Interview with Tzipi Strauss

The healing power of human touch in times of disconnection

In 2016, Prof. Tzipi Strauss, a leading neonatologist from Israel, gave an important speech on the “power of touch” at the TEDx Tel Aviv University conference. We talked to her about her passion for the topic of touch and the relevance of touch during times of disconnection.

"Skin-to-skin care reduced mortality of premature babies by 20 percent."

Role of physical touch for premature babies

Prof. Strauss, can you describe the role of physical touch in the survival of premature babies and the evidence behind it?

Until 15 years ago, the NICU (neonatal intensive care unit) was a place with a lot of noise, fluorescent light from the ceiling and painful stimulation. It was often a scary environment for babies and very different from life in the comforting womb of their mothers. Parents were scared to touch their 500 gram or one kilo baby. We, the doctors, didn’t emphasize it enough. Over time, however, with more research on the role of human touch and pain prevention, we’ve come to appreciate that touch is extremely important. When people touch each other, there is a release of oxytocin, the “bonding” or “love” hormone. Once oxytocin is released, blood pressure goes down and the passive sympathetic nerve system starts to work. During birth, for example, the mother’s oxytocin level goes through the roof. Immediately after birth, she bonds with the baby because of the crazy amounts of oxytocin set free in her system. Several other studies have shown that skin-to-skin care helps to develop the immune system of the baby, has a positive effect on weight gain, improves breast milk production and makes mother and baby more relaxed during a very stressful time in the NICU.

The latest studies are on brain development. Our mature brain looks like a walnut, with many folds and creases. The preterm brain does not look like that. At 26 weeks old, the brain is still completely smooth. This means that during the time babies spend in the NICU, in the incubator, the brain is still developing. A study involving brain MRIs on preterm babies showed that those babies whose parents did not come to touch them or talk to them while they were in the incubator had less developed temporal lobes. The temporal lobe is the area of the brain responsible for listening and communicating. In those babies who did not receive talk or touch, it stayed flat: no wrinkles, folds or creases. This sensory deprivation—meaning not enough human touch or verbal stimulation—slowed down brain development. Finally, other studies in Africa have shown that skin-to-skin care reduced mortality of premature babies by 20 percent.
"We try to use Zoom so that mothers can witness their baby having a bath for the first time."

Giving birth under stressful conditions

Since the outbreak of the COVID-19 pandemic, a lot of babies were born—including preemies—under stressful hospital conditions, with fathers not being there to support mother and child. Other families decided to give birth at home. What do you recommend to parents and doctors in this overwhelming, anxiety-filled situation?

I never imagined that this kind of scenario could happen. Ever. At the beginning of the pandemic, all deliveries were performed alone, with no one besides medical staff present to support the mother. Unimaginable. On those occasions when the mother was COVID-positive, we were told to separate the baby from the mother right after birth. Some mothers insisted on keeping the baby with them, and we considered this to be their decision. We didn’t have enough information at that point on the risks that mothers might infect their babies. Now, fortunately, there is increasing evidence that the virus isn’t passed on to babies in this way and that breastmilk is safe, too.

For obvious reasons, we still have to limit visits to the NICU. We have to protect our own staff and keep up our hospital services. With 18 babies in the NICU in the same room, we can’t always ensure social distancing, but we have implemented all kinds of rules and processes to keep everybody safe. Despite our best efforts, this situation is very stressful for everybody. We try to use Zoom so that mothers who can’t enter the NICU can witness their baby having a bath for the first time, or being fed. But we have to acknowledge that it is not like the real thing—and it’s frustrating for both the staff and the parents.
"The fact that people have to be isolated is devastating."

Health consequences of isolation

Our global survey shows that people in single-person households and of older age have been particularly affected by social isolation. People in hospitals, nursing homes and hospices have been separated from their loved ones and isolated as much as possible even from caretakers. Given the “healing power of touch,” how would you describe the health consequences from an individual and societal point of view?

The fact that people have to be isolated is devastating. We will see the consequences later on. Already, we can observe more depression, more heart disease and delayed medical care for things as serious as cancer treatment, because patients are afraid to leave the house. We observed around 20% fewer premature births during the first few months of COVID-19. One explanation could be that mothers avoided regular check-ups, with the consequence of more stillbirths. For older people, depression is common and influenced by the level of connection, social engagement and sense of community they have. It keeps them alive to see their children and grandchildren. Research into longevity often references the “blue zones"—the five areas in the world where people tend to live much longer than average. These studies have shown that apart from a healthy diet, all five regions have one thing in common: high respect for and inclusion of the elderly in the community. Getting back to COVID-19, the evidence is overwhelming that isolation and loneliness affect our life span.

Contact, connection and compassion for the work of physicians

To improve the situation for parents and premature babies at the hospital, you have proposed a triangle of touch: contact, connection and compassion. How does this translate into the work of a physician?

Our motto is to see any situation through the eyes of the parents. For them, no news is bad news. Parents need to be updated all the time. We need to connect with the parents as often as possible, even if there is no news to share. It is better to over-communicate than under-communicate. Doing so will help them see our compassion, trust our judgment and cooperate on everything that’s necessary. Years ago, we treated a baby with a rare skin disease that resembled elephant skin. I stayed close to the parents, encouraged them and talked about sensory deprivation and the importance of human touch. Years later, the mother wrote a book in which she emphasized the importance of the connection she had with the hospital staff. She had memorized every little detail of our conversations at the time. It opened my eyes to the influence that we have as doctors when it comes to communicating with patients and their families.
"We have adapted to masks, and we will adapt back, when it’s possible."

Physical contact after the Pandemic

Let’s look into the crystal ball: when this pandemic is over, will we all change our approach and attitude toward physical touch? To what extent will our society change, and how does it affect our health?

We are changing our behaviour already—often based on fear, but also based on logic. We have become suspicious towards people. We ask people to put on their masks if they are next to us in an elevator, for example, which is understandable. We have become more reserved. But that also depends on the culture where we live. In Israel, we love to hug. Hugging or kissing is our default behaviour when we meet, and social distancing is difficult.

But I am optimistic: we are an adaptable civilization. We have adapted to masks, and we will adapt back, when it’s possible. This is a traumatic time, and the virus is not a game. We will still find ways to connect and will get back to physical touch once we can, because connecting through touch is in our nature.
Prof. Tzipi Strauss

Prof. Tzipi Strauss

Specialist in pediatrics and neonatology

Prof. Tzipi Strass is a master of healthcare science from Harvard University and the Director of the Neonatology Department and NICU at Sheba Medical Center, considered one of the ten leading hospitals in the world.