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VIEWS: 14 PAGES: 22

									‫‪HOW IS KANGAROO MOTHER‬‬
‫?‪CARE IMPLEMENTED‬‬


                ‫دک ترمحمود راوری متخصص اطفال‬
                        ‫دانشگاه علوم پزشکی اراک‬
         ‫عضو كميته كشوري ترويج تغذيه با شيرمادر‬


              ‫‪Dr ravari‬‬
Introduction
• About 20.6 million low-birth-weight (LBW) babies are born
  each year,
• Low Birth Weight (LBW) frequency in the developing world
  (10% to 30% of total live deliveries)
• The global prevalence of LBW is 15.5% (the highest incidence
  in South-Central Asia (27.1%) and the lowest in Europe (6.4%).
   • four million newborns are dying each year,
   • Low birth weight directly or indirectly may contribute up to
      60–80% of all neonatal deaths,
• Kangaroo Mother Care (KMC) has emerged as a
  promising modality of care for LBW newborns,
    • Research results have shown that Kangaroo Mother Care can
      decrease morbidity and mortality from LBW.



                                                                    Dr.Ravari
TEXTBOOKS SPEAKING TO KMC:

• Fanaroff and Martin, 2006. in 8th Edition, Neonatal-Perinatal
  Medicine.
• Beck D, Ganges F, Goldman S & Long P. 2004. Care of the
  Newborn.
• Kenner C, Lott JW (Eds.)Comprehensive neonatal nursing.
• Kenner, C, & McGrath, J.M. (2004).Developmental Care of
  Newborns and Infants. A guide for health professionals. Mattson
  S, & Smith J.E. (2004). Core Curriculum for Maternal-Newborn
  Nursing- 3rd Ed.
• Merenstein G.B., Gardner, S.L. (2002). Handbook of Neonatal
  Intensive Care. 5th Edition.
• Verklan TM, Walden M (Eds.) 2004. Core Curriculum for
  Neonatal Intensive Care Nursing.
• Vergara E.R., Bigsby, R. (2003). Developmental and Therapeutic
  Interventions in the NICU….


                                                                    Dr.Ravari
  KMC
• Strategic Guidance Note on the Newborn UNICEF
  and Save the Children October 2006.
• WHO Recommended Interventions for Improving
  Maternal and Newborn Health, 2007.




                                                  Dr.Ravari
KMC
Benefits to the baby
• Most low birth weight infants can be kept warm and stable
  (breathed better and had a more stable heart rate) with KMC
• Infants grow faster , fewer energy-consuming movements, which
  leads to satisfactory weight gain
• No additional risk for infection and reduction of the occurrence
  and severity of hospital acquired infections
• Less crying
• Less apnoea
• More quiet sleep periods
• Increased initiation and duration of breastfeeding with more
  exclusive breastfeeding

                                                                Dr ravari
KMC

           •   an increased sense of bonding with their baby
           •   an increased confidence in caring for their baby
           •   they feel less stressed
           •   Skin–to-skin care also enables both fathers and
Benefits   •
               mothers to participate in their infants’ care
               mothers are empowered to play an active role in
 to the    •
               their infant’s care
               humanization of neonatal care
parents    •
           •
               breast feeding is promoted
               less neglect and abandonment
           •   It improves bonding between fathers and infants,
               which is particularly important in countries with
               high rates of violence towards children.




                                                                   Dr ravari
HOW IS KANGAROO SUPPORT PROVIDED?


EMOTIONAL SUPPORT:
 • The mother needs encouragement if she is to give KMC.
 • Many young mothers with their first infant need an enormous amount of reassurance from
   family, friends and health professionals.
 • KMC empowers mothers to meet all their infants’ needs.
PHYSICAL SUPPORT:
 • During the first few weeks of KMC, nursing the infant takes up most of the mother’s time.
 • Adequate rest and sleep are essential. Therefore, she needs support with household chores and
   managing the family.
EDUCATIONAL SUPPORT:
 • It is important to give the mother the information she needs to understand the whole process of
   KMC and accept that KMC is important.
 • She needs to be made aware of the many advantages of KMC. This makes the KMC
   experience more meaningful and increases the chances that she will give KMC successfully
   both in hospital and after discharge.
  Types of KMC
 • Sporadic KMC: Mother not available every day – she
   puts baby in skin-to-skin (STS) position when she visits
   and if she wishes
 • Intermittent KMC
        • Mother has baby STS certain times of day (e.g. at certain feeding times)
        • Mother has baby STS during the whole day, but not at night
        • Mother has baby STS any time she wishes – not 24 hrs/day
 • Continuous KMC: Mother has baby STS + 24 hrs/day




Kangaroo Kangaroo mother care in hospitals across the world ,Anne-Marie Bergh. The 6 th BiannualI international
Workshop of KMC,October 12-15, 2006.                                                                              Dr ravari
 WHAT IS A KANGAROO MOTHER
 CARE WARD?

• The KMC ward should be close to the nursery if
  possible. Ideally, a door should link the KMC
  ward with the nursery so that help can be obtained
  if needed.
• Limited visiting is allowed in the KMC ward but
  the mothers’ privacy must be respected.




                                                   Dr ravari
 TRAINING OR INTRODUCING THE KANGAROO
 METHOD AND KMP TO THE HOSPITAL
 MANAGERS:


The hospital leaders had understood and supported a lot for the KMP. For
example: giving the hospital guess house for Kangaroo unit, to buy the
refrigerator, beds, tables, chairs for mothers and staffs...




                                   Dr ravari
HOW IS KANGAROO MOTHER CARE
IMPLEMENTED?
• The implementation of KMC depends on the
  following:
  1.   The staff‘s acceptance of KMC.
  2.   Adopting a KMC policy.
  3.   Writing KMC guidelines.
  4.   Training the staff to use KMC.
  5.   Teaching mothers to give KMC.
  6.   Establishing facilities for KMC.
  7.   Educating the community to accept KMC.
  8.   Managing ambulatory KMC.
Which family member often influences a
woman’s decision to use KMC or not?

• The grandmother,
• The whole family
  should support a
  mother giving KMC.
Could her partner also give KMC?

• It is important to
  encourage bonding
  between the infant and
  both parents. Therefore,
  the father should also
  have an opportunity to
  give KMC.
• This will also help him
  understand and support
  the mother when she
  gives KMC.
"The Kangaroo Mother Program at Uong Bi Hospital, Vietnam".
Dr. Nga Nguyen

      The mother always has some one to help
      her to take care of the child at home:


     • The father: 48/134 (35.6 %).
     • The grandmothers: 72/134 (54.1 %).
     • Relatives: 14/134 (10.4 %).

     "The Kangaroo Mother Program at Uong Bi Hospital, Vietnam".
     Dr. Nga Nguyen




                                                                   Dr ravari
How often should the infant receive
KMC at home?


• All the time, both day and night.
• Someone else reliable can give KMC if the
  mother needs a break.
Why is it important that the mother learns
how to express her breasts?

• Because the infant needs
  expressed breast milk
  feeds as it is still too
  immature to suck.
• One of the most important
  skills that all mothers
  should learn is how to
  express their milk.
     Problems encountered with the implementation
     of the Kangaroo Mother Care Program (KMC)

   • The problems encountered with the directors and
     administrators varies according with the Medical
     Institution.
   • Obstacles to the KMC there were related with:
      • norms and rigid regulations, norms do not permit the
        discharge of babies below 1700g.
      • administrators are afraid of law suits, should any of
        the Kangaroo babies die in there homes.
      • medical areas to KMC is not possible , physical area is
        too small.


"Problems encountered with the implementation of the Kangaroo Mother Care Program (KMC) in Tepic, Nayarit, México".
Dr. Miguel Licea Pérez Peña
   • The problems encountered with the directors and administrators varies
     according with the Medical Institution.
   • Obstacles to the KMC there were related with:
      • the nurses wanted to know if their area was going to receive more
        pay, or if they were going to have more work.
      • all doctors agreed with the KMC, but they do not want to work
        more.
      • everybody in the area is afraid about the changes, in the
        established routines.
      • there are no problems with mothers, except that they get tired
        sometimes, but in all instances they want to continue.
      • in conferences about KMC was of utility to change there mind
        except some directors, that did not want to hear about the KMC.

"Problems encountered with the implementation of the Kangaroo Mother Care Program (KMC) in Tepic, Nayarit, México".
Dr. Miguel Licea Pérez Peña
L. Rosero, R.Martinez (Colombia)

      Implementation of KMC in the
      Colombian Social Security in Bogotá

      • We1 will present you some of the difficulties we
        meet with the medical and nurse staff of the
        maternity in the implementation of our KMC
        program in his first year.
            • At the begining we meet a neonatologist resistance from
              neonatologist against the change introduced by KMC in the
              medical and nurseries routine
            • At the same time we found a deep nurses distrust about mothers
              competence to look after their very small babies at home. We
              found resistance from nurses to accept to take the baby off the
              incubators and to give him to their mothers


   1: L. Rosero, R.Martinez (Colombia)                                      Dr ravari
L. Rosero, R.Martinez (Colombia)

      Implementation of KMC in the
      Colombian Social Security in Bogotá
      • We1 will present you some of the difficulties we meet with
        the medical and nurse staff of the maternity in the
        implementation of our KMC program in his first year.
            • We had to resist a high pressure of the same pediatricians for early
              discharge, sometimes before the infant had cumplished the
              elegibility criteriae.
            • In the ambulatory consultation , as you can see we have some
              problems with the space in the kangaroo little house where the
              ambulatory kangaroo program take place.
            • Another problem we meet in the first year of implementation of
              KMC was the emergency consultation of the kangaroo baby during
              the night because doctors were no prepared to attend this very
              small baby caring at home. ………

   1: L. Rosero, R.Martinez (Colombia)                                        Dr ravari
  Resistance to Kangaroo Mother Care (KMC)
  implementation in developing countries
  •     Resistance to the overall KMC intervention
          •    KMC is judged as sub-standard care because is perceived as the “poor man’s
               alternative” for developing countries.
          •    Staff believes that KMC represents extra work.
  •     Resistance to Kangaroo Position
          •    Direct skin to skin contact (KMC position between a naked baby and the
               Kangaroo position provider (usually the mother) is regarded as “unusual” or
               even “improper”.
          •    Mother privacy and modesty.
          •    Newborn cap (bonnet) and socks,
          •    Diaper,
          •    Health care personnel not pursuing continuous (24 hours a day) kangaroo
               position when indicated,
          •    Mother objects maintaining Kangaroo Position 24 Hours a Day.
          •    “Authorization” for the mother to commit herself to continuous kangaroo position.
          •    Participation of the father:
Nathalie Charpak, MD 1 Juan Gabriel Ruiz-Peláez, MD 2 MMedSci The 6 th BiannualI international Workshop of KMC,October 12-15, 2006,
                                                                                                                                      Dr ravari
  Resistance to Kangaroo Mother Care (KMC)
  implementation in developing countries
  • Resistance to Kangaroo Nutrition
          • Breastfeeding infant is an extra workload.
          • Lack of feasible alternatives to supplement breast feeding when
            indicated.
          • Artificial formula feeding is regarded as a marker of economic
            wellbeing.
  • Resistance to early discharge and follow up policies
          • Concerns about assuring the infants safety when discharged early
            to home, despite satisfying the requirements for safely discharging
            the infant.
          • High risk follow up policies.



Nathalie Charpak, MD 1 Juan Gabriel Ruiz-Peláez, MD 2 MMedSci The 6 th BiannualI international Workshop of KMC,October 12-15, 2006,
                                                                                                                                      Dr ravari

								
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