Piloting kangaroo mother care in the community: dyadic responses to a novel innovation facilitating skin-to-skin contact

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IntroductionSkin-to-skin contact between a mother and her baby may first occur straight, or soon after birth, where the naked baby is dried and placed prone on the mother's bare chest. The maternal chest is regarded as the ideal evolutionary habitat for the fulfilment of the baby's immediate and long-term biological needs through its own neurodevelopment, such as the establishment of feeding (Moore et al 2016).Kangaroo mother care (KMC) was developed in Bogotá, Colombia in 1979 (Rey & Martínez 1983). It consists of a care package that incorporates early, continuous, or prolonged mother-baby skin-to-skin contact, ideally with exclusive breastfeeding, and early discharge from the hospital unit, with appropriate neonatal follow-up (World Health Organization 2003). This care package was designed in response to inadequate incubator facilities for low birth weight babies which, once stable, required support only to feed and grow (World Health Organization 2003).A systematic review of trials using KMC demonstrated a reduction in neonatal morbidity and mortality rates in low birth weight and premature babies when compared to babies receiving incubator care (Conde-Agudelo & Díaz-Rossello 2016). Meta-analysis of neonatal outcomes for preterm and full-term babies being cared for in KMC demonstrated a reduction in the incidence of neonatal sepsis, hypothermia and hyperthermia, hypoglycaemia, and hospital readmission — concluding that implementation strategies were necessary to facilitate KMC across the neonatal population (Boundy et al 2016).Breastfeeding behaviour also differs between babies receiving KMC and those receiving swaddling or cot care. Mother-baby skin-to-skin contact following birth results in increased effectiveness of the first breastfeed (Moore et al 2016), and is associated with an increase in breastfeeding exclusivity up to six months postpartum (Vaidya et al 2005).Despite rigorous data on safety and neonatal health benefits, implementation of KMC within high-income settings has remained low (Engmann et al 2013). UNICEF's Baby Friendly Initiative standards advocate maintaining close proximity between the mother and baby, and skin-to-skin contact from birth, and throughout the postnatal period (UNICEF UK Baby Friendly Initiative 2012). However, routine separation of mothers and babies immediately following birth has occurred widely in industrialised nations since the 20th century, with babies being dressed and wrapped, and cared for in a crib or nursery (Moore et al 2016). Further separation of the mother-baby dyad may result from obstetric or neonatal medical interventions, such as maternal caesarean section, or admission to a neonatal special care unit.Specific to the UK, extremely low breastfeeding rates, coupled with discouragement of mother-baby bed-sharing, based on the association between co-sleeping and sudden infant death syndrome (National Institute for Health and Care Excellence (NICE) 2006,The Lullaby Trust 2017), may also contribute to the separation of the baby from the evolutionary habitat of the maternal chest.

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