All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Incubators out - Mums in!

If this is the first time you have heard this suggestion, you are probably thinking either that I've just landed from another planet; or am some radical, hippified, Neo-Luddite who has clearly lost it.  Not true, honest!

As this is a rather large topic due to it's impact on many different areas -I thought I might tackle it over more than one blog post, with this being an introduction to.  So it's mainly aimed at those not too familiar with the concept of using mothers instead of incubators - often called Kangaroo Mother Care (KMC) which includes Skin to Skin (STS)

Let's start by jumping back to pre-incubators.  Premature baby care was at this time poor; the majority of infants were born at home, often without a doctor readily available.  Preemies were just considered "weak" babies, and as a result many were considered too small to survive.  In general doctors were "in no position to extend their direct responsibility for the newborn", so perhaps not surprisingly death rates were as high as 85%.

Around the turn of the 20th century, America's first incubator hospitals for premature infants were built.  Alexandre Lion had developed the first incubator suitable for hospital use; but they were complicated, expensive, and the technology was hard to sell to hospitals.  To get round this Lion displayed the incubators and their premature residents at fairs and amusement parks, charging an admission fee to offset the cost of running the equipment.

Survival rates soared; in part because of the clean, warm environment and appropriate medical care - but also because after seeing the techniques used at the hospitals, parents were better able to care for their own premature infants.  Incubator hospitals challenged many of the social norms of the time, but ultimately were designed to make a very large profit.

From this point,  research surrounding vulnerable infants, (and the development of incubators) was based on one fundamental assumption; that the incubator was the best way to care for a premature or sick infant. Today developments are still constantly underway to try and create an ever more womb like environment; controlling oxygen levels and other vital systems, with an array of sensors, monitors and alarms. Nowadays they are highly advanced pieces of equipment, costing in the region of £30,000.

But what if this initial assumption was wrong? What if the whole foundation was based upon an assumption that was massively flawed? What if, creating a womb like environment wasn't the
optimum way to care for a baby that had been born and something else could increase survival rates more?

Dr Nils Bergman has been researching, practising and lecturing on KMC for twenty years and firmly believes an infant should not be separated from his mother.   What Bergman discovered is that separation causes something called the "protest - despair response"; the protest response is one of intense activity seeking reuniting, the despair response that follows, is a withdraw and survive response - temperature and heart rate decrease, caused by a massive rise in stress hormones.  When reunited with mother, there is conversley a rapid rise in heart rate and temperature.

The "protest-despair response" was first described in human orphans after WWII, and was subsequently studied in monkeys and then in many other mammals. "Separation distress calls" have been documented in rats and very similar distress calls have been identified in human infants.  Cot babies make ten times as many cry signals as babies held skin to skin, and Bergman believes there is not only physical but neurological implications to separating the dyad.

There is compelling evidence a baby should be with mum, and that in fact she is the perfect incubator.  The infant's temperature sits within a very narrow range, because mum's core temperature rises and fall as her baby requires - so much so STS has been proven better than an incubator for rewarming hypothermic infants.  KMC has also been shown to improve oxygenation, to the extent that STS is used successfully to treat respiratory distress.  Baby's breathing becomes regular, stable, and is coordinated with heart rate.

Despite all this, KMC is not about shunning technology; on the contrary all the usual modern technological equipment should be used alongside the mother. It is purely about keeping mum and baby as one unit.

Isn't this risky? is the first question people ask.  The fact is that in over seventy studies. not a single adverse outcome has been reported for KMC. On the contrary, time and again KMC infants have improved outcome over traditional methods of care - something widely recognised in available scientfic literature.

Why isn't it practised? is usually the next.  But, as I promised to keep this a short introduction - I think that's for another blog entry!


  1. Well said!
    My daughter was not breathing at birth and was taken to SCBU. They put her in an incubator and strapped her up to the machines. I was making trips to scbu to feed her and during one of those night time trips the nn nurse commented on her traces that 'we never see that in here'. By this she meant that my daughter's oxygen saturation levels were going up to 100% and that was very unusual. When she was at the breast, being close to me she was thriving. I didn't need the machine to tell me this, but clearly they did. I got her back the next day. So sad that little babies are whisked away from the only consolation and comfort they have ever known, especially after trauma. It is not necessary to be a professional to know this - you only need to be a mother.

  2. After writing to the local press around the issue of funding KMC instead of another incubator ( you might remember!) a colleague spoke to me after seeing my letter, and others. He was prem, not touched by his mum for months (I think he said she was advised to not handle him too much once home as well), and although is grateful he survived (of course!) feels the lack of touch had a huge impact on him and how he relates to other people even now, 40 yrs on. He'd never heard of KMC but his personal experience has made him feel babies should be held. I felt very moved when he shared this, as he does come across a bit awkward and hard to know and can't help but wonder how many babies might be affected in such a variety of ways from the lack of mums touch.
    Looking forward to reading your next posts!

  3. As you know I interviewed Dr Nils and what he told me shocked me to the core. I couldn't believe there has never been any scientific evidence to back up the use of incubators and that babies in them are significantly more likely to need medical intervention. But it's so hard getting people to believe babies will do better on mum's chest. Remember how shaken up YOU were in SCBU with all your knowledge and expertise. Imagine a mother without all that. And quite aside from the preemies, babies who were routinely separated from their mothers at birth in the 1960's and 1970's. I feel so sad for them.

  4. What a waste of money, in my local hospital Mum's aren't even given a place to sleep near their baby, KMC is almost impossible. You go to a private room AWAY FROM BABY to express milk which is more often than not given via bottle to baby once tube feeding ends. Hospital practices must change!! If you have an MSLC at your local hospital ask them to campaign for this, I will be. Although it will require some new training for the DR's and HP's I'm sure.

  5. Yep totally "Our Baby Shop" - going to cover all that in next blog post as makes me very cross too! All the money raised for incubators could make a real difference for a start!

  6. Hi AA, I love your blog btw :))

    "What Bergman discovered is that separation causes something called the "protest - despair response"; the protest response is one of intense activity seeking reuniting, the despair response that follows, is a withdraw and survive response - temperature and heart rate decrease, caused by a massive rise in stress hormones."

    This makes me so sad! It really does. When they should be next to the warmth and comfort which is so easily available! I really really hope that KMC becomes the norm where possible.

  7. My baby would not be here if he was not put in an incubator. Not being in one is fine for older prems but to suggest incubators are not needed is very narrow minded. my baby was born at 26 weeks, 20 years ago he would not have survived at all so i for one am very thankful for all the medical intervention and state of the art incubators supplied by the 3 hospitals that cared for him in his first 14 weeks of life.

  8. Hiya
    Just to be clear I wasn't suggesting no medical intervention - which is the lifesaving bit, and indeed today's incubators are better than yesterdays, but where's the evidence they are better than a mother's body?

  9. my body ejected my baby 14 weeks early. also my body cant provide the humidity needed for my babys skin.i done kangaroo care and apart from the level 3 intensive care unit i was encouaged to cuddle him for as long as poss.

  10. scroll down to discussions re SSC and humidity.

    Stratum corneum hydration and transepidermal water loss are indications of skin barrier function in preterm infants. Stratum corneum hydration, while controlling for transepidermal water loss, increased from pre-SSC to SSC and
    decreased in post-SSC on Days 1 and 5 of the study. Thus, SSC contributed to better stratum corneum hydration and did so probably because skin-to-skin contact provides a degree
    of occlusivity at the skin surface, thereby also causing skin wetness. Skin wetness contributes to higher transepidermal water loss readings, which were present during SSC. The increased hydration finding is similar to the effects of skin occlusion in diapered areas in infants during the first 2 - 3 weeks of life but not at 4 weeks of life due to skin maturation [36, 37]. Transepidermal water loss is known to be increased in infant skin areas in which skin-to-skin contact occurs, such as in the cubital fossa when flexion of the forearm occurs due to newborn postures [38].
    Additionally, residual effects of SSC were seen. Skin hydration was higher after SSC than before SSC on both days, and skin hydration was higher before SSC on Day 5 than it was on Day 1, suggesting that the increases in skin hydration were not just momentary, but lasting. Such a possibility is congruent with the physiology of the skin in that skin hydration changes are commonly detectable for several days [39, 40]. Residual effects of SSC have been found for 1
    - 2 hours after SSC terminates [41], so these results contribute new information related to length of residual effects of SSC. Residual effects on TEWL also were suggested by data
    showing that TEWL after SSC was higher than TEWL before SSC, possibly due to SSC or maturation of the infant’s skin over the five days of study [42].

  11. The hospitals activly encourage kangaroo care, stop trying to make out they are bad for putting our babies in incubators. How premature was your baby?

  12. have you seen this story? It was big news in Australia when it happened. It shows why skin to skin contact is life giving