Kangaroo Care
Our charity is a huge supporter of Kangaroo Care. It's benefits have been proven for both parents and babies to practise as much skin to skin as possible. Thankfully many of our NICU's/SCBU's are very actively encouraging Kangaroo Care. As a parent don't be afraid to ask your babys carer's to do skin to skin, even if staff look busy, remember this is benefical for both you and your baby, most staff will oblige you unless there are medical reasons to defer skin to skin for a while.







To learn more about the benefits of skin to skin / kangaroo care we have two very informative articles written by Dr Nils Bergman and Dr. Jack Newman. Irish Premature Babies greatly appreciate these eminent doctors for their contribution to this site. If you would like to learn more about the work of Dr. Bergman and Dr. Newman, we have included their website links in this section and we have also included some books in the useful information section. You can also visit this website : www.themiracleofkangaroocare.com.

Research by Dr. Nils Bergman, Overview - Physiology and Research of KMC

The Importance of Skin to Skin Contact by Dr. Jack Newman & Edith Kernerman



Research by Dr. Nils Bergman, Overview - Physiology and Research of KMC

• Research on SSC (Skin to Skin Contact)
• Breastfeeding
• Breast Milk and Immaturity
• Neuroscience and Stress

Kangaroo Mother Care (KMC) has been variously defined, but two essential components are skin-to-skin contact (SSC), and breastfeeding (BF). From the biological perspective, in the immediate newborn period of Homo sapiens, skin-to-skin contact represents the correct "habitat", and breastfeeding represents the "niche" or pre-programmed behaviour designed for that habitat.

RESEARCH ON SSC
In the uterine habitat, oxygenation is provided through the placenta and the cord, as well as warmth, nutrition and protection. These are the four basic biological needs. Parturition (birth) represents a "habitat transition". In the new habitat, the basic needs remain the same. Research over the last ten years provides strong support for the contention that newborn itself in the skin-to-skin habitat, not the mother or the health services, provides these basic needs.

Oxygenation has been shown to be improved on SSC, to the extent that KMC is used successfully to treat respiratory distress. The breathing becomes regular and stable, and is coordinated with heart rate. When removed from incubator and placed SSC, oxygen saturation may rise slightly, or the percentage of oxygen provided to maintain good saturation can be lowered.

Heart Rate is increased when placed SSC. Though we can regard this increase as being with the clinically normal range, what is seen is actually a return to the physiologically normal heart rate, the lower rate being due to "protest despair behaviour". Infants removed from incubators and placed SSC show a rise in temperature and a dramatic drop in glucocorticoids, as predicted by the "protest-despair response". Mothers are able to control the infants temperature within a very narrow range, far better than an incubator. To accomplish this, her core temperature can rise to two degrees Centigrade if baby is cold, and fall one degree if baby is hot. Skin-to-skin contact is better than incubator for rewarming hypothermic infants.

Self-attachment refers to the phenomenon that fullterm undrugged infants, left on their mother's chest and undisturbed, will all breastfeed spontaneously within one hour, with no help at all. But this behaviour is dependent on SSC. Mother and infant should NOT be separated. The stimulations the newborn gives the mother during SSC elicit caregiving and protective behaviours from the mother. The baby’s legs kicking on the mother’s abdomen cause the mother’s uterus to contract strongly, preventing post-partum bleeding.

Nutrition is improved, both with respect to the mother’s ability to breastfeed, and with respect to the newborn’s utilisation of the feed. The volume of mother’s milk is greatly increased, and the frequency of feeds provided likewise. Even without the increased milk, with the vagal stimulation the infant receives, the gut is better able to use the milk provided, and grows faster.



Immunity is improved, demonstrable even 6 months later. Prematures seem to have poor immune systems, and are susceptible to allergies, infections and feeding problems in the first year of life. Early SSC dramatically reduces these problems.

Infections are reduced when SSC and exclusive breastfeeding are firmly introduced. Necrotizing enterocolitis (a potentially lethal and very costly disease to treat) has been dramatically reduced in many units following a KMC programme.

In no published paper is a single adverse outcome reported for KMC. Positive effects on the mother are better bonding, healing of emotional problems associated with premature birth, among others.

BREASTFEEDING
Breastfeeding is a behaviour based on hindbrain functions that regulate hormones, autonomic functions and the somatic system. Key to understanding breastfeeding behaviours in the transitional and newborn periods is "state organisation".

State Organisation refers to the ability to control the level of arousal, or of being awake. A scale of state organisation can be described varying from deep sleep to hard crying, each being associated with particular behaviours and conditions. For breastfeeding an infant should be in an awake state, and should thereafter be in quiet sleep for optimal development. KMC has profoundly beneficial effects on the state organisation of newborns.

"Suckling" is the "chewing movement" an infant makes on the nipple. Quite apart from suckling as a means to ingest food, this behaviour has essential effects. Suckling stimulates the back of the palate, and results in intense vagal stimulation, which is vital for the general wellbeing of the baby. Suckling releases hormones similar to morphine in the brain, and gives powerful pain relief to infants. While it was observed that ability to suck on a bottle only started at 34 weeks post-conceptional age, recent research has shown that suckling from the breast is possible at 28 weeks. Suckling is a myographically distinct behaviour from sucking, and research on sucking on bottles of premature infants shows it clearly to be stressful. Premature infants are unable to coordinate their breathing and their swallowing.

BREAST MILK AND IMMATURITY
Compared to that other mammals, human milk is extremely thin in terms of protein, fat and carbohydrate contents. Protein in particular. In olden days, protein was measured in terms of “nitrogen”, the assumption being that the majority of the nitrogen was a constituent of proteins. For a cow, protein nitrogen is 98%. For a human however, it is only 75%, and the non-protein nitrogen (NPN) is full quarter of the content. What human milk lacks in terms of concentration, it makes up for in terms of variety, well over two hundred NPN compounds have been found.

These are related to the evolutionary immaturity of the newborn.

NEUROSCIENCE AND STRESS
The primary violation, the worst case scenario, to any newborn is separation from its habitat/mother. This applies to Homo sapiens as fully as to other mammals studied. “Protest-despair” behaviour is a stress reaction, and the hormones related to this have been extensively studied. At high levels, these hormones are intrinsically neurotoxic to the brain, particularly areas of the hindbrain, and any area which may be already a little hypoxic. SSC has been shown to markedly reduce these levels.

http://www.kangaroomothercare.com/




The Importance of Skin to Skin Contact by Dr. Jack Newman & Edith Kernerman

There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and more normal, and the baby’s blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.


We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their need for extra oxygen, and keeps them more stable in other ways as well (See www.kangaroomothercare.com and article on Breastfeeding the Premature Baby by Jack Newman).


To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat in which he is supposed to be: with and on his mother. When a baby or any mammal is taken out of this natural habitat, it behaves in a way which is unnatural. A baby wrapped in a blanket or swaddled behaves not so much like a baby, but instead becomes too sleepy or lethargic and needs to shut down; or becomes disassociated altogether. Or, such a baby may shake and cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended, and the way that is necessary for his very survival. The mother and the baby exchange sensory information that stimulates and elicits “baby” behaviour: rooting and searching to eat, calming in his mother’s arms, staying warm, maintaining his body temperature and maintaining his blood sugar.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in the handout Breastfeeding—Starting out Right, a baby who latches on well gets milk more easily than a baby who latches on less well. When a baby latches on well, the mother is less likely to be sore. When a mother’s milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does have the appropriate amount of milk that baby requires. She is not supposed to have a large amount—that would be inappropriate for baby and no baby could safely consume a large amount of milk--Mother has enough! Yes, the milk is there even if someone has proved to you with the big pump that there isn’t any. How much does or does not come out in the pump proves nothing—it is irrelevant. Also note, no one who squeezes a mother’s breast can tell whether there is enough milk in there or not. And a good latch is important to help the baby get that milk that is available. If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.


To recap, skin to skin contact immediately after birth, which lasts for at least an hour (and should continue for as many hours as possible throughout the day and night for the first number of weeks) has the following positive effects on the baby:

• Is more likely to latch on
• Is more likely to latch on well
• Is more stable and has normal skin temperature
• Is more stable and has a normal heart rate and blood pressure
• Has higher blood sugar
• Is less likely to cry
• Is more likely to breastfeed exclusively longer
• Will self wake when hungry


There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. Baby may be placed vertically on mother’s chest and be allowed to slowly find his way to the breast, while mother supports him if necessary. During this period mother should be encouraged to allow baby to find his way while keeping her hands off his head. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. This is baby’s first journey in the outside world and the mother and baby should just be left in peace to

enjoy each other’s company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother’s partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there “just in case”). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.


Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.


Even if the baby does not latch on during the first hour or two, skin to skin contact is important for the baby and the mother for all the other reasons mentioned.


If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast because three hours have passed. The baby who is not yet interested in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in baby refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the “obvious next step” is to give a supplement. And it is obvious where we are headed.



www.drjacknewman.com


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