett J et al. (2011) A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open 2011; 1: e000023. doi: 10.1136/bmjopen-2010-000023

POPPY Steering Group (2009) Family-centred care in neonatal units. A summary of research results and recommendations from the POPPY project. London: NCT. https://s3.eu-west-2.amazonaws.com/files.bliss.org.uk/documents/PoppyreportforPRINT.pdf?mtime=20180412170449 

EFCNI, Silva E et al. (2018) European Standards of Care for Newborn Health: Skin care. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/skin-care-infants/

EFCNI, Hankes Drielsma I et al. (2018) European Standards of Care for Newborn Health: Supporting the infant during hygiene procedures. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/hygiene-procedures/