Kangaroo Mother Care: The Benefits of Skin-to-Skin Contact with Newborns
Kangaroo Mother Care, or Skin-to-Skin contact with a newborn immediately after birth, has proven to be a highly beneficial practice, with hardly any negative impact. Kangaroo Mother Care, or KMC for short, provides a newborn the warmth, stimulation, safety, protection from infection, and love that they need. KMC has benefits for not only the newborn, but also significant benefits for the mother, including a boost in her self esteem. Through various studies, pediatricians and obstetricians have found little negative impact through the use of the Kangaroo Mother Care method. The only time it should not be used is in emergency situations, where a newborn is not stable enough to remain with the mother, or vice versa. The cases that do not allow for an infant to remain with the mother often result in surgeries. More hospitals and birthing centers have transitioned to KMC over standard care because of the physical and psychological benefits it provides. Skin to skin contact, or Kangaroo Mother Care, is a highly beneficial, though only barely emerging area of study in both Obstetrics and Pediatrics. If hospitals and birthing centers transition towards Kangaroo Care over standard care, infants will develop more to their potential.
Methods
The have been numerous studies performed to test the validity of the Kangaroo Mother Care method. Each study that has been researched provided an excellent insight to the positive outcomes the KMC method offered.
Flacking, Ewald, and Wallin investigated the rates of breastfeeding for premature infants for up to 6 months, corrected age, after using the kangaroo method of care. This study found positive effects on the length of breastfeeding times and exclusivity of breastfeeding while using skin to skin contact with very premature and premature infants. Flacking, Ewald, and Wallin found that with support of kangaroo care, mothers were able to sustain breastfeeding for a prolonged duration. 1
An article in Developmental Psychology by Feldman, Weller, Sirota, and Eidelmanexplained (consider separating the two words) their research that proved the self-regulation benefits in premature and low birth weight infants when kangaroo care was used. The authors proved research in both animal models that showed negative and irreversible effects when separated from their mother after birth, even if just for a short amount of time. Human and animal models showed the positive effects of skin-to-skin contact, including an improved state organization, stress reactivity, physiological maturation, and attention. The authors also included a study that found that placing a premature infant in the nursery after birth proved detrimental to the infant’s vision and auditory development.2
Ferber and Makhoul focused their study towards the positive effects kangaroo care has on full term infants, not only premature or low birth weight infants. The authors performed a study where two different mother-infant groups were observed, one group using kangaroo care after delivery, the other did not. The authors found that the infants, who were in the KC group, slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements.3
The British Journal of Midwifery included an article by Gregson and Blacker, explaining not only the benefits of skin to skin contact for the infant, but also the mother. Gregson and Blacker found that kangaroo care reduces the length of hospital stays and improves breastfeeding rates upon discharge from the hospital. This study also tested the outcomes of kangaroo care with premature infants, and infants born to diabetic mothers. The authors study confirms that the outcome of kangaroo care is highly beneficial.4
Amy Johnson performed a study on the effects of KMC through the mother’s perspective. The study examined the experience that mothers, or their surrogate, have while using the Kangaroo Mother Care method. Mothers were especially noted to feel more needed after using KMC, and often, more joyful. Johnson found that mothers needed support while holding, meaning encouragement, planning, and teaching. The author also found that mothers who felt scarred or nervous before the birth, was more at ease after using the kangaroo care method. This study also found the need for quiet space often helped create a connection between mother and infant during skin to skin contact.5
The World Health Organization (WHO) presented information on how to improve the outcome of low birth weight infants through the beneficial technique of skin to skin contact, or kangaroo care. Though the book was geared more towards stable premature infants and infants born with a low birth weight, the information presented was highly transferrable to all infants after birth. This book could be considered a how-to guide for parents wishing to use KMC (Kangaroo Mother Care) after their child is born, but it also provides scientific research as to why the KMC way is highly recommended.6
An article in the Korean Journal of Women’s Health Nursing showed that results of a study performed by Lee and Bang. The study and article was geared more towards the psychology of the mother and the infant’s physiological stability. Lee and Bang found that after using the Kangaroo Mother Care method, maternal self esteem was higher when it came to caring for the newborn. The authors also found that KMC helped with the infant’s physiological stabilization in terms of their body temperature, respiratory rate, heart rate, oxygen saturation, and stability of the cardio-respiratory system in premature infants (SCRIP) score.7
Puig and Squassero performed research on the effects of skin to skin contact with newborns and their mother. Their research found that infants cry less when placed directly on their mother’s chest. Skin to skin contact also improves the mother-infant interaction, keeps the baby warm, and aides in breast-feeding for both the mother and the child. The authors researched not only the positive effects of initial skin to skin contact, but also the benefits of the varying lengths. It was important to note that no negative effects were found.8
An article, found in the Journalof Perinatology, was a research study comparing the effects of kangaroo care to standard care after a baby’s birth. The authors (Shohei, et al.) wanted to determine the outcome of kangaroo care through the first year of an infant’s life and whether or not it was more beneficial than standard care. The research found that infants cared for with KC (kangaroo care) tested better on various infant tests, such as NBAS and Bailey Scales. Kangaroo care was proven to have a more positive outcome on the mood, temperament, and development of infants up to age one.9
Results
Through the various studies, research has found Kangaroo Mother Care an upgrade from the usual standard care given to infants after they are born. KMC provides a great deal of additional support to newborns, whether preterm, low birth weight, or full term infants. Not only does skin-to-skin contact help the newborns, but it also helps the new mother. Breastfeeding is one of the greatest advantages associated with KMC. Through skin to skin contact, breastfeeding occurs with less force and frustration.
Preterm and Low Birth Weight Infants
Kangaroo Care was initially implemented in1978 by a Columbian pediatrician, Dr. Edgar Rey, following a realization of the inadequate equipment his hospital had.10 He found the Kangaroo Mother Care method to be even more beneficial than incubators in maintain body temperature, bonding, and breastfeeding. Dr. Rey was correct; after many years of research, KMC has still proven to be the best source for a newborn’s needs.
Various difficulties present themselves in preterm and low birth weight infants. The Kangaroo Mother Care method has been shown to stabilize an infant’s heart rate, body temperature, respiratory rate, and oxygen saturation.7 Lee and Bang scored the preterm infants using the SCRIP’s scoring method:
Table 1.SCRIP: Stability of the Cardio Respiratory System in Premature Infants Score
SCRIP Points
Perfect Stability(2pts)
Minor Stability(1pt)
Severe Instability(0pt)
Heart Rate
Regular
Deceleration to 80~100
＜80/min or＞220/min
Respiration
Regular
Apnea＜10 and/or periodic breathing
Apnea＞10, Tachypnea＞80/min
Oxygen Saturation
Regular >90%
Any falls to 80~89%
Any falls below 80%
Source:Lee, Jihye, and Kyung-Sook Bang. 2011. "The Effects of Kangaroo Care on Maternal Self-esteem and Premature Infants' Physiological Stability." Korean Journal Of Women Health Nursing 17, no. 5: 454-462. CINAHL Plus with Full Text, EBSCOhost (accessed April 19, 2012).
The Kangaroo Mother Care method also allows for a shorter hospital stay for both mother and baby.4Gregson and Blacker found in their study of 107 women, their hospitalization stay was shortened from 5 days (the control group) to 4 days.4 Through the use of KMC, infants scored higher on the Apgar scale, which led to less severe medical measure, and shorter hospitalization. 4
When preterm or low birth weight infants are not placed directly on the mother’s, or surrogate’s, chest and are taken directly to the nursery, the infant and mother experience negative effects. Feldman et al., found irreversible, negative effects, even if just for a few moments, on both mother and child in an animal study, and correlated to human mother and child.2The authors also found negative auditory and visual effects on preterm infants placed in the nursery, instead of on the mother’s chest.2
Full Term Infants
Dr. Ferber and Dr. Makhoul’s study examined the effects of KMC on full term infants. Their research found infants who used the Kangaroo Mother Care method were more likely to sleep longer and more peacefully.3 Along with more sleep, infants also cried less when placed directly on the mother’s, or surrogate’s, chest.8 Skin to skin contact provided a stronger mother-infant bond and aided with breastfeeding.1
Shohei et al., found a year after their birth, infants who used the KMC method tested higher on various infant tests.9The Kangaroo Care method was proven to have a significant positive outcome on infant’s temperament, mood, and behavior, up to age one.9The results of the NBAS (Neonatal Behavioral Assessment Scale) test were:
Source:Shohei, O. et. Al. (July/August 2002). “Comparison of kangaroo care and standard care: behavioral organization, development, and temperament in healthy, low-birth-weight infant through age one.” Journal of Perinatology.No.22 (5).Retrieved on April 5, 2012.
Effects on the Mother
The Kangaroo Mother Care method does not only provide positive outcomes for the infant, but also for the mother. The KMC method was noted to make the new mother feel more needed and closer to her child.5 Johnson’s study taught new mothers, or their surrogate (father, sibling, etc.) how to properly use the KMC method. The author also found the KMC method gives an anxious new mother a sense of calm and bond with her new baby.5
Skin to skin contact was also shown to improve the self esteem of the new mother.7 Lee and Bang found that the KMC method promoted a new mother’s self esteem by proving that she can be comforting to her new child.7 The authors gained this information directly from the new mother.
Skin to skin contact also helped the new mother with breastfeeding. When placed directly on the mother’s chest, the infant found its way to nurse, with very little outside help.1 KMC was shown to have empowering effects on breastfeeding and the bond it creates between the mother and child.1
Discussion
The Kangaroo Mother Care method has been used for only a short time, in terms of other compared to other medical practices. Though relatively new, the KMC method has many positive outcomes with very few, if any downfalls. The studies show the positive outcomes for all involved. In preterm or low birth weight infants, the KMC method helped to stabilize the heart rate, regulate body temperature, and reduce sleep apnea and crying.7 The KMC method was also useful in the same way with full term infants. In addition to regulation, full term infants were also observed having longer, undisturbed sleep cycles3, less crying, and higher scores on infant testing a year after birth, being skin to skin with their mother.9New mothers also benefited from the KMC method. The studies found out that they had a closer bond with their newborn. Furthermore, new mothers had a raised sense of self esteem and felt more comfortable with their new child.7
Conclusion
Though a fairly new practice, the Kangaroo Mother Care method has proven highly beneficial for both mother and newborn, whether preterm, low birth weight, or full term. The positive effects from skin to skin contact far outweigh the effects of standard care. More hospitals and birthing centers are implementing the Kangaroo Mother Care method. Because of this, more preterm infants have developed more to their potential. The transition stems from the physical and psychological benefits KMC provides, over standard care. Skin to skin contact, or Kangaroo Mother Care (KMC), is a highly beneficial, though only barely emerging area of study in both Obstetrics and Pediatrics. Through the positive effects it holds, more births use some form of skin to skin contact, whether for a preterm or not.
References
1. Renee Flacking, UweEwald, and Lars Wallin. “Positive Effect of Kangaroo Mother Care on Long-Term Breastfeeding in Very Preterm Infants.” JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing40, no.2. (2011):190-197.
2. Feldman, Ruth, Aron Weller, Lea Sirota, and Arthur I. Eidelman. 2002. "Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration."Developmental Psychology 38, no. 2: 194-207. PsycARTICLES, EBSCOhost (accessed April 19, 2012).
3. Ferber, SG, and IR Makhoul. 2004. "The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial." Pediatrics 113, no. 4 Part 1: 858-865. CINAHL Plus with Full Text, EBSCOhost (accessed April 19, 2012).
4. Gregson, Sarah, and Jonathan Blacker. 2011. "Kangaroo care in pre-term or low birth weight babies in a postnatal ward." British Journal Of Midwifery 19, no. 9: 568-577. CINAHL Plus with Full Text, EBSCOhost (accessed April 19, 2012).
5. Johnson, Amy. “The maternal experience of kangaroo holding.” JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 36, no. 6(2007): 568-573.CINAHL Plus with Full Text, EBSCOhost (accessed April 19, 2012).
6. 2003. "kangaroo mother care: A practical guide." Kangaroo Mother Care 1-48. Academic Search Complete, EBSCOhost(accessed April 19, 2012).
7. Lee, Jihye, and Kyung-Sook Bang. 2011. "The Effects of Kangaroo Care on Maternal Self-esteem and Premature Infants' Physiological Stability." Korean Journal Of Women Health Nursing 17, no. 5: 454-462. CINAHL Plus with Full Text, EBSCOhost (accessed April 19, 2012).
8. Puig G, Sguassero Y. Early skin-to-skin contact for mothers and their healthy newborn infants: RHL commentary (last revised: 9 November 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.
9. Shohei, O. et. Al. (July/August 2002). “Comparison of kangaroo care and standard care: behavioral organization, development, and temperament in healthy, low-birth-weight infant through age one.” Journal of Perinatology. No.22 (5). Retrieved on April 5, 2012.
10. UCL Department of Psychology. “Kangaroo Care: A Short History”. Accessed April 19, 2012. http://www.ucl.ac.uk/kangaroocare/kangaroocareashorthistory.html
