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Book review: Hold Your Prem by Jill Bergman with Dr. Nils Bergman

This book on best practices for premature baby (prem) care is invaluable. It will be exceptionally useful to empower parents of a prem AND as a resource for birth professionals. The Bergmans share best practices to meet prems’ needs that recreate as closely as possible the experience in the womb. This is quite profound, but in typical Western hospitals [dealing with liabilities (and fears) around prem care] is not always a priority. Prems being with mom, with skin-to-skin contact is best because it makes the biggest difference in terms of neuroscience (baby’s brain development) which wires babies’ nervous systems for health.

This book gives clarity on how to meet these deep needs and how we can change the landscape to prioritize prems’ needs – especially during the exceptionally significant early seconds, minutes, hours and days after a prem is born. This book is the premise for Kangaroula training offered next weekend by BirthWorks!  If you want to learn more, please register now or when it is offered again in 2021.

When certain things are not in place for the mother-prem connection, it is at the cost of stress on baby’s autonomic nervous system (ANS) and brain development.  What “the baby expects biologically” does not happen if the prem spends most of the time in an incubator (or crib), and being in this state of stress or shock, especially for a prem, wires their brains to not relax and expect stress, with costs for exceptionally important development in the first few months of their lives and longer.

“Skin-to-skin contact provides the biologically expected stimulation to wire the brain in the best way possible… The brain is stimulated by sensations. The sensations from the mother are good and reassuring. They make the brain develop… This brain-wiring depends on the mother’s presence.” (p.11)  Babies have certain sensory needs (feel of skin, smell of mother, hearing her voice and heartbeat, see her face and tasting breast milk) which if they are in place help babies relax (so they breathe, eat and sleep better).  But if a prem is not with mom, they go into “shock” when trying to regulate their own body temperature (and more) and their nervous system is stressed (fight-and-flight).  There are steep costs for a prem to be in a negative stress state, when their brain is not fully developed, lungs are not ready for breathing air, sight and hearing are highly sensitive, and skin is fragile (p.12). 

For parents, this book will empower you, so if your baby is a prem, you can take care of yourself, and understand what is happening in the hospital to advocate for your baby. [For parents of term babies, so much information is relevant to your babies’ care and needs as well.]  As parents of a prem, you will understand how normal it is to experience a multitude of emotions (such as… very confusing, scary, worry, fear, uncertainty plus joy, hope, love and also more positive ones too).  It provides information and insight into certain areas – how to read signs from your baby, technology used, problems prems might face in the NICUs, the value of skin-to-skin contact, breastfeeding (with tons of tips), neuroscience (brain development), how you can best ask for help, and taking your prem home to parent them. You can use this book to “lessen the stress” and “help you and your prem cope better” (p.9) but more than that… you will understand what is going on (what your baby is telling you, even what good reasons there are for wires and tubes on your baby) and how the key thing that can help your baby is YOU! – your presence, your touch and your love. (You can hold your baby with the wires attached, if you ask.)

For professionals, you may find academic validation that much of what you intuitively do (outside of managing technology as needed) when working with prems is already in-line with best meeting their needs. You may understand parents of prems better, and thus how to work best with them to make positive changes for ideal care for their prem. As a childbirth educator or doula, the book clarifies the ultimate best baby care… because understanding and meeting a prem’s needs best is the most extreme way we can give the absolute best care to any baby, and deeply understanding the experience of parents of prems frames the support that is also best for any new parent.  

This book emphasizes the importance of the shared journey… starting with the mother/baby connection, and the cooperative teamwork of parents and providers together.  This matters a lot! – in the context of neuroscience, honoring parents speaking for their baby, and embracing that “mom + milk” are the key ingredients in building the prem’s health. The book also states that in NICU prem care there are some areas of controversy where academic “evidence is insufficient or absent” (pp.v), which reinforces the vital bond between mother and baby, and the need to find the best balance of mother-care and technological care. The conversation with prem parents and health professionals is key to improve prem care now and in the future.

Hold Your Prem helps us choose to care for term infants and prems with deep knowledge and awareness, in conscious ways that minimize trauma (which sadly is unintentionally created in some hospital/NICU-care models). The Bergmans empower parents and providers through detailed understanding and steps to allow the best nurture science, skin-to-skin contact, positive breastfeeding support and mother-baby bonding, so together we co-create a “nurture care” model to minimize stress, maximize babies’ comfort to meet their deep developmental needs in the early moments of their precious lives, enhance bonding, and align intention to create healthy babies and brain integration, so prems’ nervous systems are balanced and well, which can give prems the opportunity to live healthier lives and effectively connect socially in the future.

If you’re inspired to learn more and to learn how to advocate for prems in your work, consider joining BirthWorks for Kangaroula future trainings, now offered virtually.