3                                                 Principles of                                                 Kangaroo  ...
PRINCIPLES OF K ANGAROO MOTHER CARE          413-2 Where did Kangaroo Mother Care start?                3-4 What are the c...
42   MOTHER AND BABY FRIENDLY CARE  NOTE Before KMC was introduced, it was believed   and staffing can be reduced. Mothers...
PRINCIPLES OF K ANGAROO MOTHER CARE              43  Twenty million LBW are born worldwide annually.    women giving KMC, ...
44    MOTHER AND BABY FRIENDLY CAREKMC moves the mother back into the position              in this method. Mothers should...
PRINCIPLES OF K ANGAROO MOTHER CARE         45incubator, which makes a constant sound and           3-20 Why does Kangaroo...
46    MOTHER AND BABY FRIENDLY CARE3-22 How can Kangaroo Mother Care save                1. In hospitals where no faciliti...
PRINCIPLES OF K ANGAROO MOTHER CARE        47   of reassurance from family, friends and          3-29 Is it safe to use Ka...
48   MOTHER AND BABY FRIENDLY CAREminutes to a few hours at a time. Even if the       mothers support and learn from each ...
PRINCIPLES OF K ANGAROO MOTHER CARE         49                                                  when the mother goes to th...
50   MOTHER AND BABY FRIENDLY CAREof infection in the infant. It is also cheaper      1. Would it be safe for her to take ...
PRINCIPLES OF K ANGAROO MOTHER CARE        51with the infant, a nurse or member of the             from the kangaroo posit...
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Mother and Baby Friendly Care: Principles of kangaroo mother care

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Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.

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Mother and Baby Friendly Care: Principles of kangaroo mother care

  1. 1. 3 Principles of Kangaroo Mother Care body temperature to keep her infant warm. Objectives Kangaroo Mother Care (KMC) is particularly useful for nursing low birth weight infants (infants with a birth weight below 2500 g). When you have completed this unit you KMC provides the infant with the basic needs should be able to: for survival, i.e. mother’s warmth, stimulation, • Describe Kangaroo Mother Care. breast milk, love and protection. As 20 million • Give the history of Kangaroo Mother Care. low birth weight (LBW) infants are born each year worldwide, KMC has become a very • List the components of Kangaroo important way of caring for these high risk Mother Care. infants. Unfortunately, attempts to lower the • Give the advantages of Kangaroo prevalence of low birth weight infants in poor Mother Care. countries has not been successful. • Explain why Kangaroo Mother Care NOTE KMC reminds one of the way mother is particularly important for low birth kangaroos (and other marsupials) care for and weight infants. keep their infants warm in a special pouch. The mother kangaroo carries her infant against her • Explain the safety of Kangaroo Mother body both day and night. While in the pouch, Care. the infant is warm, protected and able to suckle whenever it wants. The word ‘mother’ was added to kangaroo mother care to emphasise the importance ofINTRODUCTION TO the mother and her breast milk. As the wordKANGAROO MOTHER CARE ‘kangaroo’ is foreign to many people in South Africa, it may be preferable to talk about skin- to-skin care instead. The Zulu word ‘ukugona’3-1 What is Kangaroo Mother Care? (to hold or cuddle) has also been suggested.Kangaroo Mother Care (or skin-to-skin care),is a simple, easy method of caring for newborninfants where the mother uses her own
  2. 2. PRINCIPLES OF K ANGAROO MOTHER CARE 413-2 Where did Kangaroo Mother Care start? 3-4 What are the components of Kangaroo Mother Care?The idea of nursing an infant skin-to-skinagainst the mother’s bare breasts is not new KMC consists of four components:and has probably been used for thousands of 1. Kangaroo position (skin to skin contact)years. However, the idea was made popular 2. Kangaroo nutritionin modern times by health care workers in 3. Kangaroo supportBogotá, the capital of Colombia in South 4. Kangaroo dischargeAmerica. From here it has been introducedinto many developed and developing countries. 3-5 What is the kangaroo position? NOTE Doctors Rey and Martinez first started KMC in Bogotá, Colombia during 1979 in response Usually the infant is placed in an upright to a crisis with the large number of low birth position against the mother’s bare chest and weight infants, a shortage of staff and facilities, between her breasts. The infant is kept naked overcrowded nurseries and a high mortality from except for a nappy, socks and woollen cap. hospital infection. Both mother and infant are usually covered by a blanket or shirt. The kangaroo position3-3 Why is Kangaroo Mother Care natural? is also called skin-to-skin contact, as much ofMany animals give birth to young who are the infant’s skin is in direct contact with thenot immediately able to run and follow their mother’s skin.mother. They have to be carried by the mother NOTE The kangaroo position is regarded as theor hidden away while she looks for food optimal habitat or place for newborn infants.and water. Humans and other primates (e.g. In this place infants exhibit specific non-stressmonkeys and baboons) carry their newborn behaviour patterns such as ‘crawling’ towards the nipple and ‘self attachment’.infants, either in their arms or against theirbodies. The infant is emotionally and physicallyprogrammed to remain constantly with the The kangaroo position is also known as skin-to-mother. As these infants are relatively immature skin contact.when they are born, they need constant carefor some time after delivery. In this positionthe infant grows and develops rapidly. KMC is 3-6 What is kangaroo nutrition?therefore a ‘natural’ way of nursing a humaninfant. Many women want to keep their infants Exclusively breast feeding on demand. Withclose to them. Using their own bodies to keep KMC, most infants are either breast fed or fedtheir infant warm gives many mothers a sense expressed breast milk by cup or nasogastricof satisfaction and pleasure. tube. Most small infants should be fed every two hours. One of the benefits of KMC is NOTE In hunter-gatherer societies and most non- that these infants have easy access to their western cultures, mothers demonstrated the mother’s breasts. ‘carry’ pattern of infant care. The infant is always with the mother and breastfeeds frequently. In contrast, many animals such as small antelope 3-7 What is the advantage of kangaroo and hares, demonstrate the‘nesting’ pattern nutrition? of care, where the infants are hidden while the mother searches for food. In the artificial With KMC, successful breast feeding is environment of western society, this latter pattern common and most infants are discharged of infant care has become common. Infants home on breast feeds. The duration of breast are often left alone to sleep in a cot or pram. feeding is also much longer. With KMC, many Many believe it is not the best pattern of caring infants as immature as 30 weeks can begin for a human infant. KMC is a return to a natural breast feeding. KMC increases the volume of method and often preferable to incubator care. milk that a mother produces.
  3. 3. 42 MOTHER AND BABY FRIENDLY CARE NOTE Before KMC was introduced, it was believed and staffing can be reduced. Mothers can get that infants had to reach about 35 weeks home to their families sooner. However, with gestation before they could suck and swallow early discharge (kangaroo discharge), adequate adequately. However, with KMC it was noticed follow-up care and support are essential. that many much more immature infants could be partially or completely breast fed. Predischarge planning is important. Each mother should practice KMC while her infant is still in hospital. She should also Successful breastfeeding is promoted by make arrangements for her return home and kangaroo mother care. emotionally prepare herself for KMC after discharge. The family must be told that the infant will be receiving KMC at home.3-8 What is kangaroo support?This is the physical and emotional support Low birth weight infants can be discharged homewhich is given when KMC is practiced. earlier with Kangaroo Mother Care.1. Support must be given by the nursing and medical staff to the mother to assist and encourage her to provide KMC. 3-10 Why is Kangaroo Mother Care so2. The whole family should be informed important for low birth weight infants? about KMC. They may also need to be KMC is particularly important when caring supported by the staff. In turn, the family for low birth weight (LBW) infants in should support the mother. The role poor countries where there is often a high of the father or partner is important in mortality rate in hospitals which cannot supporting the mother. The support of the offer sophisticated care. These small infants mother-in-law is also helpful. often die of hypothermia (cold) or infection.3. The mother’s own mother has a very Studies have shown that the number of low important role to play in helping her to birth weight infants dying in hospitals without give KMC. incubators can be dramatically reduced if KMC4. The community should also be told about is introduced. Even in industrialised countries, the advantages of KMC. A supportive the mortality rates can be reduced with KMC. attitude by the community helps the mother to succeed with KMC. Conventional incubator care for low birth5. When introducing KMC into a hospital or weight infants is often problematic in poor clinic, the staff often also need support. countries. Not only are there not enough incubators, but they are expensive, often notWithout support, it is difficult to get mothers used correctly, are broken and cannot beto give KMC successfully. Pregnant women repaired. They are not cleaned properly andshould be informed and educated about KMC the power supply is often unreliable.from their first antenatal visit.3-9 What is kangaroo discharge? Kangaroo Mother Care has reduced the mortalityWith kangaroo discharge, the mother leaves rate of small infants.the hospital with her infant in the kangarooposition and continues to provide KMC at NOTE Infants who are delivered before term often die as a result of being born too soon.home. This practice has many advantages both With KMC, a mother is able to give her infant theto the mother and her infant. Most low birth protection, warmth and nutrition that she wouldweight infants can be discharged home earlier have given if the pregnancy had continued andif KMC is used. By reducing the time that these the infant was still a fetus. With KMC, the mothersmall infants stay in hospital, hospital costs can complete the ‘gestation’ outside the uterus.
  4. 4. PRINCIPLES OF K ANGAROO MOTHER CARE 43 Twenty million LBW are born worldwide annually. women giving KMC, should learn how to Of these 96% are born in poor countries where express breast milk. only 1% of the world’s incubators are available.3-11 Can Kangaroo Mother Care be used Kangaroo Mother Care should be started as soonfor all infants? as possible after birth.KMC can be used in the majority of infants, NOTE A recent study has shown that very smallwhether they are born in hospital, a clinic or infants who cry well at birth and do not haveat home. While KMC is most important in low respiratory distress experience fewer problemsbirth weight infants, infants of normal weight during the first few hours of life if they are givenand gestational age can also benefit from KMC rather than standard incubator care.KMC, especially in cold conditions.While the principles of providing KMCare important, the details are not fixed and ADVANTAGES OFinflexible. The technique varies slightly KANGAROO MOTHER CAREbetween different countries and services.Mothers are also individuals who havetheir own ideas and preferences. The dress 3-13 What are the advantages of kangarooand customs in different communities mother care?also influences how KMC is given. What There are many advantages of KMC to:is important is for the whole community,but especially women, to understand the 1. Mothers:advantages of KMC and to support other • The mother’s confidence and bondingwomen who are giving their infants KMC. is encouraged. They feel less stressed. • Mothers are empowered to play anDuring antenatal care visits women should be active role in their infant’s care.told about KMC and allowed to decide whether • Breast feeding is promoted.they would like to give KMC to their infant. • Less neglect and abandonment. 2. Fathers:3-12 When should kangaroo mother care • Fathers are able to play a far greater rolebe started? in the care of their infants.If both mother and infant are well enough, • It improves bonding between fathersKMC should be started immediately after and infants, which is particularlybirth once the infant is dried, examined and important in countries with high ratesthe cord cut. Many low birth weight infants of violence towards children.can be given KMC from birth. Normal infants 3. Infants:can also be given KMC for the first few hours • Most low birth weight infants can beafter delivery to promote bonding, encourage kept warm and stable with KMC.breastfeeding and prevent hypothermia. • Infants grow faster.Infants who are ill at birth should receive • Serious infection is less common in theKMC once they have recovered and their infant.clinical condition is stable. While a small • Less apnoea (stopping breathing).infant is still unstable and being nursed in an 4. Health care providers:incubator, the mother should be taught how • Fewer staff and less equipment areto express her breasts so that the infant can needed in hospital nurseries.be given breast milk as soon as possible. All • Infants can be discharged home earlier.women who choose to breastfeed, especially • It is cheaper.
  5. 5. 44 MOTHER AND BABY FRIENDLY CAREKMC moves the mother back into the position in this method. Mothers should be taughtwhere she can play a meaningful role in the what danger signs to look for (e.g. breathingcare of her infant. KMC also enables her to difficulties or cyanosis).choose breast feeding above formula feeding. NOTE Many scientific studies have demonstrated that almost all measurements of wellbeing are3-14 What are the disadvantages of better in infants receiving KMC when comparedseparating mother and infant after birth? to infants nursed under overhead radiant heaters or in closed incubators. The infant’s skin and coreKMC keeps the mother and infant together. temperatures remain within the physiologicalIf the infant is separated from its mother, it range with KMC. Survival rates are the same forbecomes stressed. This may be harmful. Only infants receiving KMC or conventional incubatorin modern times have women in western care once they are stabilised..traditions been separated from their newborn Very small infants, sick infants and infants withinfants who have been nursed alone in complications are best cared for in incubatorsincubators or cots in hospital. This is the price where they can be closely monitored andthat is often paid when small infants have to treated. Once they are stable with normal vitalbe moved to an intensive care unit. At home, signs and no major complications, they can bemany infants are again separated from their considered for KMC.mothers when they are placed in cots, often inanother room. 3-16 How does Kangaroo Mother Care keep NOTE Both human infants and young animals the infant warm? that are separated from their mothers after birth display the features of protest and despair. When The temperature of the skin over the mother’s prolonged, this stress response has been shown breasts warms the infant’s naked skin. This to be harmful. Many people believe this to be a is a very effective way of both keeping an cause of behavioural disorders. In contrast, infants infant warm and of warming a cold infant. If receiving KMC exhibit a ‘vagal response’ which the infant is cold the mother’s skin becomes promotes growth and development and speeds warmer. When the infant becomes too hot, up the adjustment from an intra-uterine to an the mother’s skin cools down. In this way, the extra-uterine existence. The mother and infant pair is often referred to as a ‘dyad’ to emphasise temperature of the infant receiving KMC is that they should be kept together. kept in a very narrow range (often with better control than an infant in a servocontrolled incubator). A woollen cap helps to keep the Mothers and their infants should be kept infant warm during KMC. In cold weather together. the infant can wear a cotton jacket which is open in front. NOTE The temperature of an infant receiving3-15 Is Kangaroo Mother Care safe? KMC is slightly higher than that of an infantYes. Most small infants can be safely and in an incubator. With KMC, the mother’s skinefficiently nursed with KMC once their clinical temperature may rise as much as 2° C to keep thecondition is stable. Many scientific studies on infant warm.human and animal infants have shown thatKMC can be as safe as conventional incubator 3-17 How does Kangaroo Mother Carecare for stable, small infants. The infant is kept reduce the risk of apnoea and bradycardia?warm, heart and respiratory rates are normal, It is probably the constant temperature togetherthere is less apnoea and bradycardia (slow with the mother’s movement, breathing andheart rate) and fewer episodes of cyanosis heart sounds that stimulate the infant and(turning blue). It is important that KMC is reduce apnoea and bradycardia. This is verydemonstrated and supervised by staff trained different to the infant in a conventional closed
  6. 6. PRINCIPLES OF K ANGAROO MOTHER CARE 45incubator, which makes a constant sound and 3-20 Why does Kangaroo Mother Caredoes not move. Infants in incubators cry more improve a mother’s confidence?and then sleep deeply from exhaustion. Infants By having her infant with her all the time, anursed by KMC also require less oxygen and mother giving KMC becomes both confidenthave better oxygen saturation in their blood. and competent in the way she handles herThey also sleep for longer. infant. Mothers prefer KMC as they feel NOTE Studies have confirmed that the number more satisfied, relaxed and fulfilled by the of apnoea and bradycardia spells is less with experience. Mothers feel less anxious if their KMC while the oxygen saturation and oxygen infant is with them. consumption are improved. Infants also have more quiet sleep with KMC. They sleep for longer Most women feel relaxed and happy giving but not so deeply. KMC and do not find it stressful and exhausting. However, they need the support of3-18 How is breastfeeding promoted by the hospital staff and their families.Kangaroo Mother Care? NOTEKMC helps to restore a mother’s self esteem,Many studies have confirmed that more which is often low after delivering a low birth weight infant.women successfully breast feed for longer withKMC. Breast milk production is also betterand more infants are discharged home fully 3-21 Why do infants receiving Kangaroobreast fed if KMC is practiced. KMC promotes Mother Care have fewer infections?a feeling of well-being in the mother as she Low birth weight infants, cared for incan see and touch her infant all the time. This incubators or cots in a newborn nursery, are atstimulates milk production and helps with high risk of becoming colonised and infectedthe let-down reflex. KMC is a very important by hospital bacteria which have becomebenefit in many poor communities where resistant to many antibiotics. In contrast,breast feeding reduces the risk of infant death. infants being given KMC tend to becomeIt is important that the opportunity to feed is colonised with the mother’s own skin bacteria.available continuously day and night. As the cells and antibodies in a woman’s breast NOTE The secretion of both prolactin and oxytocin milk are produced in response to her own is inhibited when a mother is anxious, unhappy, bacteria, a mother’s breast milk is specifically worried and separated from her infant. protective against those bacteria, which colonise her infant (‘designer milk’). A number3-19 Do mothers have to breast feed if they of studies have shown that infants receivinggive Kangaroo Mother Care? KMC have fewer serious infections, such as necrotising enterocolitis, than other infantsNo. If for some good reason the mother is who do not receive KMC. This is one of theunable to breast feed, or is advised not to main benefits of using KMC to care for smallbreast feed, the kangaroo position can still infants in both poor and wealthy countries.be used. Some very small infants are fed Therefore, KMC and breast milk act togetherexpressed breast milk by nasogastric tube to reduce infections.or cup while receiving KMC. Mothers canalso give formula feeds while using the KMCposition. If the infant is formula fed, the Low birth weight infants receiving Kangarooformula should preferably be given by cup Mother Care have fewer serious infections.rather than by bottle. Kangaroo nutrition(exclusive breast feeding) is, therefore,desirable but not essential for KMC.
  7. 7. 46 MOTHER AND BABY FRIENDLY CARE3-22 How can Kangaroo Mother Care save 1. In hospitals where no facilities are availablemoney? to look after low birth weight infants. Here KMC is the only alternative if there is a1. Breast feeding saves the cost of buying lack of incubators and nurses. formula. 2. In hospitals where staffing and facilities2. Fewer nurses are needed as the mother are good but limited and not sufficient to provides most of the care to her infant. care for all the low birth weight infants.3. Less hospital equipment, such as KMC is then used instead of conventional incubators, are required. incubator care.4. With less infection, fewer infants have to 3. In hospitals with good and adequate be admitted for intensive or special care. staffing and facilities. Here KMC is used5. Small infants can be discharged home to promote bonding between mother sooner. and infant, reduce the risk of infection, promote breast feeding and shorten3-23 When can infants receiving Kangaroo hospital stay.Mother Care be discharged home? The survival rate of low birth weight infantsInfants receiving KMC can be discharged given KMC is the same as that whenhome (kangaroo discharge) when all the conventional incubator care is provided.following criteria are met:1. They are healthy and gaining weight (at 3-25 Can the father also give Kangaroo least 20 g per day). Mother Care?2. They are breast feeding or cup feeding well. Yes. It is very important that the father also3. The mother is confident and able to becomes involved in the care of the infant. manage her infant. This helps build a bond between the father4. Good follow-up care is arranged. and infant, and also helps the father supportWeight and gestational age need not be used the mother in caring for their infant. Inas strict criteria for KMC discharge. The communities with a high rate of child abuse,maturity of the infant is more important, KMC promises to improve the relationshipi.e. feeding well. The weight at which most between men and their children. This simpleinfants receiving KMC are discharged home intervention may also improve the relationshipvaries from one hospital to another. With between men and women in society.KMC, infants can be discharged home much Other family members, such as a sister or theearlier than with conventional care. With early grandmother, may also play an important roledischarge from hospital, it is important that in giving KMC. They can give the mother athese infants are seen frequently at a follow up break to visit the bathroom or have some timeclinic for the first few weeks. for herself. NOTE With the use of KMC, many hospitals discharge their infants when their weight reaches 3-26 How is kangaroo support provided? between 1500 and 1700 g. These infants should be gaiingn at least 15 g/kg/day. After the birth of an infant, the mother needs support in many different ways. KMC3-24 When is Kangaroo Mother Care for low empowers the mother to meet all her infant’sbirth weight infants useful in hospitals? needs. However, she in turn needs help:There are three circumstances when KMC 1. Emotional support: The mother needsis particularly useful in the care of low birth encouragement if she is to give KMCweight infants in hospital: successfully. Many young mothers with their first infant need an enormous amount
  8. 8. PRINCIPLES OF K ANGAROO MOTHER CARE 47 of reassurance from family, friends and 3-29 Is it safe to use Kangaroo Mother Care health professionals. KMC empowers to warm up cold infants? mothers to meet all their infants’ needs. KMC is a very effective and safe method of2. Physical support: During the first few warming infants with hypothermia (axillary weeks of KMC, nursing the infant takes temperature below 36.5° C). If an overhead up most of the mother’s time. Adequate heater or closed incubator is not available, rest and sleep are essential. Therefore, she KMC is the best method of warming cold needs support with household chores and infants. KMC has been shown to warm cold managing the family. infants better than an incubator.3. Educational support: It is important to give the mother the information she needs to understand the whole process of KMC and 3-30 Should Kangaroo Mother Care be accept that KMC is important. She needs used in extremely small infants? to be made aware of the many advantages Infants that are extremely preterm and are of KMC. This makes the KMC experience not viable can also be given KMC. This more meaningful and increases the chances ‘compassionate care’ of infants too small to that she will give KMC successfully both in survive is far better than simply leaving the hospital and after discharge. infant to die in the labour ward or nursery. It helps the mother psychologically to come to3-27 Why has Kangaroo Mother Care only terms with her bereavement.been introduced recently?Because health professionals believed that 3-31 What are the two types of Kangarooinfants would develop problems, such as Mother Care?hypothermia, and apnoea, if they were taken KMC can be given to small infants in twoout of the incubator too soon. Infection was different ways:also seen as a great risk if the mother handledher infant. Mothers were not viewed as capable 1. Intermittent KMC: This type of KMC isof looking after a low birth weight infant. not given all the time but only when aHowever, there are many reports of individual mother visits her infant who is still beinginfants surviving with KMC after they had nursed in an incubator.been refused standard incubator care because 2. Continuous KMC: With continuous KMC,they were thought to be too small to survive. the mother provides KMC all the time, both day and night.3-28 Can Kangaroo Mother Care be usedfor transporting infants? 3-32 When is intermittent kangaroo care used?Yes. KMC is very useful in transporting smallinfant between clinics and hospital, especially It is usually given to very small infants whoif a transport incubator is not available. If the are well but still need to spend most of themother is not available, the ambulance staff time in an incubator. During her visit in thecan give KMC themselves. nursery, the mother takes the infant out of the incubator and places the infant in the kangaroo position while she sits beside the Kangaroo Mother Care is a safe and effective incubator. This enables her to play an active method of transporting infants. part in the care of her infant while the infant is still in the nursery. Intermittent KMC can range from many hours per day to only once every few days. The length of time an infant spends in KMC can also vary from a few
  9. 9. 48 MOTHER AND BABY FRIENDLY CAREminutes to a few hours at a time. Even if the mothers support and learn from each other. Amother only gives KMC for 10 minutes during well managed KMC ward is of great benefit toa visit, it is beneficial to her infant. Not only a newborn nursery. A KMC ward provides adoes this increase the infant’s weight gain but wonderful opportunity to also teach mothersit also promotes breast feeding. Intermittent about primary health care (immunisation,KMC allows the mother to learn and practice family planning, good nutrition).how to give KMC, which will help when theincubator is no longer needed and the infant 3-35 Can infants receiving intensive care beis big enough for continuous KMC. It is given Kangaroo Mother Care?important that nurses teach mothers how toprovide KMC correctly. As soon as infants are stable and no longer very ill, they can be given intermittent KMC, provided that they are monitored. Even Intermittent Kangaroo Mother Care in the infants receiving ventilation can sometimes be nursery has many advantages for both mother given intermittent KMC. Many stable infant and infant. receiving headbox oxygen can be safely placed in the KMC position and given oxygen by face mask or nasal cannulas.3-33 When is continuous Kangaroo MotherCare used? 3-36 Can infants be given Kangaroo MotherIt is usually used with low birth weight Care at home?infants who are ready to be taken out of the Yes. When small infants leave hospital, theyincubator permanently. Some infants are should continue to receive KMC at homeonly given continuous KMC when they are (home, ambulatory or domiciliary KMC) untilalmost ready to be discharged home while they weigh at least 2000g. Intermittent KMCsome mothers provide KMC to their infants in the intensive care and high care nursery,for many weeks before discharge. It is best followed by continuous KMC in the KMCgiven in a KMC ward but can also be used ward, and finally KMC at home is an ongoingin a general postnatal ward. Mothers usually process. Many small infants born at home orhave experience from giving intermittent in a clinic will thrive and survive with homeKMC before their start providing continuous KMC. Infants receiving KMC at home must beKMC. This form of KMC should always be seen frequently at the local clinic to check thatused for a small infant where there is no they are healthy and gaining weight. Clinicsincubator available. Continuous KMC can should have a KMC room where mothers canalso be practiced at home after small infants give KMC and breastfeed their infants.are discharged from hospital. In nurserieswith very little equipment, even the smallest 3-37 Should mothers with HIV infectionof infants receiving nasogastric tube feeds and give Kangaroo Mother Care?oxygen can be given continuous KMC. Yes. KMC is particularly important in theseIntermittent KMC should be followed by women, even if they decide not to breast feed.continuous KMC as soon as possible. They can nurse their infant in the kangaroo position and give formula feeds by cup. KMC3-34 What is a Kangaroo Mother Care ward? has many benefits to HIV exposed infants whoThis is a special ward where mothers and their are often low birth weight and at increasedinfants are kept together so that KMC can be risk of bacterial infections. Many HIVgiven all the time. Although supervised by the positive women in rural areas may choose tonursing staff, the mothers take responsibility exclusively breast feed their infants.for all their infant’s care. In a KMC ward,
  10. 10. PRINCIPLES OF K ANGAROO MOTHER CARE 49 when the mother goes to the bathroom or Kangaroo Mother Care can be used safely in HIV wants a little time alone. KMC promotes positive mothers. bonding between a father and his infant and should improve the later emotional relationship between a father and his child.CASE STUDY 1 5. When should KMC be started?During the antenatal period, a woman arranges It is best to start KMC immediately afterto deliver in a primary care clinic where the infant is born. Once the infant is dried,Kangaroo Mother Care (KMC) is encouraged. examined, and the cord is cut, it can be givenHer husband agrees with her choice and says to the mother to start KMC. Most healthythat he also wants to help by giving KMC. infants can be given KMC even if they are small at birth.1. What is KMC? 6. Which infants benefit most from KMC?KMC, or Kangaroo Mother Care, is a methodof caring for an infant where the mother Low birth weight infants, who would otherwisenurses her infant against her bare breasts. have to be separated from their mother to beThe infant, who usually only wears a woollen cared for in an incubator or crib in a nursery.cap and a nappy, is kept upright, often with This is particularly important in poor countriesa towel, piece of cloth or binder. The mother where incubators may not be available.wears a dress or shirt over the infant. This isknown as the KMC position. CASE STUDY 22. What is KMC nutrition?Most infants who are nursed in the KMC A young, primiparous woman delivers aposition are breast fed. However, expressed healthy, active 36 week infant weighing 1800 g.breast milk can also be given by cup or The infant has good Apgar scores with nonasogastric tube during KMC. Breast feeding is clinical problems. When the mothers asks toan important part of KMC and is referred to as keep the infant with her and nurse the infantKMC nutrition. However, a mother can still use in the KMC position, the staff tell her thatthe KMC position if she wants to formula feed the infant is too small and must spend therather than breast feed. This is important in first 12 hours in an incubator. The mother issome mothers who are HIV positive and have transferred to the postnatal ward and does notchosen to formula feed. If formula is given, a see her infant until the following day.cup rather than a bottle should be used. 1. Do you agree with the decision of the3. What is KMC support? staff to place the infant in an incubator?This is the help, encouragement and support No. There appears to be no reason why theprovided to a mother by the father, family mother and infant should be separated andand community. This physical and emotional why she cannot give KMC to her infant.support helps a mother to successfully giveKMC. 2. What are the advantages of this infant staying with its mother?4. How can the father also give KMC? Remaining with the mother from birthThe father and other members of the family promotes bonding, increases the chances ofor a friend can also give KMC. This is helpful successful breast feeding and reduces the risk
  11. 11. 50 MOTHER AND BABY FRIENDLY CAREof infection in the infant. It is also cheaper 1. Would it be safe for her to take the infantas extra staff and equipment are not needed. out of the incubator and give it KMC?In addition, infants getting KMC can be Most well preterm infants who still needdischarged home sooner. incubator care can be taken out of the incubator and given KMC during the time3. Is it not safer to observe this infant in an that the mother visits. This is known asincubator in the nursery for a few hours? intermittent KMC.No. With KMC the infant can be kept warmand breast feeding can be started. As this infant 2. What are the benefits of intermittentis healthy and active, there is no danger in KMC?giving KMC. The infant should only be moved It promotes bonding and breast feeding andinto an incubator if there are abnormal signs usually results in faster weight gain by thesuch as cyanosis, respiratory distress or apnoea. infant. Intermittent KMC allows the mother toHealthy, active infants should be given KMC. play an active part in caring for her infant and helps to reduce the risk of infection.4. Why is KMC a more natural method ofcaring for a newborn infant? 3. Is it safe to give KMC in cold weather?Most primates carry their infants against their KMC is a very effective method of keeping anbodies after birth. Similarly, many human infant warm. If the infant’s skin temperaturemothers feel a great desire to keep their drops, the mother’s skin temperature increasesinfants with them. Using their own bodies to to keep the infant warm.keep their infant warm, gives mothers a senseof satisfaction and pleasure. Many mothersfeel this is the normal and natural way to care 4. What is continuous KMC?for their infant. Once an infant no longer needs to spend part of the time in an incubator, it can be given5. Why do infants receiving KMC have fewer continuous KMC day and night. Continuousserious infections? KMC is usually given in a KMC ward in the hospital until the mother and infant areBecause they are colonised with their mother’s discharged.bacteria rather than the dangerous bacteriaoften found in nurseries. Breast feeding alsoreduces the risk of infections. Therefore, KMC 5. When can infants receiving KMC inand the use of breast milk act together to hospital be discharged home?prevent serious infections. Once they are healthy and gaining weight, breast or cup feeding well, the mother is confident and able to manage her infant,CASE STUDY 3 and follow up care is arranged. Weight and gestational are less important as criteria forA mother visits her small, preterm infant who discharging KMC infants home from hospital.is nursed in an incubator. The infant weighsonly 1200 g but is otherwise well and active. 6. Can KMC be safely used to transportShe sits beside the incubator and spends hours small infants?looking at and talking to her infant. Many small infants who are clinically well can be safely transported with KMC. This is especially useful when a transport incubator is not available. If the mother is not able to travel
  12. 12. PRINCIPLES OF K ANGAROO MOTHER CARE 51with the infant, a nurse or member of the from the kangaroo position, support andambulance crew can give KMC. discharge even if she decides not to breast feed her infant.CASE STUDY 4 3. Do you agree with the management of this infant?An HIV positive women delivers a healthy No, as there is no indication to isolate theinfant weighing 2300 g at term. She has read infant even if the mother does not breast feed.about kangaroo mother care and is keen to try The question of feeding choices should havebut the nursing staff tell her that it is dangerous been discussed and decided upon duringas she may transmit HIV to her infant, pregnancy. Some HIV infected mothers mayespecially if she breast feeds. Therefore the choose to exclusively breast feed.infant is taken away from her after delivery andsent to an isolation nursery for formula feeding. 4. When should women be informed about the benefits of kangaroo mother care?1. Is it dangerous for this mother to holdher infant in the kangaroo position after This should be an important part of antenatalbirth? education.No. The mother and infant should not have 5. Are there problems with the termbeen separated. Using the kangaroo position kangaroo mother care?immediately after delivery is important as itpromotes bonding. HIV cannot be transmitted Although KMC is widely used some peopleby skin-to-skin contact between a mother and would rather talk about skin-to-skin care.her infant. This however promotes the position and not the benefits of good nutrition, the emotional,2. Can KMC be used even if the mother physical and educational support and thedoes not breast feed? early discharge.Yes. Although there are four components toKMC, the infant and mother can still benefit

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