Column Editor Deb Discenza, MA
Postpartum depression (PPD) strikes one in eight women. (1) Mothers of premature infants are at especially high risk for PPD because of the amount of stress involved in a premature birth and in caring for the infant in the NICU. The mother is struggling with loss of a “normal” birth and has been thrust into the scary world of the NICU, where she must watch her infant fight for life. Stress and lack of a decent recovery period combine to tax the mother’s emotional state and put her ability to cope at risk.
The concept of nurturing touch, however, can bridge the gap between mother and infant while providing emotional, medical, and developmental benefits. To find out more, I sat down with Linda Storm, executive director of Infant Massage USA, a nonprofit company devoted to helping NICUs create appropriate nurturing touch programs for their families. Here are Linda Storm’s responses to some of the questions I raised.
Postpartum depression is common among mothers of premies. How does infant massage work as a therapeutic approach for both mother and infant?
The theory underlying infant massage is to encourage parent-infant interaction and communication. These activities promote bonding and attachment between parent and infant. While in the NICU, the infant may not be able to tolerate massage, but nurturing and positive touch can be introduced. These help infants thrive, allow mothers to feel connected to their infant, and help mothers work through the many feelings and emotions they are dealing with. Mothers of premies can feel that there is little they can do to help their infant while he is in the NICU. Doctors Klaus and Kennel in the early 1980’s advocated that mothers need to be actively involved in the baby’s care for the well-being of the baby and mother.
Mothers need to be supported, encouraged, and reassured that their involvement is important. This type of support helps the mother’s PPD and fosters parentinfant communication, bonding, and attachment.
If the infant is too fragile to touch, the mother can talk to him. The infant can hear her voice and know that he is not alone. Mothers can start nurturing positive touch initially by simply resting their hand on a body part. This can help the infant stabilize, and it stimulates the release of the hormone oxytocin in both parent and infant. Oxytocin, also known as the “cuddle” hormone, helps to reduce stress. (2)
It sounds as if this interaction happens in stages. How should a mother with PPD start infant massage with her premie? Can the process occur in the NICU? Can it take place only under certain circumstances?
Nurturing touch can begin in the NICU as soon as the infant is stabilized. A perfect way to begin—one that is beneficial for both parent and infant—is kangaroo care. (3,4) Just place the infant (tubes and all) on the mother’s chest skin-to-skin. Kangaroo care provides the infant with all the physiologic benefits of bonding with the mother. An added benefit is that the mother’s body warmth keeps her infant at the perfect temperature, so the infant has to use fewer calories to keep himself warm. The mother can enjoy this time with her infant and see how calming it is for her child.
If kangaroo care isn’t possible, resting a hand or hands on a body part or containment in a fetal position are alternatives. The mother needs to be in a comfortable position so that she can maintain her touch for some time. When nurturing an infant with touch, it takes the infant some time to stabilize after the initial contact. As he continues to grow and develop and move toward discharge, more touch can be introduced.
What is the best setting for a mother to do infant massage with her premie?
A nice way to learn about infant massage is in a class with other parents or at the bedside with a certified educator of infant massage (CEIM). Each infant is different, and each parent has a story. A CEIM will individualize nurturing touch to meet the needs of the infant and parent. When a mother is encouraged and guided to use nurturing touch with her baby, it builds her confidence and she begins to feel like a part of the team caring for him. Being with others who listen, who understand her feelings, and who have experienced or are experiencing similar feelings helps her work through many of her emotions.
What research and specific outcomes support infant massage as a therapeutic approach to PPD?
Onozawa and coworkers, and Tiffany Field and colleagues, have done research that found infant massage beneficial for mothers with PPD. (5,6)
Also, as I mentioned, a great way to learn infant massage techniques is with a CEIM, who demonstrates touch techniques on a doll for the mother to do with her infant. Research suggests that interaction coaching helps to improve the mother’s interaction with the infant. (7)
Field and associates studied elder retired volunteers who gave infants massages and then received massages themselves. The study involved infants, between the ages of three and eighteen months, who had been neglected or abused. Results showed stronger positive effects for the elder retired volunteers after giving massage to infants than after receiving massages themselves. The elders who gave massages reported less anxiety and fewer depressive symptoms; they had decreased stress levels, improved self-esteem, and positive lifestyle changes. The massaged infants showed increased quiet sleep, alertness, tracking behaviors, sociability, and soothability. (8)
Additional support for touch in reducing PPD can be found in Kerstin Uvnas Moberg’s The Oxytocin Factor: Tapping the Hormone of Calm, Love and Healing. In essence, her research shows that when a mother touches her baby, oxytocin is released in both the mother and the infant. Touch and connection with the infant change the mother’s hormone levels. Oxytocin, prolactin, and endorphins are released, and the mother’s body begins to help itself feel better. When she holds or strokes her baby and the baby smiles at her, this gives additional positive feedback to the mother. (2) By guiding mothers to use nurturing touch with their infants, we not only help them to begin feeling better about themselves, but their infants are happier as well.
What if hospitals do not have staff who are trained in infant massage? How can Infant Massage USA help?
Infant Massage USA has qualified trainers who can help train hospital staff and develop an appropriate program. This would help staff encourage parent involvement while the baby is in the NICU and help the mother feel more confident when the time comes to take her baby home. Once the infant comes home, we have educators across the U.S. who can help families in one-on-one sessions or group classes.
Where can NICU nurses get more information on infant massage and on training parents in their unit?
Infant Massage USA’s website, infantmassageusa.org, lists training sessions throughout the U.S. where NICU and hospital staff can learn to incorporate appropriate infant massage practices in their NICUs. Interested parties should connect with us at our website to learn more about our comprehensive program.
Thank you, Linda.
Thank you, Deb, for helping to educate professionals on the importance and power of nurturing touch. Infant massage is a low-tech, cost-effective intervention that makes sense on so many levels. An infant massage program lends a positive image to an NICU and to its hospital. NICUs that incorporate nurturing touch into their treatment plans can claim that they are making their best efforts to serve the emotional and developmental needs of their infants and their families.
This article appeared in Neonatal Network, VOL. 30, NO. 1, January/February 2011
Editor’s Note: Publication of Ms. Discenza’s interview with Ms. Storm does not imply endorsement of infant massage therapy, nor of Infant Massage USA by Neonatal Network:® The Journal of Neonatal Nursing or by the Academy of Neonatal Nursing.™
Disclosure: Deborah A. Discenza is a partner in PreemieWorld, LLC, a product company based in Virginia that is building relationships with organizations and product companies that relate to the field of premature infants, neonatal medicine, and therapeutic programs.
References: 1. Postpartum Support International. (2010). Retrieved from http://www. postpartum.net/ 2. Moberg, K. U. (2003). The oxytocin factor: Tapping the hormone of calm, love and healing. Cambridge, MA: Da Capo Press. 3. Bergman, N. (n.d.). Kangaroo mother care. Retrieved from http://www. kangaroomothercare.com/ 4. March of Dimes. (n.d.). Parenting in the NICU: Holding your baby close: Kangaroo care. Retrieved from http://www.marchofdimes.com/ prematurity/21295_6090.asp 5. Onozawa, K., Glover, V., Adams, D., Modi, N., & Kumar, R. (2001). Infant massage improves mother-infant interaction for mothers with postnatal depression. Journal of Affective Disorders, 63, 201–207. 6. Field, T., Grizzle, N., Scafidi, F., Abrams, S., Richardson, S., Kuhn, C., & Schanberg, S. (1996). Massage therapy for infants of depressed mothers. Infant Behavior and Development, 19, 107–112. doi:10.1016/S0163- 6383(96)90048-X 7. Malphurs, J., Field, T., Larrain, C. M., Pickens, J., Pelaez-Nogueras, M., Yando, R., & Bendell, D. (1996). Altering withdrawn and intrusive interaction behaviors of depressed mothers. Infant Mental Health Journal, 17, 152–160. doi:10.1002/(SICI)1097-0355(199622)17:2<1 8. Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn, C. (1998). Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229–239. doi:10.1177/073346489801700210
About the Author
Deb Discenza is the cofounder of PreemieWorld, and her first book, The Preemie Parent’s Survival Guide to the NICU, may be found at www.PreemieWorld.com along with a number of free downloads for NICU families. With each future column, Ms. Discenza will be a parent guide, helping professionals down the often difficult path of assisting families in the NICU. Ms. Discenza welcomes your feedback at Deb@PreemieWorld.com or at firstname.lastname@example.org.