Skin-to-skin contact is 
                 A PLACE

 … a place where CARE is provided!  Our *care* does not change… it is a place where any*care*we give works with our biology.

People often call this Kangaroo Care, and Kangaroo Mother Care (KMC), and even Skin-to-Skin Care. Words are important, and precise definitions help us understand better. The WHO (World Health Organization) has defined “Kangaroo Mother Care”   (LINK) as a total care strategy with several components (LINK), and the first of these is called “Kangaroo Position”. When I define SSC as a PLACE … it is this position. “Maternal-infant skin-to-skin contact” is the default, the usual place for subsequent care, the expected place for the DNA to work best, and for brain development, and much more. Fathers and others can do SSC, but the basic default is MOTHER, as in Kangaroo MOTHER Care.

Understanding that SSC is a place … we can then look at the details. The technique is as important: how is the PLACE made safe, comfortable and sustainable.   We can also look at when the place is first provided (initiation), and for how long it is provided (duration), and how often it is provided (frequency). HOWEVER … I will argue on other pages that this maternal-infant skin-to-skin contact is the ONLY SAFE PLACE for newborns. The default position is that mothers and infants are NOT SEPARATED. So from birth they should be together. Now, if for any reason they do need to be separated, then we must carefully record when such separation started, how long it lasted, and how often.

The term “kangaroo” fits the context of preterm and low birth weight babies. Kangaroos are marsupials that carry offspring in a skin pouch, humans are primates that carry their offspring in skin-to-skin contact. The skin-to-skin contact is primarily for all full term babies, because it is the safe place where biological needs are provided. Preterms infants need those biological needs even more. They may also need additional technological CARE … and this we can then add, without separation.

The key problem I have with “Kangaroo Care” (KC) as defined and practiced worldwide, is that the PLACE is assumed to be the incubator, or some other form of separation … as in separation from the right place. It is given as an add-on, a nice piece of extra care. Kangaroo Care is being given as if it were a drug or some special treatment, many people seem afraid of overdosing. Increasingly the evidence base is showing that it should be more than this, and it is being practiced on 25 week infants weighing 500g (and even smaller).

The term “skin-to-skin care” is very similar to KC. For everyone in the 20th century, putting the small baby in a different place is at first scary. But I want to emphasise that the actual CARE we give does not change. The baby is on the same ventilator or CPAP, the same nutritional support, the same CARE. What we see however, almost universally, is that in this place the infant needs less oxygen, and less of our care.

 

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