For Susan Ludington, the Carl W. and Margaret Davis Walter Professor of Pediatric Nursing, the bond between mother and infant is something spectacular to witness.

Kangaroo care, the primary subject of Ludington’s research, is a method of care that can help facilitate the bond between mother and child and also introduce a variety of physiological and developmental benefits to newborn babies. This care refers to the prolonged skin-to-skin contact between parent and baby, especially during the first few weeks following the baby’s birth.

Ludington, who has studied this method of care for almost two decades, is currently conducting a study to analyze newborns who are delivered and then immediately placed skin-to-skin, chest-to-chest with their mothers.

“At delivery, when you put a baby immediately on his mother’s chest, cord still attached … I noticed that while we’re waiting for the cord to be clamped, they’re very quiet, they’re very alert, they’re not moving about, they’re looking about with their eyes, and they don’t move their arms, they’re not screaming … none of the things that you see when the baby is put under a warmer,” Ludington said.

Newborns who are placed in kangaroo care directly after birth also tend to exhibit stable heart rates and respiratory rates. However the Apgar score, which is a scale commonly implemented to measure a newborn’s complexion, pulse rate, reflex, activity and respiration at one and five minutes following birth, is not entirely receptive to the use of kangaroo care.

Newborns placed in kangaroo care tend to warm up slowly since it takes time for blood circulation to reach their extremities. Decreased peripheral circulation may mean that the babies appear less pink, which can affect the complexion criteria for the Apgar score and result in a lower score, despite the relative health of the babies.

“Both physicians and nurses … use their general interpretation of the baby’s overall condition rather than scoring exactly,” Ludington said. “So I would really want to provide the world with an accurate Apgar score for babies in kangaroo care within one minute of birth.”

Ludington is currently in the process of compiling videos of newborns’ behavior at one, five, and 10 minutes after birth to record healthy behaviors and eventually rewrite the criteria for the Apgar score.

Another component of Ludington’s newborn behavior study involves the development of a tool to minimize one of the risks associated with kangaroo care.

According to Ludington, during the first two hours after birth, babies who are breastfeeding or in kangaroo care receive a surge of oxytocin from the physical contact with their mothers. Oxytocin will then cause the babies to fall asleep.

“Looking at the literature, there are very few reports of any negative effects [of kangaroo care],” Ludington said. “Most people, including most professionals, don’t realize the overwhelming benefits.”

Beyond maternal bonding, kangaroo care also provides newborns with better self-regulatory control, motor and mental development, and emotional attachment to their parents, says Ludington. Through kangaroo care, newborns also experience sleep benefits, pain reduction, and an introduction to good microbes from their mothers.

“The oxytocin released from the skin-to-skin contact goes to the pain receptors in your brain and it turns off pain reception,” Ludington said. “It’s wonderful because you can give a baby a shot and they don’t cry at all. They’re with their mothers and they’re so relaxed, it’s really beautiful to see.”

Ludington would like to further explore the pain reduction aspects of kangaroo care in the future by working with babies with congenital heart defects and babies undergoing chemotherapy and radiation.

“I think the science is developed and established well enough that it’s time for us to say no more swaddled-holding of a newborn,” Ludington said. “If you can hold the baby swaddled, he should be skin-to-skin, chest-to-chest.”