Kangaroo Mother Care (KMC) is a practice where skin-to-skin contact is initiated within the first hour of life for all stable newborns (birth weight 2000 g or higher). This has been found to reduce mortality among these infants.
KMC has proved effective, yet its uptake and service coverage remain inadequate in many countries. To expedite global implementation of KMC, standardized operational definitions and clinical standards are necessary to ensure its success.
How to do KMC
KMC (Kinder to Mother Contact) is a form of skin-to-skin contact between mothers and their infants that can take place both at the hospital or home, regardless of age, parity, education level, culture or religion.
Holistic parenting promotes physical closeness between mother and baby, which aids the infants’ neurodevelopment, sleep patterns, and stress levels. This approach may aid weight gain as well as overall health for the newborn.
Health care personnel strongly promote this practice, which can be started while the infant is still in the nursery or during recovery from medical treatment for a serious condition. Short KMC sessions can be given while they’re being fed via orogastric tube or oxygen therapy or being ventilated.
KMC has not been widely adopted in Kenya despite its benefits, due to a variety of obstacles such as lack of support at home; difficulty quickly returning to the hospital in case of an emergency; too many chores that must be done at home (often alone due to gender roles); and financial struggles.
Mothers and healthcare workers agreed that lack of knowledge about KMC was a major barrier for its implementation. To address this, some suggested pregnant mothers be educated about KMC during antenatal care so they would not have to learn about it for the first time when their preterm baby arrives.
Some mothers also suggested health workers train their husbands, partners and attendants in KMC as part of couple counseling. This can be done by teaching them how to give KMC and providing them with information on its advantages.
KMC has been found to improve the gastrointestinal function of newborns, aid in weight gain and reduce energy expenditure. It may also decrease cortisol levels in babies which are linked to stress, and boost oxytocin – a hormone which promotes bonding between mother and infant – by stimulating milk production. Thus, KMC helps mothers produce more milk more easily during breastfeeding sessions.
What to expect
KMC (Kinetic Mechanical Compression) is an intervention that has been scientifically proven to increase survival rates of preterm or low birth weight (LBW) babies and reduce neonatal mortality. The World Health Organization (WHO) endorses KMC as an effective way to help these infants survive and develop normally; however, its uptake remains low. Despite this, there is now a renewed global push to scale up KMC practice after hospital discharge; however there remain significant challenges associated with its implementation after discharge from hospitals.
Key barriers included human resource shortages, inadequacies in infrastructure and lack of community support. These factors prevented NCU staff from providing adequate training for all mothers and their supporters, leading to limited implementation of KMC in the NCU. Moreover, yearly rotations of nurses between units decreased capacity to implement KMC effectively.
Unfortunately, there was little coordination of care between the NCU and community members. This was particularly true for VHTs and traditional birth attendants who delivered pre-term babies in their communities without receiving formal training on KMC (Knowledge Management Care).
Mothers and other support personnel were reluctant to try KMC due to a lack of information about it. Many had never heard about it before, and some even admitted they didn’t know if it was safe or how to go about doing it. Furthermore, they weren’t certain how many hours should be dedicated to KMC and when to end it.
They were unaware of the health advantages associated with KMC, such as increased breastmilk production and a more secure sense of parental role identity. These effects were felt by both mother and baby.
At the time of the study, researchers identified and interviewed mothers practicing KMC both in the hospital and at their homes. Phone numbers registered in hospital record books were used to contact these mothers by telephone.
In addition, the researchers spoke to a select group of community members including VHTs and traditional birth attendants as well as health workers in six hospitals. These stakeholders were asked about their experiences with KMC practice, their opinions on KMC policy, and potential solutions for improving KMC in the community. They identified several potential enablers such as community follow-up by qualified health workers and CHWs (community health workers).
Getting started
KMC is an essential element of newborn care, helping to prevent infant mortality and morbidities among preterm and low birthweight (LBW) babies. It reduces hypoglycaemia and neonatal infections, promotes weight gain and increases breastfeeding rates; furthermore, KMC enhances mother-infant bonding while cutting down hospital admissions and length of stay at hospitals, among other advantages.
However, KMC has proved difficult to implement and scale-up in low income countries due to differences in health worker capacity, resource availability, leadership, health information systems, cultural/community structures that make it difficult to create a global definition of KMC that incorporates common components across different settings.
In this formative research project, we sought to identify barriers to KMC initiation, practice and acceptance in rural and urban health facilities and community settings in Southern Ethiopia through 24 focus group discussions (FGDs) and 14 individual-dialectical interviews (IDIs) with 144 study participants. The themes identified included missed opportunities in identification of preterm and LBW babies; inadequate referral systems; community perceptions toward preterm and LBW babies; traditional care for both types; health workers’ knowledge, attitudes and practices towards KMC; as well as challenges encountered during its inception and continuation.
Our research indicates that many factors influence a mother’s willingness to engage in and continue KMC practice, such as her stress, fear, stigma, shame or guilt about having a preterm baby; her community’s beliefs and values regarding preterm and LBW babies; health professionals’ knowledge, attitudes and practices; and support from family members. To address these barriers, scale up KMC practices at three levels by identifying all pregnant women, providing them with an organized referral system to health facilities; weighing all newborns at community level before linking them to facilities if eligible; and providing training to community members as well.
To accelerate KMC adoption globally, a standard operational definition and evidence-based implementation strategy must be created. This should include indicators and measurement tools to track SSC initiation criteria, duration as hours promoted per day promoted and observed, feeding protocols, discharge criteria from facilities to community, as well as follow-up standards.
Safety
KMC offers a safe and efficient solution to caring for newborns who are premature or low birth weight. It can help avoid complications, improve long-term health outcomes for these babies and their mothers, reduce hospital-acquired infections, boost breastfeeding rates, and safeguard an infant’s neuromotor and brain development.
However, implementing KMC in health facilities and communities presents several obstacles. These include differences in healthcare worker capacity, financial resources, leadership and health information systems – all of which pose obstacles to creating a global definition of KMC that can be scaled up and implemented at scale.
Furthermore, many healthcare workers are unfamiliar with KMC practice, leading to delays and missed opportunities to utilize KMC. Other challenges include lack of equipment, insufficient training and supervision, as well as infrastructural shortcomings.
Some of these challenges can be mitigated by providing education about KMC’s advantages to expectant mothers and community health workers. This can be accomplished through outreach from health and extension workers, midwives, as well as women who have personally used KMC.
In addition to these educational efforts, the research team developed a system for measuring KMC duration. This was implemented through PDSA cycles and various parent-centric measures (provision of bed to mothers, foster KMC, structured KMC counselling through video recording, making KMC an integral part of treatment orders).
The QI team, comprised of nurses, nursing in charge, consultants and QI champions, monitored the duration of KMC on a daily basis through fishbone analysis. Based on these results, various PDSA cycles were introduced and tested; such as providing beds for foster KMC, structured KMC counselling and hosting a monthly perinatal statistics meeting where KMC rate was presented as a quality indicator to maintain motivation levels.