Dr Bergman

Speaker and talks information

Dr Bergman’s passion starts with “skin-to-skin contact”, his preferred term for what many people call Kangaroo Care. Dr Bergman regards maternal-infant skin-to-skin contact as a first and critical intervention in perinatology, with broad public health impacts and implications. His expertise extends to developmental neuroscience, breastfeeding, neonatology and obstetrics. He takes an integrated view of these areas, regarding skin-to-skin contact as the neurological pre-requisite to successful breastfeeding, with neonatal and obstetric care re-orienting its purpose to maintaining the integrity of the mother-infant dyad. This holistic view he terms “Kangaroo Mother Care”. He was however previously a hospital manager, and is currently a Public Health Physician, and sees these issues in the broader context of hospitals, health systems and society as whole.

On the following pages is a compilation of talks he is able to provide.

Note however:

1          They are described by titles which seeks to convey the content succinctly, but cover broad areas of collated research..

2          Though they are presented here as standard talks, they are constantly changing and developing as new science and knowledge is available.

3          The detailed content for each talk is described in outlines and objectives, and are not provided in this document.

4          Dr Bergman will of his own make minor adjustments and tailor his presentation to any specific conference theme or title, or to perceived or observed needs.

5          Dr Bergman is prepared to give other talks, or tailor make content according to particular needs, by special arrangement as negotiated.

6          Dr Bergman can also provide Powerpoint summaries of his talks in “handout format”, note however that he never gives exactly the same talk twice, therefore these handouts will not accurately match his presentation.

            (A selection of slides on CD is available with a DVD of videos

distributed by Geddes Productions    www.geddesproduction.com .)

7          Audiences should be encouraged to follow the presentation without reference to handouts or making notes, as Dr Bergman talks too fast for that.   J

Talks overview

All talks have prepared outlines, objectives and references. On request, content can be customised, and these can be amended appropriately.

Topics suitable for Grand Rounds

Grand Round (GR for doctors): 50 minutes, plus time for questions

             “Perinatal neuroscience and skin-to-skin contact”

 “The Scientific and Evidence Base for Skin-to-skin Contact” 

Workshop presentations s or talks

As Dr Bergman charges per day, his time is best used for whole day workshops. For such workshops, the basic neuroscience and evidence base is best covered with any two of the following titles. They are based on 90 minute presentations,  but can if necessary be condensed a little. Conclusions can be customised to address specific issues or Conference themes.

"Perinatal neuroscience and skin-to-skin contact"

“The Scientific and Evidence Base for Skin-to-skin Contact” 

 “Kangaroo Mother Care: Restoring the Original Paradigm for Infant Care"

The following topics are all 90 minute presentations, which are available in 60 minute versions. They build on core knowledge from the first two presentations, they do NOT stand alone!

 “Neurologically supportive Labour ward and NICU environments”

“Clinical research update on skin-to-skin contact”

“Skin-to-skin contact: current evidence and future directions”

“A neurobehavioural approach to breastfeeding”, (incl’ breastfeeding premature infants)

“A Neurobehavioural approach to feeding frequency” (evidence on stomach capacity)

“Maternal perinatal neurobehaviour”

“Anthropological and sociological aspects of skin-to-skin contact”

The following can stand alone, but make more sense at the end of a workshop or conference. The implementation session can be done with audience participation, for which 120 minutes is preferable, (looks at social marketing and strategy planning in local context)

 “Third World solutions for premature infants”

 “Public health implementation of skin-to-skin contact”

D         Other “consulting services”

A common feedback at previous events around the world has been the wish that the information Dr Bergman is presenting should also reach doctors in the hospitals. The following “hospital options suggest three additional ways in which thica  be done, apart from the Grand Rounds.

Hospital Option          “FIRESIDE” ROUND       (Appendix 1, 1 page, SEE BELOW)

Hospital Option          PRACTICAL DEMONSTRATION        (Appendix 2, 2 pages, SEE BELOW)

Hospital Option          SENSORY ENVIRONMENT

Ward round / demo from that talk,  using decibelmeter and luxometer.

Hospital Option          CHANGE MANAGEMENT

Management team meeting

Change team setup or support

Protocol session                      (Appendix 3, 1 page  SEE BELOW)

Hospital Option          “Implementation workshop”   (3 – 8 hours)

            Dr Bergman is also available on a consulting basis for Services wishing to implement or improve their practice in any way, or planning new physical infrastructure appropriate to the latest developmental neuroscience.

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Appendix 1

Hospital Option         “FIRESIDE” ROUND

Purpose: to provide health professionals working in the NICU (and unable to leave) to hear the review of the latest perinatal neuroscience, particularly the sensory needs of the neonate, and the role of skin-to-skin contact in care, and respond to this.

Many NICU nurses and doctors have difficulty attending lectures as they cannot leave their patients. “Fireside” lectures are conducted in the NICU, where staff can respond to alarms and monitors, and still attend to the topic. This requires a smaller group of attendees, for which a projector is not necessary, the laptop screen can be used directly. I keep my voice level low so as to not disturb babies. Parents can also attend these, specially if the lecture is combined with practical demonstrations (C ) that they may consent to afterwards. The timing of these should obviously be such as to meet the staff needs best, and avoid working rounds and busy periods, as far as possible. These meetings also work well in the evenings for the night staff.

The prepared content covers similar areas to the GR, but includes information on the sensory environment of the NICU and the developing brain. With a small group I work flexibly with all the material in my database of slides, and I can change the topic to meet the immediate needs and questions of staff. My own observations of the particular NICU sometimes guide my choice of topics. Time flexibility and a relaxed atmosphere is required, up to two hours to allow for interruptions and interactivity.

This session can stand alone, but is best combined with Option “practical demonstration”.

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Appendix 2

Hospital Option         PRACTICAL DEMONSTRATION

Purpose: to provide all practicing health professionals with direct “hands-on” skills development in techniques to initiate safe continuous skin-to-skin contact.  As this may be a daunting and novel idea, I provide some details as to what is entailed below.

Time required 60 – 120 minutes

In the workshop environment I regularly use a manikin to demonstrate the technique for the KangaCarrier. Such demonstration does however not compare with the real life situation. The very concept of removing a baby from the incubator may in real life be frightening for some staff, and sufficient preparation of and knowledge transmission to staff is required beforehand. Careful preparation for the actual demonstration is also essential.

Staff issues: The neonatologist in charge must give his expressed consent, both to my presence in his unit, and to working with any particular mother-infant dyad. His actual presence during the demonstration is desirable but not essential. Likewise the sister-in-charge of the unit must be consenting, and willing to apply the techniques in the future. A practical way of doing so is to identify one or two key members of staff who can function as “trainers”, who I will then also train to train, (the sister in charge can obviously be one herself). Finally, the specific nurse in charge of the baby must be willing. She will remain responsible for the baby’s wellbeing throughout the demonstration, and (along with neonatologist and sister in charge) has the expressed right to “bail out” and return to routine if she is at all unhappy or uncomfortable at any stage. The actual baby transfer and equipment handling will be done by the nurse-in-charge, with myself in direct support.

Equipment requirements: A recliner chair that allows for fixing of the backrest, or a hospital bed that allows for changing the angle of rest are preferable. Alternatively a comfortable sofa or divan, with pillows that can achieve different angles is adequate. Rocking chairs are not suitable. The chair or bed needs to be positioned so that the required technology is equally accessible to them as to the incubator.

Baby: I am prepared to work with almost any gestation and weight of baby, but I will make my own assessment of the general condition and current state organization of the baby. For this appropriate consent for me to peruse the patient charts and folder is required. A NICU wishing to implement such changes should start an incremental process with bigger, more stable and less technologically dependent babies, and develop from there. I am therefore happy to start with a completely normal healthy fullterm baby, for which the technique is also applicable. But for the Unit’s sense of confidence, just having witnessed a very small baby in SSC may be helpful to launch the incremental process. There are some practical details with the positioning of very small infants, and the management of the technology, which I like to point out.

Mother: The mother is the most important!  She should be able to give informed consent, which requires that she has some knowledge of what she is consenting to. This may be difficult, but attending a GR or other lecture works fine. Consent should also be obtained by a “third party”, someone the mother does not feel beholden to such that she feels she ought to agree even if she is unhappy. I also prefer that from the outset the father (spouse or partner) be included in the request for consent, and that he be present for the demonstration. (Father’s can and should do SSC, and I am happy to demonstrate on fathers also!) The mother should be told that her consent is preliminary, and that she and her partner will be interviewed by me before any demonstration, and that she may refuse after finding out more details from me.

(It is very valuable for the change process to have media support and coverage, and media generally love the idea. Particular care and sensitivity should however be taken in selecting mothers for such exposure, a particular personality is required ! )

At such an interview, I will introduce myself, and I will ask if mother wants the nurse in charge of her baby to be present or not. I will explain briefly the purpose of the demonstration, and at an early stage explain that skin-to-skin contact requires no brassiere and therefore some very brief exposure of her breasts to me as the doctor doing the technique, and to any audience that she is willing to allow. I attempt to corroborate her sensitivity with partner, and invite refusal of consent. If she does consent, I ask specifically if she is prepared to be photographed, and undertake to convey and enforce her refusal. I establish the size of audience she will tolerate. (Issues about purpose of demonstration, exposure, photos, audience, refusal and bail out can all be covered by staff eliciting preliminary consent, but I will nevertheless go over those again.).

I explain the role of the nurse in charge, including the “right of bail-out”, and extend that right also to the mother to exercise at any time.  I establish when she last fed her baby, and how she feels about the baby at that moment in time. The skin-to-skin demonstration should preferably be timed to follow immediately after a feed, the worst time is just before a scheduled feed. The mother should be prepared to spend longer than one hour providing SSC. I then use a manikin to explain what I will do, in terms of the baby, the wrapper, the shirt, the technology and her own reactions. I do the actual demo while speaking through all the stages, from equipment preparation, chest preparation, baby preparation, placement, securing of baby, positioning of baby and mother, and mobilization of mother. Mother is exposed for two brief moments only, and baby is not exposed to any cold stress at any stage.

For a single dyad, this takes less than one hour. Preferably there should be three or more dyads, allowing for “time juggling” for feeds, state organization, procedures, refusals, decompensations and other unforeseen events. Part of the demo does involve observations during the SSC time, during which time simple psychological support (e.g. allowing crying) to the mother (and or father) should be available. The technique requires regular changing of position timed to feeds, such a change can be included, but can also be managed by the nurse. Such a change can also entail changing to father or other primary caregiver. A minimum time for the demonstration is therefore three hours, but can be extended to 8 if different clinical areas and more staff want the benefit of the demonstration.

At the end of the time it is useful to have a debriefing session with staff involved, and perhaps with parents also. Reflections and impressions can be shared, but also practical detail questions and clinical concerns. Initial thoughts to planning ahead can be shared. Making such formal plans to change practice should however be a subsequent and separate exercise, far too much is involved just to start, without allowing for an extensive and responsible change process.

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Appendix 3

Hospital Option         CHANGE MANAGEMENT / PROTOCOL SESSIONS

Purpose: to provide health professionals at management level to structure a change process that will implement continuously improving use of SSC.

Management meeting

The target audience must include key decision makers and members of management with the authority to make and implement practice changes. Implementing SSC requires a systems management approach. Key stake holders that should attend include clinicians, nurses, department and unit managers, administrators, and finance managers. Such stake holders are however very seldom able to attend a whole day workshop, and therefore may come to the table ill-equipped with the information and reasons that motivates change. Attending a GR should however be a minimum expectation, the language and content will not lose them. Depending on the circumstances, context and individuals present, I can make a formal presentation as to the need, costs and benefits. Such a session should be followed by time for discussion and questions, a one hour time slot is adequate, specially if members attended GR or other presentations. The whole meeting should be minuted and formally tabled to the management hierarchy for approval and followup. Management is fully entitled to make such approval conditional on more information, before releasing required resources. The resources required are in fact minimal, and the benefits greatly outweigh the cost.

Change team meeting

A desired outcome of such a meeting should be the formal appointment of and expressed support to a “change team”. That team should have a formal channel of communication to management, and at best could include a member of management. Such a team may already exist, in which case its members can be named in the minutes. One or two members of the team, not more, could be present at the above meeting.

Allowing for the prior presence of such a team, my involvement should entail a separate meeting with them. I would give a 30 – 40 minute presentation of some basic public health tools and concepts related to make health system changes. These are generic, and apply to making any change. However, change processes must always be unique, being determined by specific contexts, various cultures, current practices, and a host of other variables. My role would be that of a “catalyst”, identifying particular areas that have key leverage or that need attending to before other changes can follow. I would facilitate the identification of key objectives and means of achieving them, and I strive to make such facilitation without producing future dependency on my services! This requires a minimum of three hours, but can be shortened, or extended to a whole day.

Protocol review meeting

A specific part of the above process that can be done as a stand alone, is a round table meeting reviewing existing policies on skin-to-skin contact, breastfeeding and sensory support. This should be attended by senior clinicians, nursing unit managers, and clinical nurse practitioners. The existing protocol can be presented briefly, and then the evidence, interpretation and application of it discussed with a view to making improvements. I maintain a database in my laptop, and can leave references (and often pdf articles) for immediate review and study.

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