Kangaroo Mother Care:An Argument for the Adoption of a Comprehensive

KMC Program in U.S. Hospitals

By

Nathaniel B. Broyles

PSY 281 - Developmental Psychology IProf. Elizabeth Geiling

August 3, 2011

Kangaroo Mother Care (KMC) is a technique wherein newborns are carried directly

against the skin of the mother. The practice was “started in 1978 in Bogota (Colombia) in

response to overcrowding and insufficient resources in neonatal intensive care units associated

with high morbidity and mortality among low-birthweight infants.” (Charpak, 514) It is

practiced in low, middle, and high-income countries but is most prevalent in developing

countries that do not have access to the same level of health care and medicine found in countries

like the United States. It is primarily practiced because there is very little cost associated with its

practice, which makes it affordable in a country where there may only be one trained medical

doctor serving the needs of the equivalent of a mid-sized city in a more developed nation.

Surprisingly, however, those infants who are “getting by” on KMC may be better off in some

ways than those who are cared for in what we envision in America as “normal.”

Dr. Edgar Rey Sanabria founded the KMC practice in 1978 in order to address the critical

“lack of incubators, cross-infections, and infant abandonment at his hospital.” The overcrowding

and insufficient resources in Dr. Sanabria’s neonatal intensive care unit led to a high morbidity

and mortality rate among low-birthweight infants. The intervention that he developed involved

continuous skin-to-skin care between infant and mother, exclusive breastfeeding, and early home

discharge in the kangaroo position. (Charpak, 514) The theory behind KMC has its basis in

neuroscience and operates on the premise that mother and infant are a dyad that should not be

separated. Kangaroo refers to the means by which some marsupials care for their young, wherein

the infant is kept warm in a maternal pouch and close to the breasts for unlimited feeding. (Ali,

156) Brain development in infants requires maternal sensory stimulation based on skin-to-skin

contact and the incubator strips that stimulation away, leading to poorer brain development.

(Etika, 220) In many cases, incubator treatment is unnecessary for the health and survival of the

infant but is still used as a matter of course.

Low-birthweight (LBW) infants are a major problem all over the world and not solely in

less-developed countries. In developing countries, however, approximately 30% of all neonatal

mortality is directly related to LBW. It has become common practice in hospitals around the

world to treat LBW infants in incubators or with radiant warmers. In developing countries, these

practices are often extremely difficult to implement due to the high costs of the equipment,

difficulty in maintenance and repair of that equipment, unreliable power supply, and a lack of

trained staff. (Ali, 156) It was an innovative and creative solution to a critical problem. The

solution also had unexpected benefits that had researchers flocking to Bogota to learn this new

technique.

Later testing to determine whether or not KMC was truly a viable alternative to what we

think of as conventional care for LBW infants proved that, in many ways, KMC is a better

alternative, provided that there are no other barriers than LBW for the infant to overcome. For

instance, babies born prematurely would need more help than KMC can provide in order to

develop physically enough that KMC becomes an option for care. When comparing conventional

treatment of LBW infants with those receiving KMC, as was done from March 2006 to

September 2007 in a randomized controlled trial (Ali, 159), the KMC infants demonstrated

significantly higher weight gain during the course of their hospital stay. It is theorized that this is

due to reduced energy requirements that the infant was able to direct towards growth. There was

also a large reduction in respiratory rate and an increase in oxygen saturation in the infants

receiving KMC. Since both processes are gravity dependent, the upright position utilized in

KMC practice seems likely to be a factor in explaining those results. Since placing an infant in

skin-to-skin contact with their mother underneath a blouse or shirt inevitably creates an

insulating effect, the KMC infants showed very few instances of hypothermia and a higher rectal

temperature than those receiving conventional care. Incidences of infection were also

significantly higher in the infants receiving more conventional care. (Ali, 160)

If the physical differences between LBW newborns receiving conventional care versus

those being given KMC were not astounding enough, studies show that KMC has an effect on

the neurobehavioral responses of infants. In fact, there is a significant difference in

neurobehavioral development between infants receiving radiant warmer or incubator care and

those receiving KMC. (Rebecca, 54) In one study, performed from June 30, 2008 through

August 5, 2008, the physiological differences were observed through electronic thermometer and

monitors. A Modified Brazelton Behavioral Assessment Scale was used to judge the

neurobehavioral state of the infants. It should also be noted that this study was aimed at full-term

newborns that were not classified as LBW. When observing the physiological state of both

groups of infants, it was seen that both fell into what could be classed as normal parameters. It

was in the neurobehavioral results that significant differences were found. The mean behavioral

response score of the radiant warmer care infant was 5.6500 and the KMC infant mean was

5.9500. That is a differential that certainly cannot be ignored and explained away as an anomaly.

Although originally intended as an alternative practice in lower income settings, it is clear

that KMC can also be utilized to great effect in high-technology environments also. Where KMC

is practiced in those more wealthy areas, the more traditional treatment tends to be supplemented

by KMC sessions of one to a few hours for intermittent periods. (Nyqvist, 812) Many of the

same effects noted in those LBW infants whose mothers utilize KMC are found even in those

babies fortunate enough to be born in a more high-tech environment and receive intermittent

KMC. In addition to those positive effects previously mentioned, infants experience: a decrease

in the pain response for painful procedures, lower infant cortisol, and physiological parameters

tend to be more stable during transport when KMC is used by parents (even hospital staff if the

child’s parents give permission). (Nyqvist, 813)

Other common benefits of KMC are psychosocial in nature. For instance, when engaging

in KMC there is a more rapid healing from parental crisis reactions after the birth of a pre-term

or LBW baby. In addition, recovery post-partum depression in new mothers is increased over

those mothers who engage only in more conventional care of their infants and feel less stress

associated with their newborn. Even the intermittent KMC usually practiced in more affluent

hospitals results in a higher breastfeeding rate, longer durations of breastfeeding, and a higher

proportion of exclusive breastfeeding while in the hospital and through follow-up care. (Nyqvist,

813)

KMC is not relegated to the sole domain of mothers as it can be equally important, even

beneficial, for the father to also engage in the skin-to-skin contact of KMC. The interaction of

the father is especially beneficial once mother and infant have been discharged from the hospital

and are in their home environment. Unlike the marsupials whose name we use to characterize

this particular method of infant care, humans do not have a belly pouch to carry an infant around

in and so mothers will, inevitably, need help in order to provide continuous KMC. Although the

father cannot breastfeed the infant, the skin-to-skin contact provides much the same benefit that

would be received from the mother. In fact, studies show that the father’s involvement in more

direct KMC carries with it a greater sensitivity by the father, a better perception of the child by

the father, and an all-around better home environment. It is hypothesized that this sense of co-

responsibility and greater involvement happens the first time that the “carrying position” is used.

(Tessier, 1448) Fathers who engaged in more traditional care may also develop those same

feelings but it is more likely that KMC fathers will form those deeper connections more quickly.

Whereas the more traditional high-tech care found in Western societies, and which have

become the norm around the world, can often cost tens of thousands of dollars in equipment and

training, the implementation of KMC has no such costs associated with it. In fact, the only costs

associated with KMC is for the training of the hospital personnel who would be responsible for

educating new mothers and fathers on how to properly implement their personal KMC program

and, perhaps, some literature to be printed and distributed to those same parents. There would be

tremendous cost savings for the parents, too. Buying formula can be extremely expensive but

breastfeeding is, essentially, free. Caring for a newborn can be a financial burden with all of the

associated costs but paying for something that nature provides should not be one of them.

In 2010, a proposal was made to revise the World Health Organization’s practical guide

to include updated information and extensive revision. That proposal includes an exhaustive

argument for the WHO to strongly endorse more comprehensive KMC practice worldwide.

(Nyqvist, 825) All of the available evidence supports KMC as not just an alternative treatment

for LBW infants in low-income areas of the world but as an important component infant

development. While low-income hospitals may, out of necessity, have KMC as the totality of

infant care, KMC has proven to be equally as effective in a high-tech environment. While it must

be acknowledged that KMC cannot completely replace all of the neonatal care that infants

deserve, especially when the treatments are available, KMC should be universally practiced and

taught to mothers in every hospital around the world. The benefits of KMC are tangible and

cannot be denied as advantageous both to the dyad of mother and infant but to the entire family

unit as well.

Works Cited

Ali, S., Sharma, J., Sharma, R., & Alam, S. (2009). Kangaroo Mother Care as compared to conventional care for low birth weight babies. Dicle Medical Journal / Dicle Tip Dergisi, 36(3), 155-160. Retrieved from EBSCOhost.

Charpak, N., Ruiz, Juan G., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo., M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., Worku, B. (2005) Kangaroo Mother Care: 25 years after. Acta Paediatrica, 94(5), 514-522. Retrieved from EBSCOhost.

Etika, R., Roeslani, R. D., Alasiry, E., Endyarni, B., & Bergman, N. J. (2009). "HUMANITY FIRST, TECHNOLOGY SECOND" REDUCING INFANT MORTALITY RATE WITH KANGAROO MOTHER CARE: PRACTICAL EVIDENCE FROM SOUTH AFRICA. Folia Medica Indonesiana, 45(3), 219-224. Retrieved from EBSCOhost.

Rebecca, J., Nayak, S., & Paul, S. (2011). Comparison of Radiant Warmer Care and Kangaroo Mother Care Shortly after Birth on the Neurobehavioral Responses of the Newborn. Journal of South Asian Federation of Obstetrics & Gynecology, 3(1), 53-55. Retrieved from EBSCOhost.

Nyqvist, K. H., Anderson, G. C., Bergman, N. N., Cattaneo, A. A., Charpak, N. N., Davanzo, R. R., & ... Widström, A. M. (2010). State of the art and recommendationsKangaroo mother care: application in a high-tech environment. Acta Paediatrica, 99(6), 812-819. doi:10.1111/j.1651-2227.2010.01794.x

Nyqvist, K. H., Anderson, G. C., Bergman, N. N., Cattaneo, A. A., Charpak, N. N., Davanzo, R. R., & ... Widström, A. M. (2010). Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care. Acta Paediatrica, 99(6), 820-826. doi:10.1111/j.1651-2227.2010.01787.x

Tessier, R. R., Charpak, N. N., Giron, M. M., Cristo, M. M., de Calume, Z. F., & Ruiz-Peláez, J. G. (2009). Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatrica, 98(9), 1444-1450. doi:10.1111/j.1651-2227.2009.01370.x