Lakshmi* was pregnant again. She was going to have twins this time. It was her third pregnancy. Unfortunately, none of her young ones survived more than a month. All of them were born preemies. The first weighed 1600 grammes and the other 1650 grammes. The loss had an effect on her. She suffered from post-natal depression both the times.
However, she was ready this time. She was not going to take any chances.
So, when the sonograms showed that babies were not gaining as much weight as they were supposed to, she moved from her village in Central India to Mumbai, a big city. She registered in a hospital where I worked. I was an intern, doing my Obstetrics rotation. Because of her condition, we saw her every week towards the late third trimester. Every Tuesday morning, I was greeted by her soulful smile on my way to the clinic.
She went into labour on a Friday. Her husband and a couple of other relatives rushed her to the hospital. She was in her 34th week of pregnancy. We were prepared.
However, things rarely go as planned. I was waiting for her with a colleague on the first level. As soon as she entered, we made her comfortable on the gurney and entered the lift. Suddenly, she had a contraction and she grabbed my hand. "The baby is out" she exclaimed! I was stunned. It was literally 2 minutes more to the labour room. We were not ready to deliver the baby in the lift! She was dilated, the baby was crowning.
We wheeled her quickly in the ward. I pushed the gurney with the ward attendant. My colleague was keeping a tab on the baby. "Wait." She said. The baby's head was almost out. She got into action and delivered the first baby just outside the room. By that time, the team arrived as well. The second baby was on the way. We barely made it to the labour room and the second baby was born. This time, the babies weighed 1700 and 1730 grammes respectively.
Low birth weight babies
It is estimated that about 4 million infants die within the first 4 weeks of life1. A lack of access to proper healthcare facilities is one of the causes of this mortality. A baby with a birth weight on less than 2500 grammes is termed as Low Birth Weight Baby.
These babies have it tough.
They are susceptible to infections, jaundice, and often fail to thrive. They may have delayed milestones in the future. They have trouble suckling and are at times intubated for food. The small baby with a feeding tube coming out of her nose is a heart-rendering sight.
Kangaroo Mother Care
Mother giving Kangaroo care to her premature baby. Image: Polihale
Imagine a small town in Columbia in the 80's. Infants often could not see their first birthday because of a lack of healthcare facilities. The condition was depressing for the parents of preemies. There were very few fully-functional incubators in the town. But, things began to change when in 1978, Dr Edgar Rey Sanabria introduced kangaroo mother care (KMC) in Bogotá, Colombia as an alternative to incubators for LBW infants2.
To give Kangaroo care, the baby is gently strapped to the naked chest of either parent. The World Health Organization defines KMC with 4 components: early, continuous, and prolonged skin-to-skin contact (SSC) between the newborn and mother, exclusive breastfeeding, early discharge from the health facility, and close follow-up at home3. The newborn will receive the necessary warmth from the mother as well as would be able to breastfeed on demand2.
KMC or skin-to-skin contact has been shown to be more effective than the conventional methods in the early growth of the baby4. The preemies who receive KMC are more alert, latch sooner and have seen to gain weight faster than their counterparts receiving conventional treatment5,6. In clinical trials, SSC alone has also been associated with improved breastfeeding, cardiorespiratory stability, and improved responses to procedural pain7,8.
However, your baby need not be a preemie to receive skin-to-skin contact. Most of the parents prefer this method to give the baby some tummy time in the early few weeks. It is the way a father can bond well with the baby, spend some quality time, relieve the mother and get peed on! It is a privilege.
My professor thought that it would be best for the babies if they received KMC. The babies were premature and like her previous babies, they had a higher chance of mortality than the other healthy neonates. The girls checked for their vitals, and within a few minutes, each on was snuggling against the warm chest of the either parents. Both of them opened their eyes in less than an hour and were latched in 90 minutes. Lakshmi could breastfeed them, unlike her earlier babies. In her eyes, they were out of danger.
We saw the girls a few times after that. They were gaining weight nicely. Till this date, she attributes their health to my Professor's decision to give the girls Kangaroo Mother Care. "My preemies are alive today thanks to KMC" she is often heard telling this to other new mums.
So mums and mums-t0-be, be sure to ask your obstetrician about KMC. It is a great way to bond with your baby.
*Name changed to protect the identity of the mum.
- 4 million neonatal deaths: when? Where? Why? Lawn JE Cousens S Zupan J. Lancet. 2005;365(9462):891–900pmid:15752534
- Kangaroo Mother Care: 25 years after. Charpak N, Ruiz JG, Zupan J, et al. Acta Paediatr.2005;94 (5): 514 522 pmid: 16188735
Kangaroo Mother Care: A Practical Guide. World Health Organization Department of Reproductive Health and Research. Geneva, Switzerland: World Health Organization; 2003
- Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis.Ellen O. Boundy, Roya Dastjerdi. Pediatrics December 2015
- ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. Int J Epidemiol. 2010;39(Suppl 1):i144–i154pmid:20348117
- Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Conde-Agudelo A, Díaz-Rossello JL. Cochrane Database Syst Rev. 2011;3: CD002771
- Early skin-to-skin contact for mothers and their healthy newborn infants. Moore ER, Anderson GC, Bergman N. Cochrane Database Syst Rev. 2007;3: CD003519
- Skin-to-skin care for procedural pain in neonates. Johnston CC-Y, Fernandes A, Inglis D, Streiner D, Zee R. Cochrane Database Syst Rev. 2014;1: CD008435
Also, read Breastfeeding during pregnancy 101: What you need to know if you have not done that already.