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Book and Video Reviews:
Kangaroo Mother Care: A Practical Guide
by The World Health Organization
Kangaroo Mother Care:
Rediscover the Natural Way to Care for your Baby

by Nils Bergman, MD

Kangaroo Mother Care: A Practical Guide
by The World Health Organization
Softcover, 48 pages
Kangaroo Mother Care: Rediscover the Natural Way to Care for your Baby
by Nils Bergman, MD
VHS, 26 minutes

reviewed by Ann Calandro, RNC, IBCLC
Waxhaw NC USA
From: LEAVEN, Vol. 41 No. 6, December 2005-January 2006, pp. 138-139.

Kangaroo Mother Care (KMC) is a powerful, effective, and inexpensive way to care for premature well babies. Its beauty is in its simplicity. Sadly, it is underutilized in many countries.

What is KMC? It is continuous skin-to-skin contact between mother and baby. During KMC, babies receive the advantage of their mother's warmth, develop an attachment to their mother, and have frequent easy access to their best food—human milk. As La Leche League Leaders, we are particularly interested in how KMC can promote and protect early breastfeeding in this vulnerable population because we know how important human milk can be for all babies. With its nutritive and protective values, human milk is particularly important for premature babies. The rocking, cuddling, and stroking that KMC facilitates are also very important for a baby's healthy growth and development.

KMC has maternal benefits as well. Mothers who care for their babies using KMC feel empowered and confident in their role. KMC requires mothers to take an active role in caring for their babies, which is far different from the role that non-KMC mothers of premature babies typically play in a hospital environment. Fathers report that they, too, enjoy caring for their babies skin-to-skin, feeling comfortable and relaxed, while holding their babies. Although very small babies with medical complications will need skilled care and incubator observation, KMC is a logical choice for baby care after that initial period of intense care.

The 48-page softcover booklet titled Kangaroo Mother Care: A Practical Guide, written by the World Health Organization, explains KMC thoroughly. This guide includes implementation methods to plan for hospital policies, hospital staffing needs, the mother's needs, and the baby's needs during this special time of growth and development for premature babies. Aimed at health care providers, it combines both evidence-based and anecdotal information for incorporating KMC into current practice. Without a written protocol and involved participation of all involved staff, KMC implementation might easily be phased out. That is why medical staff consensus in implementation, as described in this booklet, is important.

Simple line drawings depict how to position, carry, feed, and sleep with premature babies during KMC. The only special item needed for KMC is a support binder made of a soft piece of fabric. This can be a pouch, a special shirt, or a band, which secures the baby snugly onto his mother's chest, allowing her to have both hands free to move about and continue daily activities. The baby's attire is simple: a diaper, a warm cap and socks.

An in-depth discussion on infant feeding is included. Nursing at the breast is best. If the baby is not mature enough to breastfeed well yet, there is a description of how to express milk, and how to feed baby alternatively with cups, syringes, or feeding tubes. Directions are given on how to insert an oral feeding tube and how to tube feed the infant. A useful chart illustrates the amount of milk and the number of feedings a baby would need each day while progressing from a weight of 2.2 pounds to 4.4 pounds (1,000 to 2,000 grams).

KMC begins in the hospital and continues at home. Once home, mothers will continue to need support and follow-up care to ensure that their babies are growing and thriving in their family environment.

KMC is a way of giving back to the baby the warmth and love of mother's body, which cannot be provided by modern technology. It is a lifesaving practice in many countries. However, babies are the same everywhere, and the need for mother-love has no boundaries.

Kangaroo Mother Care is a short book suitable for all health care workers. It is useful when used in its entirety and also when selected portions are used.

While the apparent outcome of KMC babies may be no different from the outcome of babies cared for in a highly medicalized nursery, perhaps the psychological and positive long-term effects of KMC have yet to be compared and examined. Certainly the psychological effects that KMC brings to parents should be examined, as premature babies are among the most frequently abused or neglected children. Kangaroo Mother Care is a method of care that looks beyond the early weeks. The engagement and bonding that occur during this special type of care may bring lifelong benefits.

Dr. Nil Bergman's video, Kangaroo Mother Care: Rediscover the Natural Way to Care for your Baby, is an affirmation of all that is right with natural instincts of mothers in our world. Human babies need skin-to-skin holding, human milk, warmth, and protection. In Dr. Bergman's words, "Hold me, Feed me, Love me." Nothing has changed regarding the needs of babies since the beginning of time.

This video is beautifully filmed. Women from many cultures are shown with their newborn full-term or premature babies, sharing special gifts through skin-to-skin closeness.

The video begins with an explanation that human babies are the least mature of all mammals and need their mother's care to thrive. Babies experiencing KMC have more stable heartbeats, lower stress hormones, and breathe in a normal pattern. Babies in incubator care have much higher levels of stress hormones, have less stable heartbeats, and experience periodic (irregular) breathing patterns. When a baby is relaxed and in a safe environment, especially chest to chest with his mother, he can hear and feel her breathing and tends to breathe in a rhythmic way similar to adults. Newborn premature babies may sometimes "forget" to breathe and have apnea spells. They take a few breaths then wait a while before taking a breath, which is abnormal. This irregular breathing pattern is called periodic breathing. When babies are sleeping and forget to breathe, their heart rates go very high in order to pump enough oxygen to their brains. This abnormal heart activity uses a lot of calories and may slow baby growth. KMC helps babies to regulate their breathing so that they rarely have periodic breathing episodes.

One in 20 babies is born prematurely in developed countries, and one in five or six babies is born prematurely in developing countries. KMC provides a natural incubator for premature babies, which is far healthier for stable infants than the separation experienced in incubator care.

The video's images are compelling. I loved the demonstration of how to place the baby in the skin-to-skin binder. I also loved the look on the father's face when his baby was placed skin-to-skin with him. At first he seems amused, later he seems absorbed in the wonder of his baby. Babies work magic when placed skin-to-skin with their parents.

This fact-filled video is colorful, fun, easy to watch, and empowering. It would be a wonderful experience for all mothers to have the opportunity to view this video, and especially so for mothers of premature babies.

Someone just needs to help parents of premature babies learn how to practice KMC. Perhaps that will be you? Afterwards, sit back and watch love grow. It's awesome to play a small part in this fantastic experience.

Ann Calandro, RNC, IBCLC, has been an LLL Leader for 28 years, and is also a hospital-based lactation consultant who works with premature babies and their mothers. Ann is married to Jim and has four children and three grandchildren. She lives in Waxhaw, North Carolina, USA. Christine McNeil Montano is the Contributing Editor for Leaven Reviews. She has been an LLL Leader for six years. She and her husband, Tony, have two boys ages 8 and 5. Christine is also a member of the LLLI Book Evaluation Committee, is active in the Connecticut Area Council, and works as a hospital-based breastfeeding support group leader.

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