"Kangaroo mother care" @ Politics of BFing

[brillopads]

I am reading The Politics of Breastfeeding at the moment, and there's a part about how premature babies in Columbia were give "kangaroo mother care" - placed between their mother's breasts 24 hours a day (p.59). According to the book the babies thrived using this method. My question is, if my baby was premature would I be able to attempt this here, or would doctors take over in the best interest of my child and have them in an incubator ?
I apologise for the naivety of this question, or if this is the wrong board to be asking it on- this is my 1st pregnancy; sometimes I feel myself floundering for lack of advice (apart from reading book after book)- hence so much time spent on MN in general

IME they encourage kangaroo care in the SCBU as soon as baby is strong enough..there is a level of prematurity where the babies are too fragile to be held and of course some need to be connected to ventilators etc. I was def encouraged to do kangaroo care with DS1.

Why are you worrying about this? Have you been advised that you may give birth prematurely?

brillo, yes technically you can although I suspect you would have a real fight on your hands and they could take you to court as has been done with rulings for turning off life supports etc against the wishes of a parent
actually i guess they would start by getting SS inolved if they felt that you were in danger of harming your child?

but in theory yes, it is your child and you could insist on doing that.

You may have to advocate for this and part of this means that you need to make sure that you are fully informed about the benefits and practice of KMC. We have jsut written a book based on just this filled with parents and world leading experts stories. We also have articles and free reports available to you if you go to our website and leave your email details. Hope this helps
Tony & Nyrie Roos
www.themiracleofkangaroomothercare.com/blog

i would imagine that a lot depends on the health and / or gestation of the baby. i think kangaroo care is fairly standard practice in most scbus in the UK nowadays.

Even as long ago as 1997 when ds was born at 31 weeks i was encouraged to give kangaroo cuddles and with dd2 in 2006 (a 27 weeker) i was giving kangaroo care at just 3 days. But it was always medically led - i certainly wouldn't have insisted if the drs were not happy. For the extreme prems in particular as little handling as possible is best as they can get quite distressed very easily.

AFAIK our local hospital encourages this, although I've not had personal experience as my babies weren't early. DS was 11 days late, the little monkey :o

Ask your MW if it's a concern. Congrats on your pregnancy :)

BTW I was certainly encouraged to do a lot of kangaroo cuddles anyway, they are a 'baby friendly hospital' and taught me to cosleep safely etc.

As peer supporters we waffle on for hours talk about the benefits of skin to skin. Dads too!

Most neonatal ITUs strongly encourage kangaroo care. Bar a few nurses (who were mostly nervous I think rather than opposed as such) I was always encouraged to spend several hours a day doing skin to skin, even when my son was hooked up to numberless machines, from when he was a few days old (born at 26 weeks). When he was very ill he had to stay in his incubator, but mostly I spent between one and four hours a day holding him.

I suspect the Brazil studies were done at later gestations than 26-29 weeks though, as they were initially borne out of necessity - ie there were not enough incubators, so mothers had to hold their own babies, and only later did they realise that it improved outcomes. In that environment, babies born before about 30 weeks would stand virtually no chance at all. I just can't imagine 24 hour kangaroo care would work for very early babies - the care needed is just too great for it to be a realistic option. Early babies' skin for instance needs constant moisture levels which it takes an incubator to provide, and many invasive procedures would simply not be possible while lying on a parent.

Beyond this, I have always wondered how on earth 24 hour kangaroo care would work in practice. How do the mothers eat, sleep, go to the toilet, express milk for babies too weak to feed? The really traumatising part for the babies is being moved on and off the parent, so you couldn't keep putting them on and off - once on they stay on until they go back into the incubator.

As you said yourself, you don't have any notion of what having an early baby is like. Hopefully of course it stays that way:) For my part, though I lived for kangaroo care and died a small death on days that I couldn't hold my son, there is no way I could have stood the intensity for 24 hours a day. Holding him was a complex operation: his breathing tubes had to be held precisely right or he would lose oxygen saturation in his blood (ie go short of oxygen), every move (even to scratch my nose) had to be calculated so as not to rip out one of the IV lines or probes attached to every limb. With a 2lb baby, there is as much equipment to hold as there is baby. I'd watch the monitors like a hawk and quail at every alarm in case I'd moved him into the wrong position. When the time came to put him back, it was a relief as well as a sadness to be able to move freely, leave the unit for a while and regain a sense of the outside world.

I hope that helps give you some idea of the realities involved. Kangaroo care is an extraordinary thing, but don't romanticise it - it is emotionally gruelling and physically exhausting.

I read that section in politics of breastfeeding too.

I think that when mum had to shower etc the baby was passed to another family member.

I would say that the romantic notion of how nice it would be to hold the baby 24/7 would be outweighed by practicalities. libelulle makes some very good points.

My Dd was born at 31 weeks and although I did enjoy the closeness of kangaroo care it was also quite stressful, I often knocked her sensors so the monitor would go off etc. It's a hard balancing act because little premmies need that close physical contact but they also need to be left in peace a lot to just sleep and grow.

Hopefully this will remain hypothetical for you, but if you did have a prem baby I think the doctors would be unlikely to agree to 24/7 kangaroo care without a big fight.

Kangaroo care is now standard in all major NICUs, and as others have said it depends on the gestation. If the baby is over about 32 weeks and is stable on oxygen then it is relatively straight forward. It involves oxygen tubing, temperature monitor, 3 breathing / heart rate monitors, an oxygen saturation monitor and possibly one or more IV lines too. All of these have to be held steady and stable.

For earlier babies on CPAP it is also encouraged, but you have to be VERY careful that the position of he CPAP mask or prongs is not compromised by the position of the baby. This would be around 28 weeks gestation.

Even earlier, babies are ventilated and kangaroo care is quite difficult. Some units will allow you to do it, but generally the stress of moving the baby outweighs the benefits of kangaroo care. For most babies, the position of the head and neck are crucial to keeping the airways open, and it is very hard to position a baby skin to skin to maintain this. Also, the baby's skin may be too delicate to touch (prone to tearing) and the baby's neurological development not sufficient to cope with touch - so overstimulation can lead to bradychardias and even cardiac arrest.

Having said all that, kangaroo care has immense benefits if it can be done. It helps the baby to regulate their breathing and heart rate (if they are breathing for themselves of course), and the parent's chest temperature changes to keep the baby at the right temperature. It encourages milk production in the mother and strengthens bonding. Also the baby is more emotionally secure - hearing a familiar heart beat and feeling an adult beneath them is reassuring. Lastly, babies in kangaroo care tend to be mostly upright and slightly forward, like sleeping on their tummies but more vertical. This is one of the best positions for breathing if you have dodgy lungs.

Having done it all (my son was born at 24 weeks), we found he was simply not ready for any contact until he was 4 or 5 weeks old, when he could cope with a simple cradle cuddle whilst wrapped in his incubator blankets. At about 8 weeks old he could cope with kangaroo care for short periods, and we built this up until at about 3 months old I was spending up to 8 hours a day doing skin to skin.

I think the thing with Columbia was the higher gestation. No incubators probably means no ventilators too, and no other equipment. If you have a premature baby in the middle of nowhere with no medical support this is definitely the best thing to do. But a baby under about 30 weeks will probably not survive in those circumstances. If you have a premature baby in a well stocked hospital your baby has a much much higher chance of survival - about 50% at 25 weeks. Kangaroo care is still great when possible, but its not always the best thing for a baby who is so early.

Good luck with your pregnancy and I hope you never have to go through having an early baby!

My babies were born at 23 weeks and I think it was either six or seven weeks before I held them at all. They were on ventilators until then and as a previous poster mentioned, any movement of the intubation tube could have been catastrophic. Even once they were moved onto cpap, one baby was on 'bubble' cpap which has horrible nose prongs and his nostrils would bleed every time his head was moved so I actively avoided suggesting cuddles with him because it was so uncomfortable for him.

Once the babies were off cpap and out of incubators, from memory this was about 33 weeks gestation, I could hold them as often as I liked in any way I liked. We had been in hospital ten weeks by then though and I was very confident in doing what I considered best.

Sorry didn't realise couldn't post that :(

tiina

We did Kangaroo Mother care or close to it for our wee boy born at 32 weeks in Botswana (so not much in the line of anything there). He was born by emergency C-section (butchery) and spent 2 days in observation in the adult ICU as there are no neonatal facilities and then went into the nursery. We tried breastfeeding at 5 days with no succes but tried a few days later and he totally got the idea. He came home at 2 weeks and in the last week in the hospital and then when we went hom he spent much of his time on my chest.
He was fully breastfed until he started on food at 4 1/2 months and then got a mix until 11 months when he was weaned to formula for a few months and then milk with regular food.
I honestly feel that the two together worked really well.... he caught up very quickly and has had none of the problems usually associated with preemies. He's still a bit skinny for his height but perfectly healthy.

Hello

I am both a Mumsnetter and part of a research team working with neonatal units in the Yorkshire and Humber region to improve care. We're particularly interested in increasing the amount of kangaroo care offered to babies and parents - obviously when appropriate, and not in the realms of 24/7!

If any Yorkshire and Humber parents would like to share their experiences we have an online survey request on mumsnet at the moment, under the 'Media Requests' topic, or here:

www.surveymonkey.com/s/HIECNeonatal_Web