In the silent and sleepy neighbourhood, Singaporean Selina Ibrahim’s two-week-old baby’s incessant cries awakened residents, leaving the parents helpless and stressed. But when the frantic mother—upon the advice of a friend—snuggled him against her chest, the cries ceased and the baby appeared to enjoy the soothing cuddle.

Undeniably, there is something magical in the human touch.

“It was the first time I had heard about kangaroo care and its effects. My son and I had some skin-to-skin time right after delivery, but no one told me I could carry on doing it,” said Selina.

“It is recommended that, as soon as the baby is stabilised after birth, the baby should be laid onto the mother’s bare skin over her chest, provided the mother is also well enough to tolerate it,” says Dr Natalie Ann Epton, a paediatrician and neonatologist at Mount Elizabeth Hospital, Singapore.

In places when incubators are beyond their limited budgets, desperate parents can only caress their babies in the hope that the special touch would heal. And all at once, in that one miraculous embrace, all the hype of technology—however revolutionary—pales in comparison with this timeless healing therapy of human bonding.

Kangaroo Mother Care—more than a poor man’s option

An idea born of necessity and amid grinding poverty, the skin-to-skin contact has served the poorest, where infant death rates spiral—and doctors are now convinced that it could be better off than the incubator.

The concept of Kangaroo Mother Care (KMC) was the brainchild of Colombian paediatrician Edgar Rey, who felt compelled to try a more radical method against a backdrop of overcrowding and shortage of incubators—along with high cross infection and escalating infant death rates in Colombia’s biggest neonatal unit, which delivers 30,000 babies a year. In 1978, Rey introduced the concept of KMC to the Instituto Materno Infantil, which served the city’s poorest; particularly young impoverished mothers who live in makeshift houses at the foothills.

Intrigued by the revelation and the physiology of the kangaroo, Rey tested it in the hospital where he trained mothers of premature babies to carry them in the same way that kangaroos do. Together with his colleague Hector Martinez, he taught them the importance of breastfeeding and discharged them just as soon as their babies were able.

The trial – conducted by Rey alongside his colleague, Hector Martinez – achieved amazing results: death rates and infection levels plunged immediately, hospital stays were shorter—thus, freeing up incubators and reducing the number of abandoned babies.

Torres: “KMC was a ray of light”

Carmela Torres was 18 when she became pregnant for the first time in 1987. She gave birth to a premature baby who died three days later.

A decade passed before Torres was pregnant again; but a couple of months before her due date, she experienced familiar contractions and was admitted to the same hospital.

The next morning Torres gave birth to another boy whom she named immediately as Julian. He weighed almost the same as her firstborn and it was like reliving the past.

“I spent a very frightening night panicking that I was about to lose another baby,” she says.

“But the next morning a doctor came to see me. She told me about a thing called Kangaroo Mother Care—how I could act as a human incubator and carry my own baby and take it home with me. It was a ray of light at the end of the tunnel. Anything rather than leave my baby there.”

Mothers are encouraged to cuddle in close physical contact with their babies for the first hour of life, also known as the Golden Hour.
Mothers are encouraged to cuddle in close physical contact with their babies for the first hour of life, also known as the Golden Hour.

Torres and her husband shared shifts to keep continuous skin-to-skin contact for 24 hours with their baby for a month until the frail Julian hit his target weight of 2,500g and could have his first bath.

KMC is scientifically safe, studies show

There are already 1,600 studies done on KMC. Research shows a kangaroo baby bonds better with its parents than pre-term babies put in incubators. Its heart and respiratory rates improve better, more equipped to self-regulate and is calmer and better able to sleep.

In a study conducted in 1989 on a sample of babies from two of the poorest hospitals in the city, Nathalie Charpak, the French paediatrician who heads the KMC unit at San Ignacio University Hospital in downtown Bogota, showed that KMC was safe—even the smallest premature babies did not cry when taken out of the incubator.

In 1994, a larger randomised trial funded by a Swiss NGO and published in Paediatrics, 1997, proved conclusively that not only were babies dying less; but breastfeeding rates were up, hospital stays were shorter, with reduced infections.

Charpak, who is also director of an NGO that researches and promotes KMC, the Fundación Canguro—the Kangaroo Foundation, feels that kangaroo mothers feel a greater sense of purpose and experience less postnatal depression. Tests show that kangaroo babies at 12 months old have higher IQs and better cognitive development than those under conventional care.

“It is clear KMC is about much more than just saving the baby’s life,” expresses Charpak. “It is about allowing the baby to thrive and giving it the best possible quality of life. I have fought all my life to show that KMC has nothing to do with comfort or massage or anything fluffy like that. It is difficult to do and each baby is carefully followed up every six weeks for the first year, but the benefits are extraordinary,” adds Charpak.

Promising results using the radical therapy of skin contact

Many countries, mostly from low-income regions, like Venezuela, Brazil, Ethiopia, Madagascar, India, and Cameroon have received intensive training from Charpak and have returned to run their own KMC programmes.

These initiatives have fetched remarkable results. Malawi, which records the highest rate of premature births in the world (181 babies out of 1,000), has a KMC centre in every district. Over the ten years to 2015, the number of babies dying before their first birthday fell from 72 out of 1,000 to 43. The World Health Organisation (WHO) has estimated that KMC has the potential to save as many as 450,000 lives a year.

“I have seen a significant drop in mortality,” says Indira, a midwife at Zomba Central Hospital in southern Malawi. “It has also helped reduce congestion in the ward as babies are cared for at home. And it has helped reduce costs, because electricity is being saved as the mother is a perfect heat source for the baby.”

Resistance from health professionals—“things are done better in westernised countries”

The estimated cost of neonatal care for premature babies in the United States is USD3,000 – 5,000 a day whereas in low-income countries, a KMC programme can cost as low as USD4.60 a day.

While KMC has proven to be effective in many countries, there are health professionals who are sceptical that physical contact is better than incubators. The idea that things are done better in westernised countries dominates.

“We were trying to determine if it was safe and we found yes, it was safe, better than safe,” says Susan Ludington from Case Western Reserve University in Cleveland, Ohio who initiated the first ever KMC study in US. “We now know the best protection from infection [for the baby] is to be colonised by its mother’s bacteria. We also know the best thing for its brain development is skin-to-skin, the best way to maintain blood sugar levels (so it doesn’t get hyperglycaemic) is skin-to-skin.”

Keeping premature babies safe and medically stable is a priority

Over the years, KMC centres have spread far and wide, with centres in almost 70 countries across the world, including Australia, Spain and France. In the University Children’s Hospital in Uppsala, Sweden, skin-to-skin contact with mothers of babies born at just 25 weeks is encouraged.

Despite its widespread acceptance, KMC has not replaced incubators completely. “It’s just not that simple,” remarks Angela Huertas, consultant neonatologist at University College Hospital in London. Huertas believes there are times when babies are actually better off in incubators.

The American Academy of Paediatrics recommends that all breastfeeding babies spend time skin-to-skin right after birth. Mothers who practise kangaroo care with their newborns are less likely to experience postnatal depression and are more able to read their baby’s cues.

“Babies who experience kangaroo care in the NICU become more attached to their mothers, and have increased social abilities, as well as greater motor and cognitive skills,” explains Dr Epton.

This, elaborates Dr Epton, is probably due to the stimulation and release of the “love” hormone, oxytocin, during skin-to-skin contact. “It causes a rush of loving emotions, helping mum to feel more attached to her baby and reduces negative or sad feelings.”

“Cuddle time should always be important throughout a child's life—even through adolescence and into adulthood,” Dr Epton says. “Through gentle affirmatory touch, parents remind their children that they are loved and accepted.” MIMS

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