What is KMC?
What is Kangaroo Mother Care?
· Skin-to-skin contact
· Support for Mum and baby
(WHO has early discharge here)
Difference Between “Kangaroo Care”, “Kangaroo Mother Care” and “Skin-to-skin Contact”
They are different – but along the same spectrum! You will notice that our website is www.kangaroomothercare.com as this is the “popular” name for it, but also a term the World health organisation has defined. We see the term “skin-to-skin contact” as the actual intervention, or the key ingredient that makes this work, and so you can find more technical and research material on our parallel site for health professionals Skin-to-skin Contact.
So what is the difference?
In the USA, “Kangaroo Care” is the common term (KC for short), and this really means doing skin-to-skin contact between baby and mother (or father), anything from 10 minutes to an hour or more a day. It is very much an “add-on” to standard incubator care for premature babies. It should be direct skin-to-skin, but often the baby is wrapped up. KC requires that the baby is “stable”, and so may be already a week old or more. (The babies who have not survived to 1 week obviously don’t get this care.) The usual technical definition is “intra-hospital maternal-infant skin-to-skin contact”. While KC has profound effects on the baby, KMC does so much more!
“Kangaroo Mother Care” on the other hand is defined by the World Health Organisation, and means skin to skin contact starting early , PLUS breastfeeding and support for parents, PLUS early discharge. So this is much broader, but many people still believe that the baby must be “stable” before KMC can start. We think this is a major problem, becuase we believe that preterm babies are unstable because they are not in skin-to-skin contact. Now they stay unstable and if not strong enough or have access to sophisticated technology they may die. Many babies in the world will not survive because they start unstable, and are denied the skin-to-skin contact that would make them stable. KMC (as in Kangaroo MOTHER Care) makes mother more central to the team which is good and promotes breastfeeding which can of itself be life-saving for prems. We should insist on skin to skin contact between mother and baby starting early and being continuous – this is what makes all the difference. In skin-to-skin contact, the newbron brain is competent to breastfeed, without mothers help! And so all that is needed is to support the mother in keeping her infant in constant skin-to-skin contact. For very premature babies, this support means also adding technology.
The word kangaroo is the popular layman term, and applies to prematurity. The neuroscience is based on direct skin-to-skin contact, which connects sensory nervous pathways of mother and infant. So, we prefer to call it skin-to-skin contact, so there is NO question of whether the baby can be dressed or not. One reason for using “contact” is that “care” does not change, it is only the place of care that changes when baby is in contact with mother. Preterms do need technology, but it is now added while on mother (and by using father to take turns, baby can have it 24 hours a day).
Skin-to-skin contact should START FROM BIRTH.
This method uses the mother’s skin and presence to stabilise the baby. In a careful clinical study by Dr Bergman (2004), all the premature babies starting skin-to-skin contact from birth stabilised within 6 hours. Only half the premature babies placed in incubators stablised. As the baby feels SAFE on mum with familiar heart beat and voice and smell, her body, e.g. heart rate, breathing and temperature etc, stabilise much faster, and emotionally and socially she bonds with mother much earlier. The breastfeeding starts almost automatically. This can be seen from 31 weeks onwards, but even 28 weekers can breastfeed with help. It was this method that Nils used in Zimbabwe and it resulted in a 5 fold increase of survival of babies born below 1500g. The mother is the incubator, and she does it much better, because her baby does not get stressed.
Skin-to-skin contact should be continuous.
In mammalian research, separation tolerance is measured in minutes!! The underlying neuroscience is that the baby is stressed for most of the time as she is separated from Mum, and this stress keeps the baby unstable. Holding your baby in skin-to-skin for over an hour is needed to make a full sleep cycle, which wires brain circuits. It also decreases the load of stress which protects from long term “wear and tear” effects on baby organs and metabolism. The neurobiology also changes, the constant sense of safety makes for better emotional and social development.
Skin-to-skin contact is also necessary for full term babies,
The term “kangaroo” (as in premies) is not really the best for full terms, skin-to-skin contact describes it better!
If EVERY baby (full term or prem) could get skin-to-skin contact at birth, and be left on mum’s chest for the first few hours of life, we would not create so many problems caused by the stress of separation from mum. There would be less problems with babies getting cold or stressed or sick, there would be less problems getting babies to breastfeed.
If the baby is premature then add technology, but with the baby in her SAFE place, on mother’s chest!