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Problem-Based Research Paper

Kangaroo Mother Care

Mariah Little

Nursing Research NUR 340

Dr. Heacock

March 6, 2022
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Introduction

We tend to focus on all the ways technology can improve healthcare and help innovate

new medicine. But we forget to simply use the basic science and interventions that have been

with us from the beginning. This leads to the question of what effects can kangaroo mother care

have on both mother and baby? Kangaroo mother care is practiced on preterm babies, term

babies, and newborns in the neonatal intensive care unit when considered stable. Kangaroo

mother care involves skin to skin with the neonate and exclusive breastfeeding, if medically

possible.

Statement of Problem

Through my question what effects can kangaroo mother care have on both mother and

baby I can also look at the impact and ways to promote kangaroo care in more hospital and

NICU settings. Skin-to-skin has so many proven benefits for both mother and baby as well as

breastfeeding, the sooner and more frequent the mother and her newborn can perform this, is

very beneficial. Kangaroo care incorporates skin to skin while performing feeds, procedures, and

more. It is essentially like a kangaroo mother cares for her baby.

Literature Review

Kangaroo mother care has simply been practiced for years without even knowing the

actual benefits it plays. By caring for an infant through skin-to-skin contact with the mother and

exclusively breastfeeding it can significantly help increase a premature or low birth weight

baby’s chance of survival (WHO, 2021). Kangaroo mother care is emphasized with premature or

low birth weight babies in the NICU, but the same benefits can be used on healthy newborns

also. Kangaroo mother care was recommended to be initiated once babies in the NICU were
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considered stable. Although now research is showing earlier initiation can play a role in faster

stability and is even more beneficial to the newborn. In a trial conducted in hospitals in Ghana,

India, Malawi, Nigeria, and Tanzania mothers gave continuous care of their newborns once the

baby was considered stable for 24 hours. The mother and the infant stayed in the specific mother

kangaroo unit to be cared for until discharge. The study revealed that continuous mother

kangaroo care with birth weights between 1-1.799 kg improved neonatal survival rate by 25%

over intermittent kangaroo care (WHO 2021). Continuous kangaroo care requires that the mother

would be with the infant 24 hours a day during the entire NICU stay. As there are many known

benefits to skin-to-skin care and exclusive breastfeeding it is alleged that continuous kangaroo

mother care decreases the risk of infection by a reduction in number of individuals handling the

infant and the protection from the mother’s defensive microbiome (WHO, 2021). In some studies

researchers are trying to create certain criteria that enables a neonate in the intensive care unit for

kangaroo mother care. In a study conducted in Gambia, the neonates they considered stable

enough for kangaroo care was neonates with respiratory rates between 60-100, no apnea, heart

rate greater than 100 but less than 200, and spo2 level 88% or greater (Brotherton et al, 2021).

More studies and literature are needed to be able to form the best criteria for considering a

neonate stable enough for kangaroo mother care.

Kangaroo mother care not only shows a reduction of mortality in low birth weight and

preterm infants, but it also has been described as the most cost-effective interventions to promote

wellbeing (Lewis et al, 2019). Although unfortunately for some mother’s kangaroo mother care

was inhibited by various barriers. Barriers described by mothers in a study were insufficient

time, social support, medical care, and family acceptance, as well as “resource-related” barriers

like facility environment issues (Lewis et al, 2019). Mothers were prohibited from their time
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spent giving kangaroo care due to the level of stress. Stressful events reported by the mother

were the fact that her infant was in the NICU, the demanding pumping schedule, and not enough

paid maternity leave available from work. Kangaroo care was also hindered by a difficulty

recovery from birth. Mothers reported the inability to be confined to a seat in the NICU for hours

due to the pain and level of exhaustion. Mothers reported that the lack of nurses beginning

initiation of skin-to-skin contact was the hindrance of completing kangaroo care. Nurses are the

sole educators for new parents and their infants and lack of explaining or introducing concepts to

the new parents plays a significant role in outcomes. Lack of education was reported by mothers

as only 20% relayed temperature regulation as a benefit to kangaroo mother care and 15%

relayed breathing regulation. Mothers reported a feeling like no other and an increasement in

bonding between her and her infant when skin-to-skin was initiated.

Skin-to-skin should be all inclusive regardless of the mode of delivery. To incorporate

kangaroo mother care for more mothers, skin-to-skin should be incorporated in the birthing

process in the operating room for mothers that undergo cesarean sections. In hospitals that

implement the baby friendly initiative using the 10 steps to successful breastfeeding, step four

reads to help mothers initiate breastfeeding with one hour of life (Brady et al, 2014). In an

evidence-based review study conducted, nurse educators and lactation consultants worked with a

team of nurses to initiate skin-to-skin in the operating room during c-sections where the infant

was considered stable. This initiative increased patient satisfactions and increased the rate of

exclusive breastfeeding rates after discharge from 30% in December of 2012 to 63% in April of

2013 (Brady et al, 2014). This initiative also increases the kangaroo mother care for newborn and

their mothers.
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When considering kangaroo mother care, we think about when all criteria is met and

everyone is considered stable. We also focus solely on the mothers as the only performers. In a

study conducted with 30 fathers whose infants were in the NICU, skin-to-skin and kangaroo care

was performed with the fathers. Fathers from this study reported after completing kangaroo care

with their newborn that their level of stress had reduced, increased communication with staff

members, and increased time spent with the infants (Dongre et al, 2020). We must try to include

fathers in this care as their stress levels of their infants being in the NICU are also risen and

kangaroo care has been shown to decrease this.

Analysis

Most articles used a review of known information and knowledge and integrated that into

their review or study. For instance, the review of initiation of skin-to-skin in the operating room,

the authors conducted a study plan do research. With known information they incorporated this

into studies completed. Predominantly most articles all concluded the same information that

initiation of kangaroo mother care as soon as possible had positive effects on both mother and

newborn. There is some barriers that are present that most articles should learn to integrate into

their studies and future work. Gaps in the research are shown by a majority of articles focusing

kangaroo mother care on predominately low birth weight and premature babies. As this care

shows great impacts on those babies, more research should aim at both populations of well

infants and more critical.

Recommendations

Based off my findings I would recommend more facilities to practice and implement

kangaroo care for all babies, well or critically stable. Based off my research kangaroo care
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benefits the infant, mother, and even fathers when mothers are unable to participate in kangaroo

care. I would suggest more qualitative research studies to be completed in the United States to

discuss both the staff and patient’s perceptions on kangaroo care. I would also recommend more

evidence-based studies completed on specifically kangaroo care as the research was limited in

my findings. We as nurses emphasize the importance of skin-to-skin for the first hour as baby

friendly initiatives suggest but we do not highlight the importance of continuation during the

entire care of the newborn. A specific title study I would recommend is “evidence-based project

to implementation of kangaroo mother care on all newborns.” Evidence based practice studies

are seen as solving a problem to the delivery of health care that integrates the best evidence from

well studies and patient care data (hence this data could come from more qualitative studies) and

then combines it with patients’ preferences and nurse expertise. Therefore, in my proposed study

title, with the use of qualitative studies and patient care data, along with the thoughts of mothers

participating in kangaroo care and nurses initiating it an evidence-based study could be studied.

To ensure protection of human rights I would assure individuals in the trial are aware of their

five basic human rights. They have the right to self-determination, right to privacy and dignity,

the right to anonymity and confidentiality, the right to fair treatment, and the right to protection

from discomfort and harm. The implication of kangaroo mother care is to increase bonding

between mother and baby, decrease of stress in the newborn, temperature regulation, and more.

With all the known and stated benefits we can implement this strategy at all hospitals to increase

patient outcomes.
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References

Lewis, T. P., Andrews, K. G., Shenberger, E., Betancourt, T. S., Fink, G., Pereira, S., &

McConnell, M. (2019). Caregiving Can Be Costly: A Qualitative Study of Barriers and

Facilitators to Conducting Kangaroo Mother Care in a US Tertiary Hospital Neonatal

Intensive Care Unit. BMC Pregnancy and Childbirth, 19(1), 227. https://doi-

org.libproxy.dtcc.edu/10.1186/s12884-019-2363-y

Dongre, S., Desai, S., & Nanavati, R. (2020). Kangaroo Father Care to Reduce Paternal Stress

Levels: A Prospective Observational Before-After Study. Journal of Neonatal --

Perinatal Medicine, 13(3), 403–411. https://doi-org.libproxy.dtcc.edu/10.3233/NPM-

180190

Brady, K., Bulpitt, D., & Chiarelli, C. (2014). An Interprofessional Quality Improvement Project

to Implement Maternal/Infant Skin-to-Skin Contact During Cesarean Delivery. JOGNN,

43(4), 488-496. https://doi.org/10.1111/1552-6909.12469

World Health Organization. (2021, May 26). Kangaroo Mother Care Started Immediately After

Birth Critical For Saving Lives, New Research Shows. World Health Organization.

https://www.who.int/news/item/26-05-2021-kangaroo-mother-care-started-immediately-

after-birth-critical-for-saving-lives-new-research-shows

Brotherton, H., Gai, A., Kebbeh, B., Njie, Y., Walker, G., Muhammad, A. K., Darboe, S., Jallow,

M., Ceesay, B., Samateh, A. L., Tann, C. J., Cousens, S., Roca, A., & Lawn, J. E. (2021).

Impact of Early Kangaroo Mother Care Versus Standard Care on Survival of Mild-

Moderately Unstable Neonates <2000 grams: A Randomised Controlled Trial.

EClinicalMedicine, 39, 101050. https://doi.org/10.1016/j.eclinm.2021.101050