our littlest Slingbabies
By Jessica Richards
Sarah was only 29 weeks when she went into preterm labour and birthed her wee boy Aaron. In severe distress, he was whisked away by specialists who worked to stabilise him. Seeing her baby in the isolette, hooked up to tubes and cables, Sarah and husband Edward couldn't believe this was their baby. Worse, Sarah was discharged after a week as only Aaron was considered the 'patient'. She was sent home without her baby, breasts leaking and heart heavy.
As the days went by, Sarah felt more and more like the visitor, not the mother, to her baby. She was intimidated by the equipment and processes needed to keep her son alive. Aaron reacted strongly to any touch of hers, to the point where she was discouraged and avoided contact with him.
After three long weeks, Aaron's nurse talked to Sarah about starting Kangaroo Care sessions. Nervously, Sarah agreed. The nurse carefully transferred him to his mother's waiting bare chest, where he was arranged into position and tubes organised around him. Sarah wore a wrap sling which was tightened snuggly over Aaron, both to keep him warm and in position between her breasts.
Sarah took a deep breath of her baby. She sighed, and relaxed for the first time in weeks. Aaron snuffled and closed his eyes, going into a peaceful sleep on his mother. THIS was what they'd both been waiting so long for.
Sarah felt more confident with Aaron, taking over many of his cares, and interacting with him more. Ed was able to do some of the Kangaroo Care also, using the same wrap. Their little family was going to be alright, and Kangaroo Care was the turning point they needed.
What is Kangaroo Care?
Kangaroo Care (or Kangaroo Mother Care) is a care system for preterm, low birthweight and special case babies based on skin to skin contact between baby and mother. (1)
It aims to empower mothers/parents to become the main caregivers of their baby, and meet all their needs. Sessions ideally last for at least one hour, the longer the better.
The baby is placed on mothers' chest between her breasts, in the 'kangaroo' position- allowing for maximum skin to skin contact of the baby's ventral surface. Baby is covered with a blanket or supported with a wrap or tube. The mother serves as both temperature control and food source for her baby. (2,3).
Kangaroo Care was first implemented by Dr Edgar Rey in Bogota, Colombia, in 1978, with later massive contributions by Dr Nils Bergman and Dr Sue Ludington-Hoe.
Back in the late 1970s and early 1980s, the premature infant mortality rate in Colombia was a scary 70%. They just didn't have the money or equipment to provide the necessary medical care. So out of desperation the mothers were given their babies to hold, 24 hours a day. They tucked them into their shirts against the skin, and if they needed oxygen it was given under a hood placed on the chest. (4)
Instead of dying, these babies started doing so well that the mortality rate dropped drastically.
But Kangaroo Care is not just for developing nations. Babies benefit from it around the world- full term, premature and special needs.
Kangaroo Care should begin as soon as possible after birth and continue as often and for as long as appropriate.(depending on circumstances). (1)
In a randomised, controlled trial comparing skin to skin contact at birth vs. an incubator, Bergman Linley and Fawcus had this to say: “ Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian "protest-despair" biology, and with "hyper-arousal and dissociation" response patterns described in human infants: newborns should not be separated from their mothers” . (6)
Kangaroo Care has showed many benefits for baby, mother and even the hospital. Being skin to skin with mum is biologically normal for babies, it's what they come out expecting, and what they crave- physically and emotionally.
The baby has a stable heart rate (no bradycardia), more regular breathing (a 75 percent decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of "purposeless" activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge. They cope with pain better when in kangaroo care i.e. heelprick tests.
Benefits to the parents include "closure" over having a baby in NICU; feeling close to their babies (earlier bonding); having confidence that they can care for their baby, even better than hospital staff; gaining confidence that their baby is well cared for; and feeling in control—not to mention significantly decreased cost! (2, 4)
Babies who are Kangaroo Cared rely on their mother to regulate body temperature, so they don't use so many precious calories staying warm. A mother's chest can rise and fall in temperature depending on the needs of her baby. It finds the 'perfect' temperature for babies to sleep well, have less calorie expenditure, optimum oxygen saturation levels, etc. And mothers with twins in Kangaroo Care have shown temperature differences on each breast, responding to temperature requirements of each baby! (4)
Babies who receive Kangaroo Care are more likely to gain weight faster, as they are able to sleep better and use their energy to grow. They sleep longer and deeper than in their bed in the NICU.
Kangaroo Care babies experience less apnoea and bradycardia when on their mothers, and even if/when they do have an episode, it is shorter and less severe than if they are 'alone.' (4,5)
Researchers have found that babies' breathing and heart rates synchronise much faster while in Kangaroo Care, than not. They noticed a doubling of alpha waves (happy thoughts) and that 'delta brushes' were happening- new synapses being formed. (2)
Kangaroo Care in New Zealand
Kangaroo Care is known and encouraged in the Auckland NICU, our largest facility in NZ. Although there are some exclusion criteria (first five days for under 30weeks, umbilical lines/chest drains, unstable on respitory support, or after major procedures), it is gaining much popularity and staff appear supportive and enthusiastic.
Slingbabies has donated 100 wrap slings to facilitate Kangaroo Care in this unit, which are able to be taken home by the families. This helps the often rocky transition to home life, and gives parents a strategy to care for their baby.
I was delighted to see half a dozen wee babies on their mothers when I visited last year, of varying gestations and health issues. The mothers were glowing, proud to be doing such an important job with their babies. Some were even walking around the room for short periods, amazed at the liberty and security the wraps offered.
The Process: (International guidelines)
There are two methods of transfer: standing and sitting (3)
Sitting is recommended if the baby has multiple lines, CPAP, the nurse is inexperienced in transfers, or if the mother prefers not to be moving while holding her baby.
Standing transfer is appropriate if the baby doesn't have many lines and they are easy to organise.
Baby is dressed in a nappy only. Less than 30 week babies may have a beanie on, but older babies may overheat.
Baby's head should be turned to the side, but not bent forward or backwards.
It is important that the full ventral surface (navel to neck) is in contact with mum's skin- this area is full of nerve and thermal receptors for temperature control.
Baby's arms and legs should be tucked in a flexed position like a little frog.
Mum (or Dad) should wear a tight t-shirt, tube or wrap sling to hold baby securely on their chest. This will also keep baby warm (with the aid of a light blanket if needed).
KC needs to last for at least an hour each time, for baby's system to complete one whole sleep cycle (3, 8)
If you find yourself guests in the NICU or SCBU in the future, please do ask the staff about their Kangaroo Care policy and how they can facilitate it for you.
The benefits are scientifically proven, and it is something amazing you can offer your littlest slingbaby- as well as yourself.
NZ Babywearing Week runs 10-16 October 2011, find it on Facebook to check out events in your area.
KH Nyqvist, GC Anderson, N Bergman, A Cattaneo, N Charpak, R Davanzo, U Ewald, O Ibe, S Ludington-Hoe, S Mendoza, C Pallás-Allonso, JG Ruiz Peláez, J Sizun, A-M Widström.
“Towards universal Kangaroo Mother Care: recommendations and report
from the First European conference and Seventh International Workshop
on Kangaroo Mother Care”. Acta Paediatrica 2010; Vol 99, Issue 6.
Charpak N, Ruiz-Pelaez JG. “Resistance to implementing
Kangaroo Mother Care in developing countries, and proposed
solutions.” Acta Paediatrica 2006; 95: 529–34.
Susan M. Ludington-Hoe, Kathy Morgan, Amel Abouelfettoh,
A Clinical Guideline for Implementation of Kangaroo Care With Premature Infants of 30 or More Weeks' Postmenstrual Age Advances in Neonatal Care
June 2008 Volume 8 Number 3 - Supplement: June 2008 PagesS3-S2
Richardson, H. “Kangaroo Care: Why Does it Work?” Midwifery Today Issue 44, Winter 1997.
Ludington-Hoe, S.M. and Golant, S.K. (1993).
Kangaroo Care: The Best You Can Do for Your Premature Infant.
New York: Bantam Books.
BergmanNJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediactica 2004 Jun;93(6):779-85.
Smith KM. Sleep and kangaroo care: clinical practice in the newborn intensive care unit: where the baby sleeps. J Perinat Neonatal Nurs . 2007;21(2):151-157.
Jessica Richards is a mother of 3, ex-teacher, LLL Leader and founder of Slingbabies- a non-profit babywearing group and website.