15 May is international Kangaroo Mother Care Awareness Day! So that gives me the perfect excuse to write on one of my absolute favourite topics today: Kangaroo Mother Care for premature babies. Every time I read or write about Kangaroo Mother Care, I’m just astonished at how perfectly nature’s systems work. Today, I’d like to share a bit of that wonder with you.
What on earth is Kangaroo Mother Care?
Kangaroo Mother Care, or KMC, is a method of caring for babies by keeping them in skin-to-skin contact on their mother’s chest. It got its name from the way kangaroos raise their young: kangaroo babies are born extremely immature, and they spend the first several months of their lives inside their mother’s pouch, permanently attached to a nipple – kind of like being in an external womb. Some very clever people working in extremely poor countries had the idea of doing the same with premature human babies – and it worked!
KMC as we know it today was developed by Dr Edgar Rey and Dr Hector Martinez in the 1970’s. They needed a low cost, low tech method of caring for premature babies: They were working in Bogota, Colombia at the time, where the mortality rate for premature babies was unacceptably high because there was a shortage of medical care facilities. Their simple, elegant solution was to keep babies in skin-to-skin care on their mothers’ chests for 24 hours a day and feed them breast milk. Amazingly, the mortality rates dropped – not just a little, but a lot.
What no-one was expecting was that KMC proved to be not only as good as traditional incubator-based care, but even better. So KMC should not be seen as a last resort to be used when nothing else is available, but rather as the first choice and most effective treatment. And KMC is not only for premature babies either – all babies benefit from skin-to-skin care, as you can read in this post.
Kangaroo Mother Care has been shown time and time again to dramatically improve the outcomes for premature babies. Here’s just a sample of the kinds of benefits we’re talking about:
Keeping baby healthy and stable
A baby’s heart rate, oxygen saturation and breathing are all more stable when in KMC. The difference that skin-to-skin contact makes here is amazing. I’ve seen videos where they have a baby attached to a sats monitor, and you can see how the oxygen levels and heart rate are jumping all over the place. The moment they place the baby skin-to-skin on the mother’s chest, however, everything stabilises at a normal level within seconds. I’ve even seen with my own eyes how babies’ oxygen levels start climbing when they are placed in KMC – it’s very nearly magical.
KMC also helps to keep a baby’s blood glucose levels up. One of the biggest concerns with a baby that is not feeding well is that their glucose levels will fall too low. This is quite an important thing, since very low blood glucose levels can lead to brain damage – and premature babies are, for various reasons, extremely prone to getting low blood glucose. Fortunately, KMC is one of the most effective ways to prevent low blood glucose – it is very rare for a baby in KMC to have low blood glucose. Not only that, but low blood glucose can often be corrected simply by placing the baby in KMC.
Babies in KMC are also far less prone to getting infections while in hospital. This may sound strange, if you consider how clean and “sterile” the nursery environment is. But the truth is, in a NICU or hospital, only the nastiest germs can survive all the cleaning and sanitizing – so if any germs are left, they are likely to be the kind that can make baby very, very sick. In KMC, on the other hand, babies are mostly exposed to the bacteria that live on mom’s skin. These bacteria are actually beneficial – they help to strengthen baby’s immune system and suppress the growth of all the nasty bugs in baby’s gut. And because mom is in such close contact with baby, her body can detect exactly which germs baby is being exposed to and make sure that her milk is full of antibodies to fight those germs.
KMC is a very effective way of keeping premature babies warm. Now, a bit of cold may not seem like a major problem to us, but for premature babies, cold can kill: they are not able to generate much heat from inside when they get cold, so they are almost completely reliant on outside heat. Sometimes parents are worried that a baby in KMC will get cold because he is wearing only a diaper, but I’ve honestly never seen a baby get cold in KMC, not even in midwinter. What I have seen is babies who get cold in incubators, even at very high heat settings, whose temperatures normalise very quickly once they are placed in KMC. If it is very cold outside, baby can wear a cap to limit heat loss on the head, which is the only bit of exposed skin.
A mother’s body is an amazing thing, and the way temperature regulation works is a prime example. A woman who has given birth recently will actually have a skin temperature about 1°C higher than other adults, specifically so that she can act as an “incubator” for her baby. But it gets even better: her chest temperature will rise or fall according to baby’s skin temperature, to ensure that baby stays perfectly heated at all times. So if baby is getting a bit cold, mom’s skin temperature can increase by up to 2°C; or if baby is a bit hot, her temperature can drop to 1°C below normal. And as if that isn’t enough, nature has another trick up her sleeve: if mom has twins, and she places one twin on each side of her chest, the skin on each side will monitor and vary its temperature independently – so she could be heating up on one side and cooling down on the other. Isn’t that just mind-blowing?
Better breastfeeding outcomes
Of course I had to bring breastfeeding into the picture! The truth is, KMC makes an enormous difference in breastfeeding outcomes for premature babies. Some of the benefits you can expect to see include:
- Better milk production, as skin-to-skin contact stimulates mom’s body to secrete more milk-production hormones.
- Babies learn to suckle at the breast more easily. Premature babies typically have an immature suckling reflex, so they cannot actually breastfeed effectively. Without KMC, babies only start suckling effectively at around 34-36 weeks of gestation. With KMC, however, the suckling reflex can mature a lot more quickly. Some KMC babies have been shown to be able to breastfeed from as early as 28-30 weeks – that is a huge difference!
- Babies who are cared for in KMC are more likely to be breastfed exclusively and less likely to need formula top-ups. They are also likely to keep breastfeeding for longer after discharge. My guess is that this all comes down to the fact that mom has better milk production and baby develops better suckling skills.
Growth and development
Premature babies in KMC gain weight faster, possibly because they’re not wasting any energy to try and stay warm. Faster weight gain keeps the medical team happy, and ensures that mom and baby can go home sooner. It’s a win-win all around.
KMC also has profound effect on baby’s neurodevelopment, i.e. the development of the brain and nervous system. At birth – even at full term – the brain is still very immature and most of the structures are not properly formed. The experiences that a baby has after birth determines how the brain will be wired. KMC ensures that the brain develops normally and limits the damage from the stressful effects of premature birth and medical interventions. Babies in KMC also spend more time sleeping, which helps their brains to develop and mature. This is such a fascinating topic; if you would like to know more about it, check out the excellent DVD, Grow your Baby’s Brain, by Dr Nils Bergman.
If you ask a mom who did KMC what the best part of it all was, you will almost always get the same answer: the loving bond that they developed with their baby. Skin-to-skin contact with her baby releases a flood of mothering hormones in the mother’s brain, helping her to bond with her baby and learn to read and respond to her baby’s cues. A premature birth can be a very traumatic experience, and moms often carry a lot of guilt and doubts because of it. KMC is one of the best ways to help such a mother get started on her journey of motherhood. A mom who has to carry and interact with her baby all the time quickly becomes a confident mother as her instincts start to work.
Of course, KMC is also good for the baby’s psychological state. One of the most remarkable things about babies that are in KMC is that they almost never cry. Now, no matter what your granny may have told you, crying is really not good for babies. Crying (or any form of stress) releases a flood of stress hormones in baby’s body. If these stress hormones stay high, they impair everything from weight gain to brain development. Babies who are separated from their mothers can have stress hormones easily TEN TIMES over the normal limit – even if they are not crying and appear to be content. When it comes to keeping babies stress-free, KMC is a no-brainer.
Want to know more?
I hope I’ve convinced you that there’s something to this seemingly primitive practice of keeping our babies skin-to-skin. If you want to know more, I urge you to look at the work of Dr Nils Bergman. Dr Bergman is one of my heroes; he has done such phenomenal work in developing and implementing Kangaroo Mother Care in Southern Africa. Check out his website on kangaroomothercare.com, or check him out on YouTube – here’s a nice video where he talks about skin-to-skin contact. He also has a website with more technical information, for the geeks among us, here. Enjoy!
Have you ever seen KMC in action? Are you keen to try it? Tell me your stories in the comments below!