What is Kangaroo Mother Care?
Kangaroo Mother Care is a method of care practiced on babies, usually on a preterm infant, where the infant is held skin-to-skin with his mother, father, or substitute caregiver. Kangaroo Mother Care (KMC) was initially developed in Columbia as a way to keep stable preterm infants warm and decrease time spent in overcrowded hospital environments. However, Kangaroo Mother Care is not limited solely to environments where incubators are unreliable or unavailable, but is practiced in leading neonatal centers all over the world. Research conducted worldwide has quickly revealed that this special way of holding your infant has an extraordinary effect on preterm babies.
How do you “Kangaroo” an infant?
A baby is held in continuous skin to skin contact-as close to 24 hours a day as possible- with his mother. This is accomplished by placing the baby in the kangaroo position- a strictly upright position and stomach down (prone)- on the mother’s bare chest. Technology can be added on as needed. Exclusive breastfeeding is the ideal. The mother may recline in a chair with blanket draped over her chest or she may stand upright if sling or wrap is available.
Who should practice Kangaroo Mother Care?
- Preterm or low birth weight babies admitted to a neonatal intensive care unit or special care baby unit when medically stabilized. It is possible even if your baby is intubated.
- Well preterm and low birth weight babies.
- Full term, well babies.
- Babies who have been separated for some reason from their mothers to aid in maternal attachment
- Mothers and babies who wish to establish breastfeeding and maintain milk supply
Requirements for KMC
- A mother (works with fathers too)
- Supportive atmosphere
- A carrying cloth or stretchy baby wrap as an option
- A reclining chair if blanket is used
Benefits of Kangaroo Mother Care
- Mimics the environment of the womb - The baby has just been in a safe, enclosed, and warm environment. Wrapping a baby skin to skin mimics the familiar environment of the womb as the baby continues to receive touch, rhythm and pressure. (See research on exterogestation). Not only does the baby have a feeling of containment, but also the soothing and comforting sounds of his mother’s heart beat and breathing and rhythmic rocking that he was so accustomed to.
- Regulates body temperature - A mother has actual "thermal synchrony" with her infant. When a baby is placed in the kangaroo position, skin to skin with his mother, the temperature of the mother’s breasts actually change so that her baby can better maintain his own temperature. If the baby gets too cold the mother’s body temperature will actually warm up one degree to help warm the baby. If the baby gets too hot, the mother’s body temperature will decrease one degree to cool the baby. This even works when twins are kangarooed (Ludington-Hoe, 2004). Furthermore, the flexed position that the baby assumes on his mother's chest as opposed to lying on his back in an incubator is a more efficient position for conserving heat.
- Enhances lactation, the prevalence, and the duration of breast-feeding - With easy access to the breast mothers experience easier let down, increased milk supply (Furman,2002). Mothers are more likely to breastfeed exclusively and have more success with prolonged nursing. (Figueroa de Leon)
- Enhances immunological protection - If the mother is breastfeeding her baby, she will raise antibodies in response to all of the microbes that they come in contact with and transfer them to the baby (Lawn, 2010). Some antibodies can even be transferred skin to skin (Telemo,1996). Touch is so important to the healthy development of an infant that a lack of touch, or separation of mother and newborn, actually causes high amounts of the toxic stress hormone cortisol to be released. High levels of cortisol in the blood and separation from mother may negatively impact immune function as the body may stop producing leukocytes.
- Lessens crying - Babies, both preterm and full-term, cry less when placed in skin to skin contact with their mothers. Decreased crying means less stress and subsequently lower levels of cortisol.
- Enhances growth/weight gain - High cortisol levels that result from mother baby separation has a negative impact on growth hormone. With mother present to help assist in regulating the baby’s breathing, heart rate, and temperature, the baby has decreased energy needs and can conserve his energy and calories and direct it toward growth. (Charpak, 1997). In an upright prone position babies also regurgitate less (Ludington-Hoe, 1993)
- Leads to shorter hospital stays - Babies that are practicing Kangaroo Care can have up to a 50% shorter hospital stay than babies who are not “kangarooed”. (Charpak,1997)
- Provides a buffer against over-stimulation - In an upright prone position babies tolerate noise and activity around them much better (Ludington Hoe, 1993). A typical NICU is a very busy place
- Supports arousal regulation - When held skin to skin with their mothers babies spend more time in a quiet alert state. When carried in mother's arms the baby is in a safe place from which to view the world. It is from this safe known place that babies learn about the unknown. In a calm and alert state and in touch with mother, a baby is in the optimum state for observing and processing.
- Reduces apnea and uneven breathing - Kangaroo Care markedly decreases apnea episodes in preterm infants (Ludington,1998). When a baby is placed skin to skin on the chest of either parent there is usually an improvement in breathing patterns. The baby can hear the breathing and it stimulates the baby’s breathing so that the baby imitates the parent.(Ludington,1998)
- Stabilizes heart rate - Heart rate is actually more regular in babies under Kangaroo Mother Care (McCain, 2005). During KMC, bradycardia (low heart rate below 100) is markedly reduced and tachycardia (heart rates of 180or more) rarely occurs (Ludington-Hoe,1993). Babies’ cardio status stabilized faster after open heart surgery with Kangaroo Care (Gazollo, 2000). Heart rate is so important because baby’s brain requires a steady and consistent flow of blood to get the oxygen it needs to grow and perform properly.
- Relieves Stress Reactions - Babies deal with pain better and cry less in response to pain (for procedures such as heel sticks) while in Kangarooed (Kostandy, 2008).
- Improves neurobehavior - Preterm babies that were given many hours of KMC in the early weeks after birth, compared to those given little or no care, scored higher on mental and motor development tests in the first year of life (Charpak et al., 2005)
- Increases oxygenation of the baby’s body (Feldman, 2003).
- Assists in bonding process and builds attachment - increases maternal sensitivity, responsiveness and connectedness. (Dodd, 2005)
- Builds parent confidence and competence - Holding baby close reduces stress among parents and family (Feldman et al., 2002, 2003). Kangaroo Mother Care empowers parents as they feel that they can do something incredibly beneficial and positive for their preterm infants
- Helps parents play an active rather than passive role in their baby's recovery
- Provides longer periods of restful sleep - Kangaroo Care when carried out in a low light, quiet environment with any baby, full or preterm, helps babies to remain more calm and transition from one sleep state to another (Ferber, 2004). Preterm babies were found to have spent more time sleeping during Kangaroo Care (Messemer, 1997).
- Saves lives- The latest studies show a 51 percent reduction in newborn mortality when babies (stable and less than 2 kg) were kangarooed within the first week after birth and breastfed by their mothers.(Lawn,2010)
The Sleepy Wrap Baby Carrier and Kangaroo Mother Care
The Sleepy Wrap is a stretchy baby wrap carrier that frees the hands of parents carrying even the tiniest of babies. Top neonatal centers worldwide are advising Kangaroo Mother Care, yet in many NICU's no special shirts or equipment are used. Most often the parents are reclining on a chair skin to skin with their naked baby covered by nothing more than a blanket.
Wrapping mother and her preterm baby together with a Sleepy Wrap is not only practical, but it
- helps maintain the correct head and neck positioning of baby
- conforms perfectly and clings to the contours of baby's and mom's body
- offers just the right amount of elasticity providing a familiar womb-like feeling of confinement
- envelops the baby's entire body that is not in contact with mother so that heat is better conserved
- allows mother to move freely
- provides ultimate softness for such delicate baby skin
- may encourage parents to practice KMC for longer periods of time as parents are less apt to tire
The World Health Organization, Unicef, The March of Dimes, and the National Institute of Health all recommend the use of Kangaroo Mother Care and deem it a scientifically sound, low cost, and a high impact developmental intervention for both baby and mother.
New research by Dr Joy Lawn shows that Kangaroo Mother Care is one of the most powerful and effective ways to save preterm babies all over the world. Below are some of his statements.
“Acceptance of the KMC method is increasingly widespread and it is considered equivalent to conventional neonatal care for stable preterm infants and more parent and baby friendly”.
“It is evident that KMC has a substantial mortality effect compared with conventional neonatal care, and it is also evident that this mortality benefit is possible even at large scale”.
“No matter if babies are born in Lilongwe, London or Los Angeles, preterm babies need extra care to survive. Kangaroo Mother Care is low-cost and feasible, and we now have proof it is one of the most highly effective ways to give more babies the chance to survive and thrive.”
“There is no doubt this intervention can save lives — but the reality is that babies will continue to die unnecessarily unless we prioritize high-impact care (KMC)”.
References
Charpak, N.”Kangaroo mother care: 25 years after,”2005 Acta Paediatric, 94 (5), 514-522.
Feldman et al. “Testing a Family Intervention Hypothesis: The Contribution of Mother-Infant Skin-to-Skin contact (kangaroo care) to Family Interaction, Proximity, and Touch,” 2003 March Journal of Family Psychology. Vol 17, 94-107
Ferber et al., “The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial,” 2004 Pediatrics 113: 858-865
Furman, L. “Correlates of Lactation of Very Low Birth Weight Infants,” 2002 Pediatrics Vol. 109 (4) 57
Gazzolo, D. “Kangaroo Care Improves Post-Extubation Cardiorespiratory Paramaters in Infants After Open Heart Surgery,”2000, Acta Pedriatica, Vol 89 (6) 728-729
Kostandy et al. “Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results,”2008 Pain Manag Nurs. 9:55-65
Ludington-Hoe, S. “Breast Infant Temperature with Twins during shared Kangaroo Care,” 2006 Journal of Obstetric , Gynecologic and Neonatal Nursing, 35 (2) 223-231
Ludington-Hoe, S. Kangaroo Care: The Best You Can Do to Help Your Preterm Infant. Bantam Books, 1993, New York.
Lawn et al. “'Kangaroo Mother Care' to Prevent Neonatal Deaths Due to Preterm Birth complications,”.2010 April. International Journal of Epidemiology.
McCain, G et al. “Heart Rate Variability Responses of a Preterm Infant to Kangaroo Care,” 2005 Journal of Obstetrics, Gynecologic, and Neonatal Nursing,” 34 (6), 689-694.
Messmer P. et al., "Effect of Kangaroo Care on Sleep Time for Neonates," 1997 Pediatr. Nurs. 23, no. 4 408-414.
