Introduction- Kangaroo Mother Care (KMC) is a special method of care for low birth weight (<2500gm) babies. As the name suggests Kangaroo Mother Care consists of keeping the baby in close skin-to-skin contact with his/her mother as practised by female kangaroo animals for their babies.

Eligibility criteria for KMC:

All babies of low birth weight, Preterm, Birth asphyxia, Sick, haemodynamically stable babies needing special care (even those on IV fluids or on oxygen)

Sick babies may need special care initially. Therefore, KMC should be started after consultation with the doctor caring for the baby.

How to start practising KMC A mother cannot successfully provide KMC to her baby all alone. She requires counselling and supervision from health care providers.

After learning from the doctor/nurse KMC is initiated in the nursery. After discharge KMC is continued at home. A regular follow-up program is crucial to ensure a safe and successful KMC at home.

Assistance and cooperation from family members help the mother to give more attention to her low-birth-weight baby.

Objective

By the end of this exercise, the participant will be able to demonstrate kangaroo mother care.

Equipment Needed: Baby doll, baby clothes, bed sheet, blanket, volunteer mother if available.

Steps		Rational
1.	Ensure the privacy of the mother and explain the procedure to the mother. Ensure she feels comfortable	KMC requires some exposure on the part of the mother. This can make her nervous and could be de-motivating. So, mothers should be provided some privacy for practising KMC. To maintain privacy may use a slider T-Shape curtain in the labour room/ PNC Ward/KMC Ward.
2.	Ensure the mother is in a sitting or semi-reclining position (40-45oc) and ensure she feels comfortable.	The mother carrying an infant in the KMC position and feeling comfortable can walk, stand, sit, engage in different activities and Sleep. A semi-reclining position is to be adopted while sleeping. This can be achieved with the help of 3-4 pillows on the hospital bed or special semi-reclining chairs.
3.	Gently undress the baby Do not remove the cap, nappy and shocks.	Undress the baby except cap, nappy and shocks required to maintain skin-to-skin contact and prevent temperature loss.
4.	Place the Baby in a prone upright position on the mother’s chest (between the Breast) Make sure the head is slightly extended and turn the baby’s head to one side to keep the airway clear	This position will help with breathing, allows eye-to-eye contact between the mother and her baby and create a love bond between the mother and baby.
5.	Make sure the skin-to-skin contact is in a frog-like position and the Baby’s abdomen should be at the level of the mother’s upper abdomen (epigastrium).	Flexed legs and arms will help to provide grip and the mother’s breathing stimulates the baby, thus reducing the occurrence of apnoea.
6.	Provide Support to the baby’s bottom by using a sling or binders	Sling/binder will help a mother to maintain a good position for a longer period of time.
7.	Cover the mother and baby by using the mother’s pallu/gown and also cover with a blanket or shawl as per the room temperature and weather.	Properly covering both mother and baby will provide warmth and prevent temperature loss also enhance the quality of KMC.
8.	Ensure Exclusive breastfeeding once every 2 hourlies	Rationale- During KMC holding the baby near the breast stimulates milk production, Baby can feed whenever feel hungry. Note- If the baby is not able to feed by itself the mother can express milk while the baby is still in the KMC position and depending on the condition of the baby fed with a paladar, cup, spoon or tube.
9.	Ensure the temperature is between 25-28oc by using a room heater/Air conditioner in the labour room/ PNC Ward/Homeroom.	25-28Oc is the ideal temperature for new-born/Infants in every weather.
10.	For effective KMC ensure these two major components- 1-Exclusive breastfeeding  2-Skin to skin Care Contact	Exclusive breastfeeding promotes Skin-to-skin contact which helps to increase breast milk production, helps the baby to suck quickly and strengthens the emotional bonding between the mother and the baby. Provide Skin-to-skin Care contact as early as can, continuous and prolonged is the basic feature of KMC.
11.	Advise the mother to provide KMC for at least 1 hour per session. Skin-to-skin contact should be maintained as long as possible	At the initial point, the mother providing KMC for a prolonged period of time is quite difficult. But must ensure each session of KMC should last at least an hour because frequent handling may be stressful for the infant. The duration of each KMC session should be gradually increased for as long as the mother can comfortably provide KMC. The infants in KMC need to be removed from skin-to-skin contact only for changing diapers and clinical assessment according to hospital schedules. The aim should be to provide KMC as long as possible preferably 24 hours a day.
12.	Encourage the mother to provide KMC during sleep and rest by using a comfortable chair or several pillows on an ordinary bed.
13.	Continues the KMC at home until the weight of new-born is 2500 g. or gestational age reaches term
14.	Post-discharge follow-up-After discharge baby should be taken to the hospital as and when advised by doctor/nurse.

Fundamentals of KMC are:

• Provide Support to the mother in the hospital and at home for effective KMC Care.
• Provide counselling to the mother as well as family
• Ensure Post-discharge follow-up for all cases.
• Knowledge Strengthening on a regular basis of all healthcare workers at the facility and ground level

Benefits of KMC

• Increased Breastfeeding rate – As per recent studies, KMC helps in Increased breastfeeding rates as well as increased duration of breastfeeding.
• Helps in Thermal control – Prolonged skin-to-skin contact maintains the temperature of the baby. This is as good as keeping the baby in an incubator.
• Improve Vital signs- KMC will help in maintaining heart rate/ respiratory rate of the new-born and reduce/treat mild respiratory distress.
• Good sleep- KMC enhance the sleep quality of the New-born as well as the mother.
• Brain development- Helps the Growth and development of the Brain.
• Get Early discharge – As per Studies, KMC cared for Low birth weight/Preterm babies get discharged from the hospital earlier than the other methods and also gain more weight during KMC than other traditional care.
• Less chance of sickness – KMC protects infants from infections as New-born spend most of their time with their mother/ Father or who are practising KMC. New-borns who receive KMC are healthier than those without KMC. Skin-to-skin contact helps to secrete Oxytocin that automatically reduces the level of pain after delivery.
• Less Stressed – Mothers feel less stressed during KMC than when the baby is receiving incubator care.
• Strong bonding- Experience a stronger bonding with the baby, Fathers feel more relaxed, comfortable and better bonded while practising KMC.
• Increased confidence- Mother and Family members feel more confident during KMC.
• Satisfaction- Feel a deep sense of satisfaction as they are able to do something special for their newly born babies.
• Low-cost Intervention- KMC does not require any cost to provide.

Need of mothers/fathers/families while going to provide KMC-

Everyone can provide kangaroo mother care, irrespective of their age, education, culture and religion; only a few things need to be kept in mind while providing KMC such as-

• Have willingness: Must be willing to provide KMC. Every mother wishes to do their best for their babies and once initiated, mothers get a great sense of emotional satisfaction from doing something special and life-nourishing for their babies.
• Have general health and nutrition:  The caregiver should be free from major illness to be able to provide KMC. Should receive a good diet and supplements recommended by the doctor.
• Hygiene: Should maintain good hygiene: daily bath/sponge, change of clothes, hand washing, short and clean fingernails.
• Have a Supportive family: Apart from supporting the mother, family members should also be encouraged to provide KMC when the mother takes a rest. The mother would need the family’s cooperation to deal with her responsibilities of household routines till the baby requires KMC.
• Mother’s clothing: KMC can be easily provided by using any front-open, light dress (cotton fabric gown) as per the local culture. KMC also works well with a blouse and sari or shawl. Kangaroo bags, baby bags, saris and binders that can help to retain the infant for a longer period may be adapted locally but it is not mandatory to have any special dress, garment or binder for KMC. KMC can be provided using any dress that is acceptable to the mother and the family.
• Baby’s clothing: Baby needs to dress in a cap, socks, nappy, and front-open sleeveless shirt or ‘jhabala’. Soft, natural, cotton fabric must be chosen for the comfort of the baby.

Counselling

• Healthcare providers need to give appropriate counselling to the mother and her family members for the initiation of KMC to overcome socio-cultural barriers and anxiety regarding handling a low birth weight/Preterm/Sick new-born.
• The first counselling session should be organized as convenient for the mother.
• The first few sessions are very important and require constant interaction to develop a healthy rapport with the mother/father.
• KMC procedure should be demonstrated to her with a detailed explanation of the correct position in a caring and gentle manner.
• Her queries should be answered with patience to reduce her anxieties.
• During counselling sessions encourage the participation of her husband/mother-in-law/mother or any other member of the family.
• Family participation will help the mother positively and make her comfortable after discharge in providing effective KMC.
• Participation of Family members will increase the duration of KMC as the aim is to provide KMC 24 hourly.

Things to be avoided-

• Caregivers need to avoid things during kangaroo care such as fast rocking, talking on the phone, or watching TV.
• Kangaroo time is a precious time to be enjoyed by the mother/caregiver and new-born.
• Having Soft conversations with the baby, singing a lullaby, or reading a book are good activities that help to develop the baby’s brain.