In a world which reaches for the latest technology to support the fragile lives of the most vulnerable of babies, human touch has turned out to be the one thing science has been unable to beat.
Kangaroo mother care (KMC), often known simply as kangaroo care, is not a new initiative.
Kangaroo care was first developed in Bogata, Colombia, in the late seventies and was documented in the early eighties.
It was a solution to the care of premature babies when there were insufficient incubators available.
Once babies had overcome any initial problems and only needed to feed and grow, they were given to their mothers to wear skin to skin, all day, every day.
Not only did the individual babies thrive, but the overall mortality rate plunged from 70% to 30%.
In recent years, Western hospitals have embraced the kangaroo care concept, and it's now common practice to see tiny babies snuggled against their parents chests. While attached to technology, premature babies can learn how to feed from their mother's breast.
In Europe, kangaroo care is replacing the incubators that those poorer countries weren't able to afford. Mothers are staying with their babies in the NICU and are practicing continuous kangaroo care with better results.
As the circle continues, mothers and babies in Africa are now benefiting from the introduction of kangaroo care.
Australian midwife, Narelle Tunks, is currently working in Tanzania for the Global Health Alliance Western Australia (GHAWA). They are working towards the 2015 World Health Organization Millennium Development Goals, of reducing the mortality rate of mothers and their babies by up to 75%. Two of the hospitals that have set up kangaroo mother care contain babies as small as 800 grams, and have experienced zero deaths.
Before this, and in hospitals which do not have kangaroo mother care, babies are left unwrapped with no assistance. Up to one third of these babies die during the neonatal period.
What The Studies Say About Kangaroo Care
Studies have shown skin to skin contact on a mother’s chest results in better physical outcomes and stability than the same care provided in an incubator. Kangaroo care stabilises the infant’s heart rate and breathing. There are no concerns about babies losing valuable heat during kangaroo care, because their mother’s own body temperature adjusts to keep the baby warm. Incredibly, in the case of twins, each side of her chest adjusts to meet the needs of the baby on that side.
Breastfeeding is enhanced by kangaroo care, as the skin-to-skin contact stimulates the release of oxytocin each time mother and baby come together — so much so, mothers are encouraged to pump immediately after kangaroo care to maximise the benefit. Even before her sucking reflex develops at around 34 to 35 weeks of gestational age, a pre-term baby will lick, touch and smell her mother’s breast, and even try attaching.
Babies who receive kangaroo care gain weight faster, as they are able to sleep better and use their energy to grow. They sleep deeper and longer against their mother’s chest. A study also found more kangaroo care infants were exclusively breastfed by the end of the study period (98% vs 76%).
How Does It Work?
Skin to Skin contact is recognised as being important for all newborns, and ideally, uninterrupted skin to skin for at least the first hour after birth should be routine for all well babies.
For premature babies, kangaroo care is as simple as being placed between her mother’s breasts (or on dad’s warm, fuzzy chest). The baby should be dressed in a nappy or diaper only – with perhaps a hat for babies less than 30 weeks gestation. Baby should be tucked into a shirt or covered with blankets to maintain body heat.
As she grows and stabilises, a stretchy baby carrier may be used. Indeed, the safety guidelines for babywearing apply equally for kangaroo care. A baby should be in an upright position, close enough to kiss, her chin tilted slightly upwards (to protect her airways), and her legs in a natural “m” or frogged position.
When Can Kangaroo Mother Care Begin?
Guidelines vary from hospital to hospital, but most have a policy allowing babies who are stable, including those who are less than 1500 grams and are breathing on their own. Some hospitals also allow babies on oxygen or CPAP to be held in kangaroo care. Kangaroo care should begin as soon as possible after birth, and continue as often and for as long as appropriate. Many families continue to practice babywearing as a continuation of the close bonds created during kangaroo care, after baby goes home from hospital.
Who Can Do It?
Mothers, fathers, siblings and grandparents can all participate in kangaroo mother care. In some European hospitals, the goal is to keep babies in this state for most of the day, with family members taking turns to ensure continuity. The mother replaces the incubator, providing 24 hour care for her baby. Even nursing staff and neonatologists have been known to tuck a little one under their shirt while they work.
Still a Long Way to Go In Australia And The US
Australian and US hospitals generally apply intermittent kangaroo mother care. Parents may have been given a general handout about kangaroo care, or it may be suggested verbally, only to be told it’s up to them. Often the practice is limited by access to suitable chairs, privacy, negative or ambivalent staff attitudes, or suggestions it will tire the baby. These barriers seriously impact on the wide implementation of kangaroo mother care, as standard practice in special care nurseries (SCN) and neonatal intensive care units (NICU), despite recommendations.
‘Towards Universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care in 2011′, states:
“The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 hours a day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC.”
More than thirty years after being implemented in Colombia out of necessity, kangaroo mother care is too often considered as an optional feel-good therapy, rather than the recognised aid to premature infant health the evidence proves.
If your baby is born prematurely, you might also like to read our article, baby in an NICU? 17 coping tips for parents.