Kangaroo Mother Care: A Strategy to Improve the Quality of Postpartum Care
The recent release of an International Consensus Statement on kangaroo mother care (KMC) for preterm and low birthweight babies has once again highlighted the importance of the KMC intervention for reducing global infant mortality and perinatal morbidities. Raising awareness of the value of KMC in all global healthcare settings is a key public health strategy towards realizing Sustainable Development Goal 3—particularly the target for preventable neonatal deaths, which are often prematurity-related.
The postnatal period is a critical phase of development for both mother and baby, and its importance in the transition between fetal and infant life is well known. From the third trimester, the environment and experience of the baby become as important for brain development as genetic processes. The biological expectation of the baby at birth and during the postnatal period is the immediate closeness of the mother, including skin-to-skin contact, close physical proximity, reciprocal gaze and vocalization, maternal smell and breastfeeding. With skin-to-skin contact, inborn behaviors are stimulated, which motivate the baby to seek mother’s milk. Physiological stability is established more quickly among babies who remain close to their mothers compared to those who are separated, laying the foundation for positive emotional and mental health.
Importantly, for babies born preterm and requiring hospitalization, KMC provides safety from the three main challenges these infants can endure: separation from their mother, environmental stress and unbuffered painful procedures. In the KMC position, the infant’s parasympathetic nervous system is activated by oxytocin, resulting in a perception that the environment is ‘safe.’ The sympathetic system and associated “fight, freeze or flight” responses are downregulated, and physiological, metabolic and immunological functioning is optimized. Crucially, KMC helps babies to establish breastfeeding sooner and continue longer, and it also provides babies with pain relief. Furthermore, research suggests that the benefits of KMC can last throughout the child’s life.
The case for widespread KMC use as a “best practice” to enhance a “normal physiological postnatal period,” is highlighted by this statement made by the World Health Organization (WHO) in 2015:
“Kangaroo mother care is recommended for the routine care of newborns weighing 2000 grams or less at birth, and should be initiated in health care facilities as soon as the newborns are clinically stable… should be provided as close to continuous kangaroo mother care as possible…(or) intermittent kangaroo mother care rather than conventional care.”
For KMC to be implemented and scaled more widely, a paradigm shift needs to occur away from routine care practices in the early postnatal period involving the separation of mothers and babies and towards a “zero-separation” model of care. This shift is recommended by the World Association for Infant Mental Health, the American Academy of Pediatrics and WHO. Supporters of this perspective agree that this strategy will result in more humanized perinatal care. KMC can be especially important for preterm and low birthweight infants in settings with limited resources, as seen in countries such as Malawi, Mali, Rwanda and Uganda.
Timely use of KMC is safe, effective, efficient, equitable and people-centered and therefore meets the WHO definition of high quality care. Short and long term physiological, psychosocial, humanitarian and financial benefits are expected for individuals, professionals and healthcare systems implementing KMC on a large scale; Indeed, there is an urgent moral and ethical imperative to do so.
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Watch the KMC press release.
Learn more about preterm birth.