Kangaroo Mother Care:
Restoring the Original Paradigm for Infant Care and Breastfeeding
Austin TX USA
From: LEAVEN, Vol. 37
No. 5, October-November 2001, pp. 106-107.
Nils Bergman is a public health physician and medical superintendent at Mowbray Maternity Hospital in Cape Town, South Africa. He has extensive experience with kangaroo care in a hospital setting. By putting breastfeeding into a biological, evolutionary, and anthropological context, he defined what he termed an "original" paradigm for infant care and breastfeeding. He also described how kangaroo care fits this original paradigm and the role that health care technology should play in the care of premature infants.
Dr. Bergman began by defining for us the term paradigm: a set of basic assumptions, a worldview, or a belief system. He emphasized that a paradigm is determined by things such as tradition, culture, and experience more than science or research. By looking at commonalities of breastfeeding behavior in all mammals, an "original" paradigm for infant care and breastfeeding can be extrapolated, as opposed to one based on current cultural traditions.
To develop an original paradigm, Dr. Bergman referred to biologists' concept of "habitat and niche." The niche refers to behaviors related to four basic needs - oxygen, warmth, nutrition and protection - which must be met through the habitat. Dr. Bergman summarized research that indicates that the human newborn's natural habitat is maternal-infant skin-to-skin contact. All newborn mammals that have been studied exhibit a sequence of behaviors that leads to the initiation of breastfeeding. The newborn's actions elicit a set of care-taking responses from the mother. He emphasized that breastfeeding is a niche, or set of preprogrammed behaviors, which the mammalian newborn exhibits that are appropriate for its habitat. Thus in the newborn habitat, the newborn gets oxygen through the air, warmth and protection through skin-to-skin contact with the mother, and nourishment through breastfeeding.
The neonatal attachment process is easily disturbed. Separation of the newborn from its mother causes "protest-despair behavior," which involves stress hormones, the adrenergic (sympathetic) nervous system, and certain somatic or muscular behaviors. The protest response involves distress cries and other behaviors that indicate the newborn recognizes he is in the wrong habitat. The despair response involves withdrawal, a slowed heart rate, and lower body temperature along with increases in stress hormones, presumably as a means of prolonging survival outside the habitat. Once the newborn is restored to its correct habitat (the mother), heart rate and temperature rises, and stress hormones are reduced. Thus the habitat-niche concept requires a paradigm whereby the mother and infant are seen as a dyad. Dr. Bergman added, "Breastfeeding's worst enemy is separation."
Anthropologists theorize humans appear to be born about one year "too early." For many mammals, brain size at birth is about 80 percent of adult size, whereas that of humans is about 25 percent. Humans don't achieve 80 percent of adult brain size until approximately 21 months gestational age or 12 months postpartum. It has been suggested that this is an evolutionary compromise to the narrowed pelvic structure of humans as they began walking on two legs: the human newborn completes its gestational brain growth outside of the womb. The correct habitat or place for this is being in skin-to-skin contact with the mother, with breastfeeding providing the human milk that is uniquely adapted to the needs of the human infant's "immaturity." Up to a point, prematurity can be thought of as an early transition to a habitat that is already designed to cope with human infants' immaturity.
Dr. Bergman also went through the anthropological evidence and arguments that human babies should be cared for by what is called "carry care," a theme shared in James McKenna's luncheon talk the same day ("The Society Who Mistook Their Children For Bats? A Bio-Cultural Perspective on Human Infancy and Parenting"). This includes almost continuous carrying of the infant, cosleeping of mother and infant, immediate nurturant response, frequent to continuous feeding, and breastfeeding for a period of two years or more. It is only relatively recent in our history that care patterns in Western society have evolved away from "carry care" to one of "cache care," where the infant is left lying still, feedings are scheduled, typical of "nesting care," and infants are expected to sleep alone. Dr. Bergman argues that it is the current paradigm of separation of the infant from its mother that has turned prematurity from an early habitat transition into a disease state.
Providing the optimal habitat is even more essential for premature babies than for full term, albeit immature, babies, according to Dr. Bergman. Kangaroo mother care is a practice that provides the natural habitat for newborns. It has significantly improved survival rates for premature infants in many settings. A general definition of kangaroo mother care includes three main components: skin-to-skin contact, breastfeeding, and support. The form of support is variable, depending upon the context. For a full-term infant, support could be provided by the father, family, or health care workers, who ensure that there is no separation of mother and infant and that breastfeeding can take place. For premature infants, support may include advanced health care technology. He emphasized that technological support should be in addition to what he called "humanity," maintenance of the mother-infant dyad, not a replacement for humanity. In his experience, infants more than 32 weeks gestational age do well without advanced technology using kangaroo mother care.
We saw a live demonstration of how babies are worn by "kangarooing" mothers in Cape Town. The baby, wearing only a diaper, is literally tied onto the mother's bare chest with a strip of cloth that is positioned underneath the baby's ear. This extends the baby's head and neck and prevents obstructive apnea. The mother than wears a special shirt that wraps around and under the baby's bottom to induce flexion, as in utero. The baby is tied tightly enough so that when the mother breathes, she pushes against the baby's chest and stimulates his breathing. Inside the mother's shirt, the baby is in a carbon dioxide-rich environment, which also stimulates breathing. The strip is relaxed every two hours and the baby is fed via breast or whatever means is necessary. For premature babies, this type of kangaroo care is done around the clock. Mothers of premature babies are also encouraged to sleep at a 30 degree angle; this aids breathing and vestibular function.
Since kangaroo mother care fulfills the original paradigm, Dr. Bergman said it is appropriate for full-term infants as well. He is researching how long kangaroo care is needed for newborns, but speculates that about six hours after birth may be long enough for the baby to stabilize physiologically, and to initiate the maternal care response. He also suggests that around six weeks of age the baby may be ready to move beyond the neonatal habitat of mother's chest in skin-to-skin contact. Usually by then the baby has better head control, breastfeeding is established, and the mother is recovered from the birth.
Dr. Bergman concluded by expanding the habitat theory to humans as they develop from infancy to adulthood, with their habitat expanding from mother's chest, to being carried, to home, to village or community, country, and the world. Thank you, Dr. Bergman, for an interesting and informative talk
Lisa Albright is an Area
Leaders' Letter Administrator for the Eastern US Division and was a
Leader for five years in Pittsburgh, Pennsylvania, USA. She recently
relocated to Austin, Texas, USA, with her husband, David McDonough,
and their two boys, Colin (11) and Kevin (8).