Skin-to-skin connect: How Kangaroo Mother Care is revolutionising neonatal health

In 1970s, Colombia was troubled by infant mortality and there started a revolutionary health practice that changed the course of neonatal care.

BySumit Jha

Published May 16, 2023 | 8:50 AMUpdated May 16, 2023 | 2:47 PM

Skin-to-skin connect: How Kangaroo Mother Care is revolutionising neonatal health

During the late 1970s in Bogotá, Colombia, a troubling situation unfolded regarding the health of babies, both premature and full-term. A significant number of these infants faced serious health complications and were at risk of mortality.

The mortality rate for premature babies was particularly alarming, with approximately 70 percent of them not surviving. Infections and respiratory problems emerged as the primary causes of death among these infants.

The situation in Bogotá

The neonatal intensive care units (NICUs) in the city’s hospitals were overwhelmed and nearing their capacity. The lack of adequate resources and access to incubators became a critical issue, contributing to the high mortality rates of preterm babies.

The overcrowding in the NICUs was so severe that it forced three babies to share a single incubator simultaneously, resulting in an increased risk of cross-infection.

As a result, the death rates continued to rise, leading to a distressing rise in the number of young, impoverished mothers abandoning their babies, as they were unable to even have physical contact with them.

This dire situation painted a bleak picture for infant healthcare in Bogotá during that time, highlighting the urgent need for intervention and improvements in the healthcare system to address these challenges.

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An idea from far away

Although there is a considerable geographic distance of approximately 15,000 km between Australia and Colombia, it is fascinating how ideas from animals in one continent can provide valuable insights and inspiration for humans in another continent.

One Colombian paediatrician, Dr Edgar Rey, came across a paper describing the physiology of kangaroos. The paper described when kangaroos are born, they are small and hairless, and the size of a peanut — just like human preterm babies.

Once the baby kangaroo is placed inside its mother’s pouch, it benefits from the direct skin-to-skin contact, which provides thermal regulation due to the absence of hair.

The baby kangaroo latches onto its mother’s nipple and remains there until it has grown to about a quarter of its mother’s weight. Only then is it ready to venture out into the world.

Rey was deeply struck by this practice and started Kangaroo Mother Care. He provided training to mothers of premature babies on how to carry and hold their infants in a manner similar to kangaroos.

It involves skin-to-skin contact between the mother (or a caretaker) and the baby, typically placing the baby on the mother’s chest, with direct skin contact, for an extended period of time.

Monday, 15 May, was International Kangaroo Care Awareness Day or, simply, Kangaroo Care Day.

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A brighter future for Colombia

Finally, in Colombia, there was an immediate reduction in mortality rates and infections. The overcrowding issue was alleviated as hospital stays became shorter, leading to available incubators, and the instances of abandoned babies significantly declined.

The introduction of Kangaroo Mother Care (KMC) aimed to provide thermal regulation, promote breastfeeding, and facilitate bonding between the mother and baby. The method has been shown to have numerous benefits, including improved infant survival rates, better weight gain, reduced risk of infections, enhanced breastfeeding success, and positive long-term developmental outcomes.

Since its inception, Kangaroo Mother Care has gained recognition worldwide and is now considered a standard care practice for premature or low birth weight infants in many healthcare settings.

It has been implemented in various countries, adapting to local contexts and healthcare systems, to provide optimal care for vulnerable infants, and support their healthy development.

Kangaroo Mother Care: A new norm

A father practicing kangaroo care. (Biju Raju/Flickr)

A father practicing kangaroo care. (Biju Raju/Flickr)

The concept of providing close physical contact for infants originated from the observation of reducing infant mortality rates. It was soon realised that this approach could be extended to all infants, with a special emphasis on premature babies.

“Researchers discovered that by keeping babies in close proximity to their mothers or caregivers for extended periods, the infants not only survived but also thrived. This finding prompted further exploration of the benefits of close contact and skin-to-skin interaction,” Director and Co-founder of Hyderabad-based The Sanctum Natural Birth Center, Dr Vijaya Krishnan, told South First.

The Sanctum Natural Birth Center aims to provide a comfortable and supportive environment for mothers, who choose natural birth, during the birthing process.

“These preterm infants are often discharged from the hospital earlier than those who do not receive KMC. Touch is essential for babies and holding them for significant portions of the day, particularly in the case of premature infants, has proven beneficial,” said Dr Vijaya.

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Why premature babies need KMC

Dr Vijaya explained that the human body, particularly that of a mother, has an incredible innate intelligence.

“When an infant is placed on the mother’s chest, the temperature of her chest is naturally about two degrees higher than the rest of the body. This is a remarkable mechanism designed to support the well-being of the newborn,” said Dr Vijaya.

However, in the modern medical environment, there is often a departure from the natural order, she said.

“Babies are frequently separated from their mothers and placed in warmers without fully recognising the importance of skin-to-skin contact, where the baby naturally belongs. Nature has its own way of ensuring that infants receive the warmth and comfort they need after birth,” said Dr Vijaya.

Now, when we consider premature infants, there are certain aspects in which they differ from full-term infants.

“Their organ systems are less developed, leading to greater fluctuations and variations in heart rate during the transition into the world. Stabilising their heart rate becomes more challenging.”

She added, “Breathing also becomes more difficult, particularly for extremely premature infants. The production of surfactant — a substance that helps the lungs function properly — may be insufficient. This can result in collapsed lungs with each breath, leading to respiratory distress.”

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How does it work?

During the time spent inside the mother’s womb, the baby is exposed to a variety of sounds. They hear the rhythmic sound of their mother’s heartbeat, the pulsations of the umbilical cord, and the sounds of the mother’s digestive system. The familiar environment consists also of the sound of the mother’s breathing.

The WHO advises immediate skin-to-skin care for the survival of small and preterm babies. (WHO)

The WHO advises immediate skin-to-skin care for the survival of small and preterm babies. (WHO)

“When the baby is born and placed on the caregiver’s chest for periods of time, with only a diaper and possibly a cloth around them, a special bond is formed. This skin-to-skin contact between the baby and the parent or caregiver has numerous benefits. It helps regulate the baby’s heart rate, improves breathing patterns, and helps maintain a comfortable body temperature,” explained Dr Vijaya.

“The need for external warming methods is reduced when this contact is provided consistently over time. Oxygenation and oxygen saturation levels also improve, enhancing blood supply to vital organs, which is particularly crucial for premature babies,” she said.

She added that in this close contact, the baby feels secure and often falls asleep peacefully.

“Extended kangaroo care has been found to have a positive effect on weight gain because the baby’s bodily functions become more stable, allowing for better absorption of nutrition, whether through breastfeeding, human donor milk, or artificial supplementation. The baby’s weight gain is an important indicator of their well-being,” she explained.

Furthermore, these babies, especially premature ones, may not cry in the traditional sense. They may whimper instead, which can convey their discomfort and pain. When in the NICU, they are exposed to a constant array of sounds, including beeping machines and tubes administering necessary treatments. While these medical interventions are crucial, they can contribute to the baby’s overall discomfort.

Dr Vijaya said that in light of these factors, incorporating periods of kangaroo care becomes essential. Even if it starts with short durations of five or ten minutes, over time, the hours of care can be increased as the baby’s condition improves.

“This additional care provides numerous benefits, allowing the baby to experience a more peaceful and comforting environment. Gradually, the baby may transition from whimpering to crying, indicating a healthier and more responsive state,” she explained.

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Benefits to the mother

While the benefits of KMC for the baby are well-known, it is important to highlight the benefits for the parents as well.

The emotional bond between parents and their baby is crucial and being separated from the newborn can cause feelings of helplessness and frustration.

“By promoting kangaroo care, parents can experience the joy of nurturing their baby skin-to-skin and regain a sense of connection. Additionally, kangaroo care has a positive impact on breastfeeding, as it stimulates the mother’s milk production. This is particularly important for preterm or premature babies who greatly benefit from their mother’s milk,” Dr Vijaya explained.

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There are challenges, but surmountable

She said that one of the potential challenges is adjusting to the process, which may take multiple sessions to get comfortable with.

“Preparing mentally involves understanding the process and discussing it with the care team. Establishing a schedule that works for both the care providers and the parents is another challenge. In the NICU, multiple doctors may be involved, consultations may take place, and adjustments to medications or machine settings may be necessary.

“Finding a balance between the care team’s availability and the needs of the baby and mother is essential. While this may present challenges, it is certainly achievable and has significant benefits for all involved,” said Dr Vijaya.