What is Kangaroo Mother Care (KMC)?

Kangaroo Care, Skin-To-Skin Contact, and Kangaroo Mother Care are terms that relate to the holding of a diaper clad infant bare-chest to bare-chest, ventral-surface to ventral-surface by the mother, father, or others(Source: USIKC).

This method started in Bogotá, Colombia in 1978, and consists of skin to skin contact between the adult and baby, from the time of birth (from the delivery room or intensive, intermediate or basic care,) the food based on breast milk, and the early discharge from the hospital. 

It is well known that while the attention of high–tech medical care is essential, babies have to endure the stress conditions from which they were supposed to be protected by the womb: noise, light, painful procedures and sleep and wakefulness cycles. All these noxious stimuli affect the development of the neurological system, which is still immature, unable to adequately respond to all this and become attacks that can leave short, medium and long term consequences.Find a wrap that holds the position and the weight of the baby that has been given the green light to be in Kangaroo Care. It minimizes disruptions, provides proper containment and support leaving the parent's handsfree for resting safely or for other activities (thus holding for longer periods of time).

Parents need to be present in the NICU with their baby as soon as they can to provide an effective, more kinder and gentler environment in Kangaroo Care. They should hold as long as they can, no less than one hour which is the length of one full sleep cycle. Many sessions a day if necessary and with minimal interruptions, as recommended by The American Academy of Pediatrics, The Academy of Breastfeeding Medicine, UNICEF, the World Health Organization, the Neonatal Resuscitation Program, and the United States Institute of Kangaroo Care.

"Best Practice is Kangaroo Care as soon as possible, for as long as possible, and as uninterrupted as possible" 
(Nyqvist et al., 2010, May Acta Paediatrica)

Kangaroo Care Position: 

Mother/adult: sitting up or reclined (never horizontal, side lying, or prone). Place the baby over the chest's bare skin. May wear an open top (shirt, blouse, robe, gown, sweater) if needed for comfort. 

Infant: Infant is placed between the mother's bare breast, strictly vertical and in a prone position, with legs and arms flexed, head in midline and lateral position to allow maximum skin-to-skin exposure. The top of the baby's head is placed a couple of inches lower than the mother's neck. Once the infant is properly positioned, lift the wrap to cover the baby's back up to the level of the earlobe. Make sure the baby's face is uncovered and the nose unobstructed.

Baby only wears diaper (no higher than the belly button) and a hat. Socks may be worn if the room is too cold.

Birth Kangaroo Care Position (Golden Hour): 

.	Vaginal Delivery: During the first one or two hours of life of a healthy or stable baby, when the baby is placed in birth KC position:  strictly vertical between the breasts of the mother, and the eye level of the child is at the level of the mother's nipples to reduce the length of the "natural journey" to the first breastfeed. After feeding keep the baby secure and vertical
	C-Section: across the chest of the mom, covered.  Mom's leads are out of the way of the baby.

Must Read for Birth Kangaroo Care, also known as Golden Hour:

"Infant Assessment and Reduction of Sudden Unexpected Postnatal Collapse Risk During Skin­ to­ Skin Contact" by Susan M. Ludington­-Hoe, PhD, RN, CNM, CKC, FAAN; Kathy Morgan, BSN, RN, CKC, NNPBC

Checklists and Procedures: Step-by-Step Birth Kangaroo Care (Competency Checklist)

Resting in Kangaroo Position:

Parents should be able to rest while doing Kangaroo Care. According to the World Health Organization, the mother will best sleep with the baby in kangaroo position in a reclined or semi-recumbent position. It has been observed that this position may decrease the risk of apnoea for the baby.

Parents that use their hands and attention to provide safety to the baby should not sleep during kangaroo care. 

Parents can rest in a semi-reclined bed or chair (the angle of the hips makes rolling over impossible while reclined), and if the baby is secured with a proper containment, warmth by a kangaroo care device that provides safety there will be no risk of the baby sliding under the wrap or falling.  Another adult must supervise the parent/baby when the parent sleeps. 

Warning:
There are many kangaroo care/skin to skin devices in the market, so make sure you carefully evaluate them for your baby or patient population before making a selection.

The device selected must be designed to prevent sliding and hold the weight of the baby without the need of the hands of the parent.  It needs to be sized correctly every time and use a fabric that keeps the baby warm.   Only a device that keeps the baby safe, warm, and in the correct position (without the parent's hands) may be appropriate for the parent sleeping while supervised.

A comfortable chair with adjustable back may be useful for resting during the day.

[All photos are published with explicit permission by The Zaky ZAK and Nurtured by Design]