KANGAROO MOTHER CARE POLICY
Millions of low birth weight (weight less than 2500gms) infants are born every year, mostly in undeveloped countries. The cause is either impaired preterm growth or premature birth. They commit to a high rate of the newborn death rate. In undeveloped countries, the rate of low birth weight babies is too high and modern technology is not present or there is the absence of skilled staff. Under such conditions, LBW infants are more prone to hospital-acquired infections, hypothermia. However, kangaroo mother care is easy and effective policy to compensate for hypothermia and to protect baby from nosocomial infections.
Kangaroo mother care is caring for premature babies include skin to skin contact with mother. It is an easy way to increase the well-being of premature babies. In terms of WHO, KMC is skin to skin contact includes breastfeeding, support for parents and early discharge from the hospital.
KANGAROO MOTHER CARE
KMC is defined as continuous skin to skin contact between newborn infant and his mother allowing exclusive and continual breastfeeding has been expected as a substitute for conventional care i.e. incubators for LBW infants. KMC is a strategy made by a team of paediatricians in Bogota, Columbia in 1979.Kangaroo care investigates to give repaired closeness of infant with family by placing the infant in direct skin to skin contact with one of the family member. This increases psychological and physical relationship and bonding. KMC for LBW infants is started in hospital after the infant condition is stable. Babies who require medical attention and are not stable can practice frequent and intermittent KMC.
Provides warmth to the baby by keeping skin contact with mother or family member
Provides nutrition to infant through breastfeeding
Develops the immune system of the newborn / parents are educated about the hygiene of baby
Fewer chances of hospital-acquired infections
Early discharge from the hospital.
1. PAIN CONTROL- kangaroo mother care reduces pain in the newborn during painful medical treatment and procedures.
2. REDUCTION IN HYPOTHERMIA- one of the commonest problems in infants is thermal regulation. Before birth, when the infant was in the womb, the baby didn’t need to regulate his body temperature but after birth, it is difficult for baby to maintain the temperature of his body. KMC helps baby to maintain normal body temperature by making skin contact with mother or family members.
3. HEALTHY WEIGHT- By frequent and exclusive breastfeeding, there will be an increase in the weight of infants. Hence fewer chances of LBW mortality. Plus when infants are warm by skin contact with mother or father, they don’t need their body energy to maintain temperature. This saved energy is then used in their body growth.
4. PROMOTES BREASTFEEDING- Skin contact between infant and mother initiates breastfeeding behaviour in infants. Infant starts to suckle on his own. Mothers who practice KMC are more likely to give exclusive breastfeeding to their children.
5. REDUCTION IN BABY’S STRESS- Skin contact reduces the level of stress in infants and promotes sleep. Increase level of oxytocin hormone stimulates parasympathetic nervous system which helps infants to feel stress-free and safe.
6. INCREASE BONDING WITH PARENTS- KMC increases the attachment and bonding of baby with parents. With KMC practice infant become more familiar with the voice of his parents and it also decreases the level of parental anxiety.
7. PRODUCTION OF MILK- when infant and mother are together, it increases lactation and also increases the level of the hormone that promotes the milk production in mother.
8. REDUCTION IN MORTALITY AND MORBIDITY- KMC builds up the immune system and help in gaining weight of the low birth weight infants, hence it reduces the chances of infant morbidity and mortality.
9. REDUCTION IN NOSOCOMIAL INFECTIONS- Parents are provided instructions regarding hygiene of the newly born, early signs of infections in the hospital which helps in reducing the hospital-acquired infections. Also, long stay in hospitals increase the risk of gaining infections, KMC practice promotes early discharge hence fewer chances of infections.
10. PREVENTS POSTPARTUM DEPRESSION- KMC also helps in preventing postpartum depression in mothers. Skin contact with infant reduces the level of depression and increase the production of oxytocin hormone which then reduces the level of maternal anxiety.
11. BUILD UP IMMUNE SYSTEM- KMC helps in building immune system of the infant. KMC promotes breastfeeding which develops immunity to fight against infections/sepsis.
THE CLINICAL EVIDENCE-
A meta-analysis study was conducted on kangaroo mother care and improvement in neonatal outcomes by ellen.O.Boundy. According to this study, among low birth weight infants, KMC compared to conventional care was linked with 36% lower death rate. KMC lowered the risk of neonatal infections, hypoglycaemia, hypothermia, readmissions to hospital and practice of KMC increased growth of infants, higher saturation of oxygen and promotion in exclusive breastfeeding.
According to an article, the effect of KMC on breastfeeding by neonatal health office, 62.5% mothers performed KMC while 37.5% in conventional care group. At the time of discharge, exclusive breastfeeding was more in KMC group. Receiving KMC and gestational age were only factors that increased exclusive breastfeeding. The results cleared that there was 4.1 times increase in breastfeeding in Kangaroo mother care group than conventional group.
An article by perinatology research branch studied the KMC to reduce morbidity and mortality in infants with low birth weight. The selection criteria include 3042 infants. At the time of discharge, KMC is identified with the powerful reduction in mortality risk (Risk Ratio RR-0.60), hospital-acquired infections (RR-0.35), low body temperature (RR-0.28). In addition, KMC was found to promote weight gain, exclusive breastfeeding, gain in head circumference and better mother-infant attachment.
Another study by the school of psychology suggested that there is a change in mother’s perception of her child. KMC creates the healthy climate in the family and makes parents more prone to caregiving. Long stay of the infant in hospital creates an isolation effect, while KMC practice promotes caregiving behaviour and bonding effect among parents. Kangaroo mother care develops a positive perception in mothers and reduces abandonment and chances of neglect and also helps in the mental development of the infants.
Mary Walters, director of Maternal child health Nursing in Colombus, told an incredible story of a mother. The mother gave birth to a baby. Within 24 hrs of delivery she underwent the total hysterectomy and came out on the ventilator and the prognosis was very poor. Her blood pressure was not stabilized and heart rate was too high. Her family was told about the condition that she would die. Mary took her newborn to her unconscious mother thinking that the infant needed to be with his mother during her last time. When the infant was placed in kangaroo care position, the mother moved her both arms. The baby was placed on the breast for two hours, when Mary was about to take the baby back to the nursery, the nurse showed Mary the BP and heart rate of the mother. The BP was stabilized and heart rate had reduced too. This nurse had seen these physiological improvements two times. The third incident confirmed that this was not by chance. The next day Mary again brings the infant to his mother for two times a day and 2-4 hours each time. Each time the unconscious mother moved both her arms up to enfold her baby. Mother’s vital signs kept on improving day by day, she weaned off from the ventilator and went home healthy with her baby. The nurses are charmed to see such improvements and want to gain more knowledge about kangaroo mother care. A mother recovered due to kangaroo care.
COMPONENTS OF KANGAROO MOTHER CARE-
1. Kangaroo position- Infant is placed in an upright position between the mother’s breasts. The kangaroo position (also known as skin to skin contact) is so called because much of baby skin is in direct contact with the skin of the mother. Infant’s head is turned to one side and body is secured with the binder. The head is slightly extended so as to keep airway intact. The arm of the infant is flexed and hips should be in a frog-like position. The baby abdomen shouldn’t be tied tight so that the infant get proper space for abdominal breathing.
2. Kangaroo nutrition- Babies with low birth weight requires frequent breastfeeding. KMC provides babies easy access to mother’s breasts. Leave the infant on the breast so that he can suck the breast. Make sure that infant is in a proper position. Tube feeding can also be given in kangaroo position. Proper position and attachment may increase suckling.
3. Kangaroo support- Psychological and physical support makes kangaroo care more effective. During the hospital stay, staff must provide support to mother and introduce kangaroo mother care. The medical and nursing staff should encourage and assist not only the mother but also other family members about KMC. The whole family should support the mother. Information regarding KMC should also be provided during the antenatal visits.
4. Kangaroo discharge- KMC leads to early discharge of mother and newborn from the hospital. KMC practice has several benefits for both baby and mother. The mother should practice KMC during the hospital stay, so that she can continue this practice at home. Predischarge planning is needed. The mother should be educated about immunization, signs of infections, hygiene of baby and follow up visits.
IMPLEMENTING THE POLICY-
1. Education about KMC- Mother and family members should be educated about KMC, its benefits, technique etc. People must be aware of this policy. According to some cultural beliefs, the baby should be placed on the back because they don’t know about the effectiveness of KMC.
2. Governmental support- KMC policy can be strengthened by the government and institutional support. Support can be either in terms of resource allocation or providing proper guidelines or documents so as to implement national KMC policy as a preference in the extension of newborn care.
3. Training the staff- Hospital and community centre staff must be trained and educated about the techniques and practice of KMC. Home visits services by community health worker can be done so as to encourage and to make rural people aware of this policy. Trainers lack knowledge, experience, and skills or have lack of clarity in order to improve this policy, in-service training should be given to medical staff so as to achieve the positive outcomes.
4. Integrating KMC with antenatal visits- To make this policy more efficient integrate KMC with antenatal check-ups. Training of mothers can be done prior so that they can understand the instructions and guidelines properly and they should be encouraged about follow up. In undeveloped countries, there is poor follow up of KMC because of poverty, long travel distance, inadequate health services.
5. Supervision- KMC registers, resources supervision is important. Lack of supervision may act as a barrier to implementing KMC policy. Supervision is backed due to long travel distances, lack of transport services, lack of staff, work overload etc.