Kangaroo mother care
A mother’s touch
Kangaroos are on to something. When they, and other marsupials, keep their live but relatively undeveloped young in their pouches (marsupium) their joeys are able to complete their postnatal development in the best possible place.
About four million babies die each year in the first week of life, according to the Lancet; replicating the protective and nourishing environment of a Kangaroo pouch, through Kangaroo Mother Care, could help 25% survive, says Dr Nils Bergman, a public health physician specialising in Kangaroo Mother Care (KMC) in South Africa.
“The very best environment for a baby to grow and thrive, is the mother's body,” says Dr Bergman. “When placed skin-to-skin on her mother’s chest, a baby receives warmth, protection and food, and its brain can develop optimally.”
What is Kangaroo Mother Care?
There are three components to KMC.
“Skin-to-skin contact should ideally start at birth, but is helpful at any time. It should be continuous day and night, but must be at least one hour to give benefit,” says Dr Bergman.
The next part of KMC is exclusive breastfeeding. That means that for an average mother, direct suckling by the baby from the breasts is all that is needed. For very premature babies, expressing milk and addition of some essential nutrients may be necessary.
Thirdly: support to the mother-child dyad means that whatever is needed for the medical, emotional, psychological and physical wellbeing of mother and baby is provided to them, without separating them. This might mean adding ultramodern equipment if available, or intense psychological support in contexts with no resources. It can even mean going home very early.
The power of touch
In the past, parents of premature babies were excluded from care directly after birth, including the neonatal ICU. Now, it’s known that separation causes harm to all babies – especially preterm infants. Recent science shows parents’ presence has a positive influence on brain development, says Jill Bergman, who has promoted KMC over 24 years. “We are realising more and more from neuroscience that the parent as central to the healthcare team is not just essential for survival, it ensures a good start to life,” she says.
Several essential processes begin directly after birth and are optimised when the baby stays in contact with the mother:
Regulation: The baby at birth is wide-awake for the first 60-90 minutes and expecting certain sensations. He hears mum’s familiar voice, feels her heartbeat, smells the familiar scent of her and her breastmilk. The baby feels safe and comforted by these sensory signs and so his body calms. Heart rate, breathing and oxygen saturation, blood pressure and temperature all stabilise far faster on mum than when they are separated. Baby has his basic needs for warmth, food and protection met.
Bonding and attachment: Baby’s brain also calms, and all of the expected sensations are collected and fire pathways in the brain. The baby will feel safe and open his eyes to make contact with his mother. This is the start of early bonding, and emotional and social intelligence. As continued contact and breastfeeding continues, a secure attachment is formed, which is the basis of all future physical and psychological health.
Breastfeeding: “A baby in the right place is very competent!” says Jill Bergman. A proper latch ensures adequate nutrition, and stimulation of all of the essential hormones. The mother’s chest will warm automatically if her baby is cold, and even cool baby if too warm.
Sleep: During quiet sleep all of these sensations collected will fire and wire circuits to the emotional brain (amygdala), be organised and sent back to the cortex when he wakes again, thus completing the brain circuits for healthy development. Sleep should not be disturbed.
Don’t cry for me
If a baby is separated from her mother early on, all those essential processes are disturbed and a stress response is created. When the baby cries, his heart rate and blood pressure goes up, and oxygen levels go down. The baby crying uses up more calories so is more likely to become hypoglycaemic; these calories are better used for growth.
“High levels of stress hormones for long periods of time are toxic to the neurons that make the brain work. The stress hormone cortisol makes more neurons die off at a faster rate. This disrupts and disturbs developing pathways and circuits. With prolonged stress after birth, the brain is measurably smaller one year later. The only difference between toxic and tolerable stress is the absence or presence of mother or father,” says Jill.
KMC babies benefit from better brain and emotional development, less stress, less crying, fewer brain bleeds, more settled sleep. They are more alert when awake and feel less pain from injections, the heart rate stabilises, more breast milk is produced and babies gain weight faster. Ultimately babies can go home earlier when they have done KMC and have better brain and emotional development.
How to do KMC
Your baby only needs a nappy and cap. Put her on your bare skin – starting at birth – facing you, inside your shirt. Sit in a chair with cushions so you can be at a 30-40 degree angle to help baby’s breathing. Tuck her legs up in the foetal position. Put her hands near her face for self-soothing. Cover her and yourself. Your body will automatically warm up if your baby is cold or will cool down if your baby is hot. Relax, knowing that your body is the best place for her.
To do this for long periods with a small or premature baby, safe technique requires that the airway is secured, and the baby firmly wrapped against parent’s chest. In this way baby and parents can both sleep. When awake and feeding, the wrapper is loosened, allowing eye contact, and access to the breast.
For more details see the book “Hold Your Prem” by the Bergmans and www.kangaroomothercare.com (Read more: Being born Premature)
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