Mother and Baby Friendly Care: Practice 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. This 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: Practice of kangaroo mother care

  1. 1. 4 Practice of Kangaroo Mother Care KMC is a way of keeping mother and infant Objectives together. 4-2 How can you get health care workers to When you have completed this unit you accept Kangaroo Mother Care? should be able to: It is often not easy to get KMC started in a • Promote Kangaroo Mother Care. hospital or clinic as both medical and nursing • Teach a mother how to give Kangaroo staff may think that KMC is dangerous and Mother Care. will result in more work and expense. Any • Use Kangaroo Mother Care in the nursery. new idea is difficult to introduce at first. A • Establish a Kangaroo Mother Care ward. clear description of KMC, together with the • Teach ambulatory Kangaroo Mother Care. advantages and safety must be presented to all the staff, including the senior management. • Use Kangaroo Mother Care for transport. Allow time for discussion where questions and fears can be raised. KMC will not be successful unless the staff are convinced that it can be done and will benefit mothers and infants.PROMOTING KANGAROO It is very useful if a few of the staff canMOTHER CARE visit a hospital where KMC is being used successfully. Here they can see KMC at first hand. It would also help to invite a few staff4-1 What is Kangaroo Mother Care? members from another hospital, where KMCKangaroo Mother Care (or skin-to-skin care) has been established, to present a talk onis a method of caring for newborn infants. their experience.The infant is nursed between the mother’s KMC is a radical change from the traditionalbare breasts in direct contact with her skin. western model of caring for small infants. TheKangaroo Mother Care (KMC) is particularly main obstacles to the introduction of KMC areuseful for nursing low birth weight infants fixed ideas and attitudes. Introducing KMC(infants with a birth weight below 2500 g). into a service represents a major shift in the
  2. 2. PRACTICE OF K ANGAROO MOTHER CARE 53way infants are managed. All the staff must 4-5 What are Kangaroo Mother Care‘buy in’ to this new method of mother and guidelines?infant care or it will not be successful KMC guidelines explain how KMC is implemented. Formal written protocols4-3 How is Kangaroo Mother Care are needed in the guidelines. Copies of theimplemented? guidelines must be freely available in hospitalsThe implementation of KMC depends on the and clinics where KMC is practiced.following: It may be useful to get copies of the KMC1. The staff ‘s acceptance of KMC. policy and guidelines from another service2. Adopting a KMC policy. where KMC is used successfully. These3. Writing KMC guidelines. documents can guide the process of writing4. Training the staff to use KMC. the KMC policy and guidelines in your5. Teaching mothers to give KMC. service. KMC should be promoted as a safe,6. Establishing facilities for KMC. effective and affordable method of caring for7. Managing ambulatory KMC. newborn infants.8. Educating the community to accept KMC. There are no fixed rules for KMC. EachEvery maternal and neonatal service should hospital and clinic has their own preferenceshave both a Kangaroo Mother Care policy and while each mother has her own likes anda clear set of guidelines. Health care workers, dislikes about KMC. However, it is importantmanagers, policy makers and funders need that the principles and guidelines are followed.to be convinced that KMC offers better, morecost effective care. 4-6 Who should promote the practice of Kangaroo Mother Care? All the staff must be encouraged and trained to All members of the staff, including nurses, help mothers provide Kangaroo Mother Care to doctors and administrators. In order that their small infants. KMC succeeds, the whole staff must support the idea and play a roll in writing the KMC policy and guidelines. Every mother should4-4 What is a Kangaroo Mother Care policy? know about KMC. The general public should also know about KMC. In particular, theThe KMC policy is a written statement which infant’s grandmothers needs to be educated togives the benefits of KMC and commits the support KMC both in hospital and at home.service to implement and promote KMC. Itdoes not have to be a long and complicateddocument. The KMC policy must be displayed The practice of Kangaroo Mother Care should befor staff and patients to see. supported and promoted by all members of the NOTE The Bogotá Declaration on KMC, signed at staff. the second International Workshop on KMC in Colombia in 1998, declares that KMC is a ‘basic right of the newborn’ and ‘should be an integral 4-7 How are mothers informed about part of the management of low birth weight and Kangaroo Mother Care? full term newborns, in all settings and at all levels of care and in all countries’. Many mothers have never heard about KMC and are afraid to give KMC, especially to small infants. Often mothers feel that their infant will receive better care in an incubator. Therefore, the benefits, safety and method of giving KMC must be explained to the mother.
  3. 3. 54 MOTHER AND BABY FRIENDLY CAREOnce the community learns about KMC, to give continuous KMC for a few days beforemany mothers will ask if they can also give their infants are discharged home.KMC to their infants. The method, advantagesand implications of KMC should be discussedwith the mother as soon as a low birth weight All pregnant women should know aboutinfant is born. She needs to know that she Kangaroo Mother Care.may have to stay longer in hospital, give KMCwhen the infant is discharged home, and 4-10 What is a Kangaroo Mother Careattend a follow up clinic. support group?4-8 How can the public be informed about This is a group of mothers who haveKangaroo Mother Care? themselves given their infants KMC. They are very effective in promoting KMC and helpingIt is important that the general public knows other mothers to provide KMC. They canabout and understands the benefits of KMC. give KMC education at antenatal clinics orThe media has an important role to play in encourage and assist mothers to give KMC inpromoting KMC. The following can be used to the nursery or KMC ward. Members of theinform the public about KMC: support group can also teach mothers how to1. Teaching KMC at schools. express breast milk. This assistance can be of2. Showing KMC in the media, especially TV enormous help to the nursing staff, especially and the local newspaper. in hospitals and clinics where staffing is3. Discussing the benefits of KMC in the inadequate. While some helpers are voluntary, media, especially radio and magazines. others may need to be paid a small fee. Even4. Using KMC posters or video presentations a few hours help each day will be very useful. in primary health care clinics. Someone needs to be identified to start and manage a KMC support group. Kangaroo Mother Care should be promoted 4-11 Why should KMC be supported by among the general public. local clinics? Because these clinics will be involved in4-9 When should mothers first be told providing follow up care to mothers whoabout Kangaroo Mother Care? are giving KMC to their small infants after discharge from hospital. Therefore, the clinicFrom the start of antenatal care when KMC staff will also need information and trainingshould be included as an important part of in KMC.educating pregnant women. The best methodof teaching women about KMC during theantenatal period is for them to see othermothers providing KMC for their infants. THE METHOD OFVideos can be shown at antenatal clinics and KANGAROO MOTHER CAREinformation sheets can be provided to informpregnant women about KMC.When small infants are first admitted to a 4-12 How does a mother give Kangaroonewborn nursery for incubator care, their Mother Care?mothers must be told that they will need to The almost naked infant (wearing only aprovide intermittent KMC as soon as their nappy and woollen cap) is placed between theinfants are well enough. They will also need mother’s bare breasts. If the room is cold, the infant can wear a cotton shirt, open in front.
  4. 4. PRACTICE OF K ANGAROO MOTHER CARE 55The infant is nursed upright, facing the mother mother’s back and then tied fast in front.with the arms and legs flexed in the frog The tails support the infant.position, under the mother’s shirt, blouse, T- 4. In preterm infants it is important to makeshirt or dress. Keeping the infant upright helps sure that the airway is never obstructed.to prevent vomiting. All mothers should be The infant’s head should be turned to onetaught how to nurse their infant in the KMC side and slightly extended to keep theposition. The mother does not need to shower airway open. Do not allow the infant’s neckor wash her chest before giving KMC. to be flexed or over extended. The top edge of the towel or binder should be just under the infant’s ear. It is best if small infants are kept upright between the mother’s breasts and not allowed to slip sideways. 5. If the mother is lying down, she and her infant should be kept at an angle of about 45° by raising the head of the hospital bed or be using a large pillow or a number of pillows or cushions. Special binders or carrying pouches are commercially available and can be helpful.4-13 How is the infant kept in position?It is important that the infant is kept warmand held securely. Holding the infant skin-to-skin, chest-to-chest against the mother willkeep the infant warm. The mother shouldhave her hands free and be able to walkaround. A number of methods are used tokeep the infant in place:1. Usually the mother’s shirt or blouse is tucked into her belt or trousers to prevent the infant slipping out.2. Sometimes a blanket or cotton towel can be tied around the mother as a binder No special equipment is needed to give Kangaroo to hold the infant firmly. The binder can Mother Care. be tied, pinned or tucked in to keep it in place. A shirt or blouse can be worn over the binder. A ‘boob-tube’ is useful.3. A special KMC top (a pouch) can be used but this is not essential. A KMC top looks like an open shirt with long tails. The shirt is pulled closed in front by crossing the tails. The tails are wrapped around the
  5. 5. 56 MOTHER AND BABY FRIENDLY CAREKANGAROO MOTHER CARE 4-17 How should the infant be taken out of the incubator for Kangaroo Mother Care?IN THE NURSERY It is important that the infant does not get cold. Before removing the infant, make sure4-14 Which infants can be given Kangaroo that it is wearing a woollen cap and cleanMother Care in the nursery? nappy. If the infant is receiving an intravenous infusion or has skin probes, be careful thatMost infants can be given KMC as long as they they are not pulled loose.are stable with a normal skin temperature,heart rate and breathing rate. Both infants in 4-18 Should the infant be monitoredcots and incubators can be given KMC. Even during Kangaroo Mother Care?infants on ventilators can sometimes be givenKMC provided that their condition allows this 1. Infants that are not being monitored inKMC has the most benefit in low birth weight the cot or incubator do not need to beinfants. All low birth weight infants should monitored during KMC.routinely be offered KMC once they are stable. 2. Infants who are not having apnoeic attacks, but are being routinely monitored withWhere there are no incubators, every very an apnoea monitor, can be disconnectedsmall infant can be given KMC. In these from the monitor during KMC. Switch offcircumstances, KMC can dramatically reduce the apnoea alarm when the infant is takenthe mortality of low birth weight infants. out of the incubator and placed in theSeverely ill infants who are going to die can also KMC position. Do not forget to switch thebe given KMC (compassionate KMC). Many apnoea monitor back on again when theparents want to hug or hold their dying infant. infant is placed back in the incubator. 3. However, if the infant is being monitored4-15 When should Kangaroo Mother Care for heart and respiratory rate or oxygenbe given in the nursery? saturation, this should be continued while the infant is receiving KMC.KMC should be given every time the parents 4. If the infant is having apnoea attacks, thevisit (intermittent KMC). The mother should infant is unstable and should either notbe encouraged to give KMC throughout the receive KMC or be monitored during KMC.visit. Even if the visit is short, the infant willbenefit from KMC. Some mothers spend most NOTE If the infant is receiving continuous positiveof the day in the nursery and can give KMC airway pressure, be very careful that the tubing is not disconnected. With care the infant can befor hours at a time. Usually KMC is given for moved from the incubator into the KMC positiona short period to start with and then the time without disturbing the ventilatory support.of the KMC becomes longer as the mother Switch the incubator to non-servocontrolbecomes more confident. mode when the infant is taken out for KMC or the incubator may overheat. Switch back to4-16 Who should take the infant out of the servocontrol mode when the infant is replacedincubator for Kangaroo Mother Care? into the incubator.The mother needs to be shown how to remove 4-19 Where should the mother sit to givethe infant and how to put the infant back into Kangaroo Mother Care?the incubator safely. Once the mother is ableto do this correctly, she can take the infant out It is best if the mother sits next to the cot orand put it back by herself. It is important that incubator in a comfortable chair. Once thethe mother informs the nursing staff when she infant is well and no longer needs ventilatorywants to give KMC. She must always wash her support, intravenous infusions (drips) andhands well before touching her infant. skin probes or electrodes, the mother may
  6. 6. PRACTICE OF K ANGAROO MOTHER CARE 57give KMC while walking about with the infant 4. Put the infant to the nipple every time shein the nursery. gives KMC. It does not matter if the infant only suckles for a few minutes.4-20 What special facilities are needed in With encouragement, many small infantsthe nursery for Kangaroo Mother Care? will take part or all of their feed from theNo special facilities are needed. Comfortable breast. The mother should start to expresschairs for the mother and partner are her breasts from the day the infant is born.required. Simple plastic chairs are adequate. A Until breastfeeding is established, the infantrefrigerator is helpful to store expressed breast should be fed expressed breast milk by cup ormilk. In a very crowded nursery, space must nasogastric tube.be created for parents to visit and give KMC. 4-24 What is a lodging ward?4-21 Should the infant’s skin temperature be Often mothers have difficulty visiting theirmonitored during Kangaroo Mother Care? infants every day as they live far away andThis is usually not necessary if the infant’s transport is expensive and infrequent. It istemperature has been stable in the incubator. very helpful if these mothers can stay in or near the hospital on a 24 hour basis so that4-22 What feeds should be given in the they can give intermittent KMC to theirnursery during Kangaroo Mother Care? infants in the nursery.As far as possible, give the infant its mother’s This facility is often called a lodging ward.own milk. Exclusive breast feeding is by far the However, it is not a typical hospital ward asbest for low birth weight infants. Some small these mothers are well. It is one or more roomsinfants will breastfeed while others will have where mothers can be given accommodation.to be fed expressed breast milk by nasogastric Often the lodging ward is next to the nurserytube until they are mature enough to suck and and KMC ward so that they can share facilities.swallow. Some mothers will choose to give The lodging ward needs to be supervised toformula feeds. Theses infants should be fed by ensure cleanliness and security but nursing iscup rather than bottle. not required. Mothers in a lodging ward need a bed, somewhere to sit and relax, and a place to keep their clothes and belongings safely. Exclusive breast feeding is by far the best for low birth weight infants. A lodging ward provides a mother with a place to stay so that she can be near her infant in the4-23 How can a mother encourage a small nursery at all times.infant to breast feed during KangarooMother Care? It is not expensive to accommodate mothers1. Hold the infant correctly to place the in a lodging ward. By providing breast milk infant’s mouth over her areola (latch and giving KMC, they reduce the hospital cost properly). Often the ‘foot ball’ position of caring for small infants. Without a lodger is easiest. Infants can breastfeed while ward, many mothers would be discharged receiving KMC. home and would not be able to afford the2. Express a little milk onto the nipple before transport to visit their infants regularly. latching the infant.3. Place the nipple into the infant’s mouth even if the infant does not suckle well.
  7. 7. 58 MOTHER AND BABY FRIENDLY CAREA KANGAROO MOTHER 4-27 What facilities are needed in the Kangaroo Mother Care ward?CARE WARD 1. A space for the mothers to sleep. One to four rooms with four beds per room is ideal.4-25 What is a Kangaroo Mother Care ward? 2. A living space where the mothers can eat and relax.This is a special room where mothers can 3. Toilets, showers and hand basinsroom-in for a few days so that they can givecontinuous KMC to their infants under Cribs are not needed in a KMC ward as thesupervision both day and night. Most of these infants are continuously with their mothers.mothers are well and do not need nursing However, plastic bassinettes are sometimescare or routine observations. Every effort used to bath infants. The room temperaturemust be made to make the KMC ward as should be 22–24 °C.homely as possible and not look like a typical Mothers should be able to give KMC duringhospital ward. Mothers are encouraged to meals. Daily showering or washing iswear their own clothes and walk around. The adequate. Mothers must wash their handsKMC ward should be close to the nursery if after going to the toilet. Facilities for washingpossible. Ideally, a door should link the KMC clothes are needed.ward with the nursery so that help can beobtained if needed. Limited visiting is allowed Some facilities can be shared with thein the KMC ward but the mothers’ privacy lodging ward. Mothers in the lodger wardmust be respected. can be encouraged and supported by meeting mothers in the KMC ward. In future all neonatal nurseries should be designed with A ‘KMC ward’ enables the mother to give her both a KMC ward and a lodging ward nearby. infant Kangaroo Mother Care both day and night while being supervised by the staff. 4-28 What furniture is needed in the Kangaroo Mother Care ward?At night most mothers prefer to sleep on their The following is recommended:backs with the infant on their chest and theirhead and shoulders propped up with pillows 1. Basic beds. Special hospital beds are notinto a semi-sitting position. Other mothers needed but enough pillows are necessary.sleep on their side with the infant still in the 2. Small lockers where the mothers’ clothesKMC position. and personal items can be safely kept. 3. Comfortable chairs where mothers can sit4-26 What is the importance of a Kangaroo to breast feed and give KMC. Light plasticMother Care ward? chairs are cheap and practical. 4. Tables and chairs for meals.A dedicated KMC ward provides a very 5. Desk, chair and basic office equipment forvaluable step between giving intermittent the staff. A telephone is useful.KMC in the nursery and giving continuous 6. Cupboards for storing extra blankets.KMC at home. In a KMC ward mothers gain 7. Curtains to allow some privacy are useful.experience and confidence before going homewith their infants. Mothers support, teach and There should be no cots in the KMC ward. Theencourage each other. mother can wrap up her infant and leave it on the bed when she goes to the toilet. If there is not enough space for chairs, mothers will have to sit on their beds, and have their meals in another room nearby.
  8. 8. PRACTICE OF K ANGAROO MOTHER CARE 59It makes an enormous difference if the KMC KMC but also about other aspects of health.ward is attractively painted, new curtains and Talks, discussion groups, demonstrations andbed covers are made, and posters or murals educational videos are used. Topics, whichof KMC are put on the walls. Funding can should be taught in the KMC ward, include:usually be obtained from local charities. 1. How to give KMC correctly and provide exclusive breastfeeding.4-29 What nursing is needed in the 2. How to give KMC after discharge home.Kangaroo Mother Care ward? 3. The importance of regular attendance atA nurse is needed to supervise the mothers the follow up clinic.in the KMC ward. It helps that most mothers 4. The importance of the Road-to-Health card.have already been trained in KMC before they 5. The importance of immunisations for thereach the KMC ward. It is important to have infant.a nurse who is experienced and enthusiastic 6. How to cup feed an older child.about KMC. A professional nurse is preferable. 7. The giving of daily vitamins and iron toHowever, a non-professional nurse can be preterm infants.used as the KMC ward supervisor. It is helpful 8. A healthy diet and lifestyle for the mother.but not essential to have a nurse in the KMC 9. How to avoid infection with HIV.ward at night. If a nurse is not available, the 10. Family planning.KMC ward must be close to the nursery so The main problems in a KMC ward arethat the mothers can call for help if needed. boredom and frustration. Other thanUsually a team of two or three nurses is education, activities such as knitting woollenneeded to provide adequate day cover in a caps, reading magazines and arts or craftsKMC ward. The nurse should have experience should be encouraged. A radio and televisionin caring for low birth weight infants and be set with a video or CD player are useful asable to recognise an ill infant. are a kettle, toaster and microwave oven.Volunteers (lay helpers) are of great help in a Community groups can be invited to helpKMC ward. They can encourage mothers, help with some of these activities. Smoking mustthem give KMC and teach them to express not be allowed.their breast milk if necessary. A kind, motherlyperson who has breast fed and given KMC to 4-31 Why may teenagers not want to stayher own infant is an ideal helper. Many helpers in a Kangaroo Mother Care ward?only work one or two days a week, often in the Teenagers are naturally rebellious and oftenmornings. Some helpers may need funds for do not easily accept any form of authority.transport or a small payment for their time. An unhappy teenager may disrupt theUsually only well, thriving infants are admitted normal routine in a KMC ward and they mayto the KMC ward. However, if infants below require support and understanding from1500 g or infants still being fed by nasogastric the staff. Weekends are often most difficulttube are admitted, then an experienced nurse for teenagers who want to be with theiris needed both day and night. Good cord care friends. They may also be anxious about theirmust not be forgotten. boyfriend or partner. Many mothers in both the lodger and KMC4-30 What education opportunities can be wards may need ‘time out’ to go home for aoffered in a Kangaroo Mother Care ward? few days. This is important for women whoThe mother’s stay in a KMC ward provides an have other children at home. Some may haveideal opportunity for education. It is important spent weeks or months in hospital. While shethat the nurses in the KMC ward are able is away, her infant will have to go back into anto provide education, not only about giving incubator in the nursery. Mothers rarely stay
  9. 9. 60 MOTHER AND BABY FRIENDLY CAREaway for more than a few days as most have hospital for running a KMC ward, as thealready formed a strong bond with their infant mothers need food and bedding. Sometimesduring intermittent KMC. It gives them time mothers may have to bring their own foodto prepare for the infant’s arrival at home. and bedding. The KMC ward has to be cleaned and staff are needed to supervise the4-32 When should mothers and infants be mothers. However, there is a great financialdischarged from a Kangaroo Mother Care saving because:ward? 1. The mothers provide all the care for theirWhen the mother is able and confident to infants.care for her infant at home. The weight and 2. Less formula is needed, as most of thegestational age of the infant are less important infants are being breast fed.than its maturity. Usually the infant is 3. The infants are discharged home earlierdischarged from the KMC ward when both from the nursery.mother and infant are ready. 4. There is also less infection in the nursery. 5. Less staffing is needed than withThe following criteria should be met before conventional incubator care.the mother and infant are discharged from theKMC ward: A Kangaroo Care Mother ward makes a great1. The mother must be able to provide KMC financial saving for the hospital. correctly and should be confident to look after her infant. Usually the infant is fully breast fed. The infant must be taking all Similarly, it is cost efficient to run a lodging feeds by mouth. ward.2. The infant and mother should be clinically healthy and the infant should be gaining 4-34 How can funding be obtained for a weight at a rate of 20 g or more a day).. Kangaroo Mother Care ward?3. The home and family must be prepared for Many hospitals have obtained funding for the mother and her infant. their KMC ward from private institutions,4. Arrangements must be made for regular charity groups and service organisations. follow up at a local clinic.Care in the KMC ward should be seen as astep between discharge from the nursery and AMBULATORY KANGAROOdischarge home. Most mothers only need tospend a few days in the KMC ward unless MOTHER CARE AT HOMEtheir infant is very small. Infants are usuallydischarged home when they are 1500 g or 4-35 What is ambulatory Kangaroo Mothermore. Many KMC wards discharge their Care?mothers when the infants reach 1800 g.Infants receiving KMC are often discharged The word ambulatory means to ‘walk around’.a little later in the cold season. The better the Ambulatory KMC usually refers to the KMCfollow up facilities, the sooner infants can be which is given after the infant has beendischarged home. discharged home from the hospital or clinic. These mothers give home (or ambulatory)4-33 How expensive is a Kangaroo Mother KMC throughout the day. Most work in theCare ward? house (e.g. washing up) can be done while giving KMC. Mothers can give KMC whileSome funding is needed to establish a KMC walking around in or near their homes.ward. Thereafter, there is a small cost to the Ambulatory KMC should also be given when
  10. 10. PRACTICE OF K ANGAROO MOTHER CARE 61attending the clinic, visiting friends, on the 4-38 How should you follow up infantsbus or going shopping. Many low birth weight receiving ambulatory Kangaroo Motherinfants need KMC for days or weeks after Care at home?they are discharged home. Mothers must As many of these infants are still small whenbe convinced of the benefits of KMC and they are discharged home, they should be seencommitted to give KMC at home. regularly at the hospital or community based local clinic to check that the infant is well and Ambulatory Kangaroo Mother Care is given when the mother is managing. The infant’s weight the mother and infant are both well and the must be measured to ensure that the infant is mother is able to walk around with her infant. receiving adequate feeds and gaining weight. Failure to gain weight must always be carefully assessed. The clinic visit gives an opportunity4-36 Which infants would benefit from to discuss KMC with the mother. Anyambulatory Kangaroo Mother Care at problems can be identified and corrected.home? 4-39 How often should infants, receivingInfants that still weigh less than 2000 g would ambulatory Kangaroo Mother Care atbenefit greatly from KMC at home. Some home, come for a check up?infants between 2000 g and 2500 g would alsobenefit from KMC, especially when it is cold. The smaller the infant, the more frequently the infant should visit a clinic. Below 1500 g, daily checkups are needed. From 1500 g and Low birth weight infants can benefit from above, three to four visits a week until 1800 g. ambulatory Kangaroo Mother Care at home after Thereafter, weekly visits until the infant discharge from hospital. reaches 2500 g. These recommendations should be seen only as a guide, and will NOTE KMC has not been well researched in depend on the mother, on her family and the home setting. However, wide experience support systems, on distances and ease of suggests that it is both safe and very effective in access to the clinic, and on how the infant allowing early discharge from hospital, promoting is growing. More frequent follow up may be breastfeeding and encouraging bonding. Mothers are more relaxed and better rested at home. needed in the cold season. Many mothers giving ambulatory KMC to4-37 When should a mother give small infants at home spend most of their dayambulatory Kangaroo Mother Care? in the KMC room at the local clinic. Here the staff can support and supervise the mothers.It is best to give ambulatory KMC all the time. Some facilities have a special KMC clinic. ThisIt can be given while the mother performs may be a better option than keeping mothersmost household duties. When she is not able and their infants in an overcrowded hospital.to give ambulatory KMC, the infant should begiven KMC by another responsible member ofthe household. KMC can be given outside the Frequent follow up visits at a Kangaroo Motherhome when the mother goes shopping, catches Care clinic are essential for low birth weighta bus or train, or attends the local clinic. infants getting Kangaroo Mother Care at home.
  11. 11. 62 MOTHER AND BABY FRIENDLY CARE4-40 When can ambulatory Kangaroo during transport. Every effort must be madeMother Care be stopped? to keep the mother and infant together. Some KMC training is needed by the transport staff.Infants usually decide for themselves whenKMC can be stopped. As infants get older andtheir weight increases with more subcutaneous 4-43 What are the advantages of usingfat, they become hot and restless during Kangaroo Mother Care for transport?KMC and try to climb out of the mother’s Delays are avoided, as there is no need to waitdress. Mothers of low birth weight infants for a transport incubator. This is particularlyshould try to continue KMC until at least important when moving low birth weight2000 g is reached. By 2500 g, most infants no infants to a level 2 or 3 hospital. It is also verylonger need KMC. However, these infants useful when moving well low birth weightstill need close contact with the mother, and infants back to the referral hospital. Thisbreastfeeding. Keeping older infants on their avoids many of the problems that commonlymother’s back or in a sling is recommended. occur when arranging transport. KMC in a motor car or van is ideal for transferring well, low birth weight infants.KANGAROO MOTHER CAREFOR TRANSPORT Kangaroo Mother Care can be used to transport infants.4-41 Can Kangaroo Mother Care be used totransport infants? 4-44 What staff are needed to superviseYes. Many stable newborn infants can be safely Kangaroo Mother Care during transport?transported with KMC. This is a cheap and KMC is usually given by the mother whenvery effective method, as a transport incubator transporting infants. She needs to beis not needed. If the infant is sick or unstable, supervised by a member of the ambulanceit is still safer to use a transport incubator. staff or an accompanying nurse. Usually the NOTE The use of KMC during transport has not ambulance staff alone are able to supervise been fully researched. If a sick infant needs to be KMC during transport. transferred urgently, and a transport incubator is not immediately available, the use of KMC by 4-45 Can Kangaroo Mother Care be safely trained staff who can monitor the infant and used in a private car? give oxygen or even mask ventilation may be preferable to a long wait for a transport incubator. Yes. It is best if the mother sits in the backIt is unacceptable for a small infant to seat and wears a seat belt. Only the hip beltarrive cold at a hospital because a transport should be used. The seat belt should not beincubator was not available when KMC could placed over the infant but between the motherhave been used. KMC can also be used to and her infant. The infant can be tied to thewarm cold infants. mother’s chest with a towel. Make sure that the infant’s neck is not flexed as this may interfere with breathing.4-42 How is Kangaroo Mother Care givenduring transport?Usually the mother gives KMC. However, CASE STUDY 1a nurse or member of the transport teamcan also give KMC if the mother is not well A mother attending antenatal care says thatenough or is not moved with the infant. Even she has read about KMC in a magazine andthe father or grandmother could provide KMC
  12. 12. PRACTICE OF K ANGAROO MOTHER CARE 63wants to know how this is done. The clinic 1. Is this infant not too small to be givenstaff are unable to help her as they have no KMC?experience of KMC. No. Most small infants can be given KMC, especially if they are healthy and stable.1. Who should be able to advise her aboutKMC? 2. For how long should the mother giveAll the staff members at the clinic should KMC during her visits?know about KMC. The staff who care for For the whole of the time that she visits herher at the antenatal clinic must give her infant. The more time she spends giving KMCthe information that she needs. Giving the better.information on KMC is an important part ofantenatal care. Videos or CDs are a very usefulway of teaching pregnant women about KMC. 3. Could her partner also give KMC? It is important to encourage bonding between2. How can the public be informed about the infant and both parents. Therefore, theKMC? father should also have an opportunity to give KMC. This will also help him understand andThrough the schools, radio and TV, newspapers support the mother when she gives KMC.and magazines, and health care facilities. 4. What special facilities are needed to give3. Which family member often influences a KMC in the nursery?woman’s decision to use KMC or not? All that is needed is a comfortable chair. It isThe grandmother. The whole family should best if the mother is able to give KMC besidesupport a mother giving KMC. the incubator.4. When should a pregnant woman first be 5. Why is it important that the mothertold about KMC? learns how to express her breasts?At the beginning of her pregnancy as soon as Because the infant needs expressed breast milkshe starts antenatal care. There is a possibility feeds as it is still too immature to suck. Onethat any pregnant woman might deliver of the most important skills that all motherspreterm and need to give KMC to a small should learn is how to express their milk.infant.CASE STUDY 2 CASE STUDY 3 The matron of a maternity hospital calls aThe mother of a 1500 g newborn infant visits meeting of her staff. She is keen to start athe nursery. Her infant appears healthy and KMC ward as the well baby nursery is grosslyis being nursed in an incubator. The infant overcrowded. She asks how KMC can beis still being fed by nasogastric tube. The given by mothers who are already living at thenursery staff ask the mother whether she is hospital to be near their infants. She also needswilling to give KMC during the times that to know what equipment will be required andshe visits her infant. They show her how to whether this will be very expensive.express her breast milk.
  13. 13. 64 MOTHER AND BABY FRIENDLY CARE1. Will a KMC ward help to solve the CASE STUDY 4problem in this nursery?Overcrowding is a very common problem in The young mother of a low birth weight infanthospital nurseries. The overcrowding, with the gave intermittent KMC while visiting herresultant stress on the staff and high rate of infant in the nursery. Later she stayed with herinfection, will be greatly improved if a KMC infant for 5 days in a KMC ward. At dischargeward is started. the infant was healthy, breast feeding well and gaining weight. The infant’s discharge weight2. What space will be needed for a KMC was 1750 g. On the day after discharge she wasward? asked to attend the local well baby clinic.A space for the mothers to sleep, a living area 1. Is it wise to discharge an infant with suchwhere they can eat and relax, and toilets and a low weight?showers. It is safe to discharge this infant provided that3. Will a special area have to be built for a it is healthy, feeding well, gaining weight andKMC ward? receiving KMC.A room will be needed where mothers and 2. How often should the infant receive KMCtheir infants can stay together. One of the at home?rooms previously used for mothers of infantsin the nursery could probably be converted All the time, both day and night. Someoneinto a KMC ward. else reliable can give KMC if the mother needs a break.4. What furnishing is required? 3. When should the infant be taken to theSimple beds, comfortable chairs, lockers for clinic?clothes, and tables and chair for meals. On the day after discharge and then three or5. What nurses will be needed for the KMC four times a week until a weight of 1800 g isward? reached. Thereafter, weekly visits are usually adequate. With very small infants receivingAn experienced and enthusiastic nurse will be ambulatory KMC at home, it is best for theneeded to supervise the mothers. Staffing is far mother and infant to visit the clinic every dayless than that required in a well baby nursery. so that the infant’s weight gain can be checkedHowever, staff need to have the skills necessary and the mother supported.to teach and support KMC. Volunteers are alsovery useful to assist in a KMC ward. 4. When can ambulatory KMC be stopped?6. Will establishing a KMC ward not be very When the infant reaches 2500 g.expensive?Some funding will be required to start theKMC ward. Thereafter, the savings to the CASE STUDY 5hospital will be greater than the running costs. A mother is transferred to a level 2 hospital on the day after delivery for investigation of a heart murmur noted during labour. Her well 1700 g infant is not moved with her as the transport incubator is broken. She is very upset about being separated from her newborn infant.
  14. 14. PRACTICE OF K ANGAROO MOTHER CARE 651. What is incorrect about the management 3. What could have been done to keep thisof this mother and infant? infant warm if the mother was too ill to give KMC?They should not have been separated. The infantshould have been moved with the mother. A nurse or ambulance driver or her partner or the grandmother could have given KMC on2. How could the infant have been kept the way to hospital.warm during transport?The mother could have given KMC.

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