Working with a Baby Carrying Educator at the Neonatal Unit.
A Guide to Working with a Baby Carrying Educator at the Neonatal Unit to Promote Skin to Skin Care and a Family Integrated Approach.
Baby Carrying Educator, Close and Calm
Nurse Manager, Neonatal Unit, Aberdeen Maternity Hospital, NHS Grampian
Developmental Therapist, Aberdeen Maternity Hospital, NHS Grampian
The Neonatal Unit at Aberdeen Maternity Hospital (NHS Grampian) has a Baby Carrying Educator visit weekly. This article aims to explains the history, the benefits, and the practicalities around this.
Aberdeen Maternity Hospital is a 34 bedded neonatal unit, the tertiary unit for the North of Scotland. The unit has adopted the Family Integrated Care model of care; working in genuine partnership with families. Parents are empowered to be their baby’s main caregivers, enabling them to be confident carers during their babies stay, transition to home and onwards in their family life. In April 2019 the unit achieved UNICEF Baby Friendly level 3 accreditation, enabling and encouraging parents to provide comfort and emotional support to meet their baby’s needs as well as working towards achieving Bliss Baby Charter accreditation. The unit has also undertaken a quality improvement project to minimise the trauma of procedural pain and stress which included providing Skin to Skin Care as a non-pharmaceutical intervention.
Jess Hippey of Close and Calm contacted the unit, and offered to volunteer once a month supporting Skin to Skin Care and speaking to parents about the benefits which we were delighted with. However, we found that once a month was not sufficient, as some parents were not seen, and others wanted weekly follow up and support. We then sourced funding to be able to support Jess Hippey coming in weekly, as she now has done for the past year.
What is Skin to Skin Care?
Skin to Skin Care is a name given to caregivers holding their unclothed baby on their bare chest, this is also known as Kangaroo Care. This apparently simple process, has incredible benefits for both the baby and the caregiver.
Skin to Skin Care is a key part of UNICEF baby friendly level 3, and UNICEF have a wide list of research that shows the incredible benefits of Skin to Skin Care: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/
What are the Benefits of Skin to Skin Care?
Carrying your baby close whether just holding them skin to skin, or by using a carrier / carrying aid has so many benefits: Human contact with other humans is vital to emotional and physical health and is a normal and essential part of development. Skin to skin contact helps babies to regulate their temperature, heart rate and breathing rates. It produces Oxytocin in both the caregiver and the baby, calming the baby and can even reduce the effects and incidence of Post Natal Depression. Studies have shown that carried babies cry less and that carrying significantly helps with both reflux and colic. Babies who are carried for just one hour each day breastfeed for longer and also breastfeed more frequently, and a recent study even showed a 40% reduction in pain activity from physical touch . These are incredible benefits for all babies, and for babies in the Neonatal Unit, they are especially helpful and may even assist with growth and reduce the length of hospital stay 
The Benefits of Skin to Skin, or Kangaroo Care as it's often known, are enormous and as well as increasing the bond between parent and child, the benefits also include these incredible things:
Accelerated Brain Growth
Increased Parent – Baby Bonding
Heart Rate Regulation
Breathing Rate Regulation
Post Natal Depression Benefits
Increased Breastfeeding Rates
Less Pain Activity
Improved Oxygen Saturation Levels
Developmental benefits – Skin to Skin Bandeaus help to create positioning which is flexed, midline and offers containment as well as a supported back, and encourages parents to provide a supported positioning for their babies. “Infants should be positioned in a flexed, contained, aligned and comfortable position to alleviate muscular asymmetry, tightness and discomfort, as well as to maintain behavioural organisation” 
What is a Baby Carrying Educator?
A Baby Carrying Educator a professional who is trained and insured in baby carrying. They have a broad knowledge of the many different slings, carrying aids and carriers available, and expertise in how to use them and how to fit them. Through their experience they're able to find the ideal carrying solution for caregivers. Their training means that they often have solutions for situations requiring more consideration, such as carrying twins, premature babies, and children with additional medical needs.
Specifically, for Aberdeen, Our Carrying Educator’s vision fits well with our Family Integrated care model.
Close and Calm’s Vision:
Close and Calm’s vision is to impact the community with the benefits of carrying, to make carrying a mainstream occurrence. It is a vision to see Post Natal Depression reduced, babies’ settled, and community built as people are more free and able to venture out. We want to see calm restored to the homes of newborns – and parenting becoming an exciting and encouraging period, instead of one of concern, loneliness and isolation. Through our grass roots connections with parents, caregivers and healthcare practitioners, we want to set the foundation for our local community, in normalising the safe and regular use of carriers. We also love that a consequence of carrying is an increase in breastfeeding rates– which is a key concern for the NHS, UNICEF and the World Health Organisation and Best Start, because of the many health benefits to both the mother and the child, and believe that an increase in carrying in our population will lead to an increase in the proven carrying and breastfeeding benefits, which in turn will positively impact our NHS services.
With the introduction of the Scottish Baby Box and free carrier included, Close and Calm will support both NHS staff and parents to see a safe and high level of uptake of the carrier and provide Drop In Sessions demonstrating usage – aiming to capture a wide audience, both those who are keen and those who are unsure, by providing a safe, reassuring and neutral venue for people to observe, learn, and meet with other parents –to see that they’re not alone.
What are Carrying Aids?
Carrying Aids are Tops, T Shirts, or Tubes of Fabric that help support the baby in an optimum position. They are not hands-free, and are mainly designed for when seated, but they offer invaluable support to the baby, ensuring optimum positioning is maintained in an upright position with good airflow, and their use helps to prevent sub-optimal positioning that sometimes may occur in the arms of tired caregiver. Carrying Aids enable the caregiver to offer Skin to Skin Care for longer periods of time, in a more comfortable, well supported way and can also offer an additional level of privacy that some caregivers desire.
There are many brands available, The Aberdeen Unit owns a supply of Vija-Design Tops that were donated by the local NCT Branch, and Kangaroo Zak Tops, both of which are loaned to parents and laundered in accordance with NHS infection control policies. Recently we made the decision to invest in Vija-Design Skin to Skin Bandeau bands, and we gift one per family to keep and take home with them, so that they can continue this important practice when discharged.
How Does a Baby Carrying Educator Promote Skin to Skin Care?
Aberdeen really is a wonderful example of where all staff encourage Skin to Skin Care, and we are so proud of the unit for recently achieving the UNICEF Baby Friendly Level 3 Award. The Baby Carrying Educator promotes Skin to Skin Care in the same way as all staff, but the fact that they are there solely to promote Skin to Skin Care, having no other medical role, demonstrates to parents the importance that Skin to Skin Care has in their family life. Very few parents plan to be in the Neonatal Unit, and the Oxytocin release that occurs in the caregivers, is one of the biggest impacts we see in the parents, with people feeling like their baby belongs to them, bonding in ways they haven't before, and helping their mental health too.
By being specifically trained in carrying methods, and carrying aids, the Educator is able to quickly and easily identify the most suitable tool for the caregiver, and help fit it to them if required.
The Scottish Baby Box Wrap is also taught to parents nearing discharge, so that they have a safe and long-term carrying solution for the future.
Feedback from Parents:
"My husband hadn't wanted to do Skin to Skin topless with people around, and didn't know about that top until you showed us it last week. He's used it every day since and it's made a huge difference so thank you for taking the time to show us"
"This is so helpful, I'd love to carry my baby close and I'd seen these In Germany but didn't know where I'd find these here or how to work the baby box wrap"
What the Baby Carrying Educator’s Support Looks Like Practically:
Our role as a trained Baby Carrying Educator is to speak to the families, talk about the benefits and enable the Skin to Skin Care to occur in the most comfortable way possible for the caregivers, to answer any questions or concerns they may have, and to provide them with carrying aids to support their time together as a family.
Practically, it looks like this - We speak to the ward staff first, and ensure that the baby is able to have Skin to Skin Care at that moment, and then speak to the parents about the benefits of Skin to Skin Care, and help to facilitate that, offering a carrying aid if desired. We are also able to demonstrate the Scottish Baby Box Wrap, and can help the caregivers to feel confident with it before they are discharged.
The Consortium of UK Sling Manufacturers and Retailers provided the following advice to baby sling wearers: "Keep your baby close and keep your baby safe. When you’re wearing a sling or carrier, don’t forget the T.I.C.K.S:
· In view at all times
· Close enough to kiss
· Keep chin off the chest
· Supported back."
The two main risks with using a carrier or carrying aid, are asphyxiation and overheating. We make that clear to all parents, but articulate how these risks are mitigated by adhering to the TICKS guidance. We also talk through the TICKS and hand a leaflet with them on to every caregiver.
If the TICKS guidelines are followed - this deals with the risk of asphyxiation. The 'Tight' prevents slumping, the 'In view' ensures constant and vigilant monitoring. The 'Close Enough to Kiss' ensures babies are not at chest level along with the associated soft tissue risks there. The 'Chin off Chest' ensures clear airflow, and the 'Supported Back' should ensure optimum positioning is maintained.
In terms of overheating - we encourage parents to be mindful of the extra layers, and to regularly monitor their baby's temperature.
The Baby Carrying Educator works closely with the nursing staff as well as the parents, and will often ask the nursing staff to help position the baby on the caregiver's chest, before aiding with fitting the top. The video below is an example of one of the Skin to Skin Bandeaus we use.
Using a Vija-Design Top:
Infection Control for Skin to Skin Care:
The Skin to Skin Bandeaus are donated to families brand new to keep, removing any infection control issues. The Kangaroo Zak tops that are loaned, are laundered on site, in accordance with the NHS infection control policy.
Nurses Carrying Babies:
For our nurses who sometimes carry babies that are finding it hard to settle, we use the following procedures.
1. We use Carrying Slings (not Skin to Skin Aids) that have been laundered according to the NHS infection control policy.
2. Baby is clothed.
3. Nurses cover the part of their uniform with clean muslin where the baby’s head rests.
4. As with any other direct patient care if a nurse's uniform was contaminated in any way they would go and change it.
5. The nurse carrying the baby would continue to complete her work as required/usual. Common sense must prevail here, if a further baby required a feed then the nurse would put down the baby she was carrying first.
For hands free carrying and walking around, we mainly use stretchy wraps. One of the reasons for this is that they often have a low minimum weight limit that our babies obviously need. They also allow for good support as they can be perfectly moulded around the baby and the staff member to ensure a good and safe fit. The staff had either already used these with their own children, or for those who were not familiar with the wraps had training from our baby carrying educator. All staff who carry are made aware of the safety guidelines: babyslingsafety.co.uk
We use various brands, often depending on their weight limits -
We also use various brands of ring slings for the staff that are experienced in those. Oscha Slings in Scotland allow our Carrying Educator to support caregivers with babies weighing over 2lb in their products.
A Note of Thanks to our Supporters.
The carrying educator and the carrying aids are funded by donations from the Friends of the Neonatal Unit, and the NHS Grampian Endowments Fund – we are very grateful for the impact it’s having for our families.
For more information contact:
Jess Hippey: email@example.com
Nicole Bauwens: firstname.lastname@example.org
Laura Angus: email@example.com
 Heart Rate Variability Responses of a Preterm Infant to Kangaroo Care Gail C. McCain, PhD, RN, FAAN. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2133345/
Pisacane, Alfredo / Contanisio, Paola / Filosa, Cristina / Tagliamonte, Valeria / Continisio, Grazie I.: “Use of baby carriers to increase breastfeeding duration among term infants: the effects of an educational intervention in Italy”. In: Acta Paediatricia, 101, 2012, S.434-438
 Vegara et al 2004