Kangaroo Mother Care: What is it
August 23, 2016 Leave a comment
By Dr Angela Muriuki, Head of Child Survival, Save the Children – Kenya
Definition and History: KMC is continuous, prolonged, skin to skin contact between a baby and a mother or any other adult for at least 18 hours a day for several weeks. It provides warmth, promotes breastfeeding, reduces infections and links with additional supportive care, if needed. It is a powerful easy to use method to promote the health and well-being of infants born pre-term as well as full term. There are two types s KMC- contious which is skin to skin contact for at least 18 hours and intermittent where contact is brief and at least for 3 hours.
KMC begun in Bogoa, Colombia in 1979 by Dr. Edgar Rey and Hector Martinez in response to a shortage of incubators and severe hospital infections.
Who qualifies for KMC? The current Moh recommendation for KMC in Kenya is for stable babies (not on oxygen, not receiving intravenous medicines) as long as they meet the criteria: baby less than 37 weeks or completed gestation and the mother willing to provided KMC for at least 18 hours, mentally sound, not ill etc. It is hard to objectively say who is most likely to use it i.e. which mother is likely to accept KMC, early involvement of their partners and family in the process and promotion of support systems at home but also using mothers who have successfully practiced KMC.
Challenges that face premature babies and which of these can be resolved by KMC: In the simplest forms, small babies are at risk of death due to hypothermia (they are not able to regulate their body temperature very well), hypoglycaemia (also not able to regulate their blood sugar very well as their systems are not fully developed),and respiratory diseases (they get severe problems with their respiratory system in part due to the fact that their lungs are not fully developed and that they get infections very easily) as well as problems with their eyes, brain and gastrointestinal systems all because of being born too soon.
Some of the benefits of KMC for the baby include thermoregulation (the constant contact between mother and baby keeps the baby warm), it promotes exclusive breastfeeding (hence addressing the issue of hypoglycaemia), babies gain weight faster (due to better thermoregulation, feeding and bonding which reduces stress for the newborn) and therefore it shortens the hospital stay (reducing the risk of exposure to infections). For the mother, it gives her confidence in caring for her newborn, it improves bonding between mother and baby and empowers the mother to be the primary caregiver. It also reduces stress for the mother since she is with her baby constantly as opposed to conventional care in the newborn unit where the mother only comes to feed her baby every 3 hours (and in between feeding times is constantly worried about whether her baby is still alive). For the hospital – engaging mothers in the care of their babies means that the nursing staff available can focus on the very sick babies and work with the mothers to care for the stable babies, incubators are in short supply and often shared so KMC ensures that incubators are left for the sick babies who really need them and the shorter hospital stay for babies is also advantageous
Some of the benefits of male involvement: There are several reasons why men should be involved (especially when mother is discharged to practice KMC at home)
– Financial support for the care of the baby especially if the mother has to be away from work (her daily source of income) to care for the baby
– Emotional and psychosocial support for the mother
– Fathers themselves can practice KMC giving the mother some time to rest or carry out other household activities
– They can help around the household so that she focuses on care for the baby (or get some help for the household)
– Financial resources so she can attend the monthly follow up visits at the health facility
Women experience the lack of male involvement differently depending on their support networks.
When is the best time and for how long? KMC is initiated immediately (and as long as mother and baby meet the criteria described above). KMC is practiced for at least 18 hours a day. When a baby gets to 2000gm, they can be discharged to go home and continue KMC until the baby is 2500gms (with frequent visits to the facility to make sure the baby is ok and gaining weight).
Can it be practiced instead of/along with incubator care and when?KMC is not a replacement for incubator care or an intervention for poor countries/communities. It is the current recommended care for small babies (in the west, even unstable babies are put on intermittent KMC – can send pics from internet though copyright could be an issue). KMC is practiced alongside incubator care because as I mentioned, there are babies who still need incubator care and don’t qualify yet for continuous KMC according to the Kenya guidelines – very sick, on oxygen, on IV medicine etc. even these sick babies can be put on intermittent KMC and returned to the incubator.
Is KC beneficial for babies born term? No, term babies don’t tolerate KMC at all.
KMC should be differentiated from skin to skin care for all babies – this is where any baby born should be put skin to skin with its mother to keep it warm until it can be wrapped warmly. This is standard practice for all babies at delivery. KMC on the other hand is for small babies (preterm, low birth weight), and is continuous (at least 18 hours)
Which institutions within and outside Nairobi are equipped to and encourage KC?
I can only speak for the ones we support. We have supported county MoHs to set up KMC in Bungoma and Busia counties and provided technical support to other organisations to set up KMC services. From August 2016, we will be supporting Nairobi County to do the same and Wajir County later in the year.
We also extend an offer to any organisation/county which requires technical support to set up KMC services. If they get in touch with us, we are happy to provide this support (technical support since financial resources are limited).
End
Photography by: Nash of NaMeD Afrika Studios and Family File