Designing and Evaluating Calmer, a Device for Simulating Maternal Skin-to-Skin Holding for Premature Infants

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We describe the design and deployment of Calmer, a technology that simulates key aspects of maternal skin-to-skin holding for prematurely born infants: its inspiration, approach, physical design, and introduction into the Neonatal Intensive Care Unit. Maternal skin-to-skin holding can mitigate neonatal pain during medical procedures by as much as 50%, which can improve weight gain, sleep and later development. However, parents cannot always be present, and some infants are too fragile to be held. Interventions targeting this gap could be perceived as supplanting the mother in this intimate role, exposing her to depression and endangering her maternal bond. Over 10 years, we iteratively developed Calmer and demonstrated infant health benefit in a randomized clinical trial. Here, we report and reflect on pursuing this goal in a socially and technologically complex context: constraints, strategies, features, reception of the device, and surprises, such as leading to mothers feeling channeled rather than replaced.