Enablers Of Kangaroo Mother Care Practice: Evidence And Uncertainties

Strengths and Weaknesses of Skin-to-Skin Care and Incubation

Discuss About The Enablers Of Kangaroo Mother Care Practice.

Provide an overview of the area of evidence uncertainty and justification of why this topic was selected, including overall significance of the problem.

The main question in this study is: Is skin to skin contact more effective than incubator when it comes to the prevention of hypothermia? A newborn child often faces a challenge fitting into a new environment in which it had not been before. A child can stabilise its temperature by having a skin-to-skin contact with the mother or by spending the first days in n incubator. This kind of care is mostly recommended for the children with a low-birth weight. A child who is born after nine months is usually mature and has the right birth weight (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc 2018). Meaning, such a child can cope up with life as a newborn without unnecessarily having an artificial support. At the same time, such a child has higher chances of surviving and leading healthy life if provided with appropriate care. However, this does not always apply to those born prematurely-before nine months (Chan, Labar, Wall & Atun 2016). Such children require additional support either by becoming into a direct body contact with the mother/care taker or and they should be supported by an artificial incubator. Both skin-to-skin and incubation have been proven to be helpful when it comes to the upbringing of such premature babies. They are also suitable for any other normal child. Each of them has made significant contributions in providing the required support to such infants and increasing their chances of survival after birth and prevention of hypothermia (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc 2018).

However, despite the significant contributions of these practices, there are still uncertainties that the current and previous researches have not resolved (Conde?Agudelo & Díaz?Rossello 2016). There are some uncertainties that are identified in the evidence based practice, in that the practice can a times be harmful for the mothers who have undergone caesarean section (Seidman, et al. 2015). The wounds do take a lot of time to heal and if the mother adopts the kangaroo care it can be harmful. There is also lack of enough education to the staffs on the skin to skin care and the parents too are not given enough education on the benefits the practice (Boundy, et al. 2015). This topic was selected because it has contributed to reduction of the infant death and it is a new practice that has been introduce in most hospital to prevent infant mortality. There are several benefits of the skin to skin care; the baby will be safe in that there will be reduced infection of the infant at early months, the baby will not loss so much weight, there will be more rest time and natural cycle of sleep.

Significance of Kangaroo Care in Australia

From this preview, it is evident that both the skin-to-skin and the incubation care have strengths as well as weaknesses that revolve around their usage. The topic is, therefore, important because it will help in addressing the uncertainties that have surrounded the use of skin-to-skin and artificial care for the newborn children. It seeks to conduct a rigorous research to find out an answer on the best alternative to adopt for the infants (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc 2018). The overall significance of the research, hence, is to provide a recommendation on the best mode of care that the parents should adopt for their children.

Summarise the current use of evidence based practice in the Australian health care setting, in relation to their topic; this may include anecdotal experience of the issue in practice.

According to the Department of Health, maternity care is an area of concern. The department has been investing resources to support prenatal and neonatal care because it means a lot for the Australian mothers and infants. Maternal care still remains a major issue of concern in Australia. The Pediatric Association of Australia is concerned that there are so many low-weight children who are born in the country each month. Most of these children are always at a risk of contracting hypothermia. Research has established that hypothermia is a condition that results from the exposure of the body to extreme cold (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc 2018). It usually takes place when the body temperature declines to below 35.0 °C. At such a temperature, the body absorbs less heat than it dissipates. Such a condition can be disastrous for a new born because it cannot actually cope-up with it (Conde?Agudelo & Díaz?Rossello 2016). In this regard, it should be the responsibility of the parents and the maternal care providers to provide that kind of child with the necessary support that it needs. Research has reported that low-birth weight is a problem in Australia (Anderson, Crengle, Kamaka, Chen, Palafox & Jackson-Pulver 2006). However, the Australian mothers have a relief because they can rely on the kangaroo and incubation care to bring up their hypothermia-risky infants. The use of kangaroo and incubation should, however, not be restricted to those with low-birth weight, but to all the infants in Australia because it means a lot for their health and growth.      

Personally, I not only know about incubation and skin-to-skin care because I have read about it. Apart from the evidence I have gathered from scientific research, I have an anecdotal experience about them. I remember an instance when my auntie gave birth to a low-weight child in one of the hospitals in Sydney. Although my auntie and her husband wanted to put the child in an incubator, the medics recommended a skin-to-skin care. We had no choice, but to listen and abide by our medic’s advice. The end result is that the child was given a kangaroo care which ended up providing it with a conducive condition for growth. My auntie managed to organize how to start breast feeding as well as creating a close relationship with the kid (Gabrysch, Civitelli, Edmond, Mathai, Ali, Bhutta & Campbell 2012). Through a continued kangaroo support, the child managed to develop and grow up to be mature, intelligent, healthy, and active human being today. This is a clear justification that low-birth weight is a problem whose solution lies in the provision of effective antenatal care to the infant.

Anecdotal Evidence of Kangaroo Care: Personal Experience

Synthesise the available literature (minimum 6 articles are required) regarding the intervention/treatment/approach/program you selected and consider the outcomes of the selected studies.

Newborn child care is a topic that has been extensively studied. Over the years, researchers have done a commendable for studying this topic to gather and disseminate information that can be used to understand the challenge and arrive at a feasible solution that can be used to address. According to the research conducted, Australian children are provided with two kinds of care. One, they may benefit from the kangaroo care which basically involves a direct contact between the newborn and the mother (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc 2018). The kangaroo care is more natural because it creates a strong bond between the mother and child right from that early age. Two, the Australian healthcare facilities sometimes opt for an incubator in which a child is provided with the right warmth in an artificial setting. Meaning, once born, the child is kept enclosed in an incubator where there is enough oxygen and the temperature that favors the condition and supports growth and development (Charpak, Tessier, Ruiz, Hernandez, Uriza, Villegas, Nadeau, Mercier, Maheu, Marin & Cortes 2016). Such an environment can be suitable for a newborn because it does not allow any unnecessary shocks that might arise due to the variation in the body temperatures.

In their research, Charpak, N., Tessier, R., Ruiz, J.G., Hernandez, J.T., Uriza, F., Villegas, J., Nadeau, L., Mercier, C., Maheu, F., Marin, J. and Cortes, D., found out that kangaroo care still remains the most popular standard practices in Australia, its widely recognized being that it has so many benefits (Charpak, Ruiz-Peláez &Charpak 2001). There is holistic approach that is taken to provide for the preterm babies by the use of the skin to skin care which is known as the kangaroo care (Charpak, Tessier, Ruiz, Hernandez, Uriza, Villegas, Nadeau, Mercier, Maheu, Marin & Cortes 2016). Most hospitals in Australia prefer it because the practice supports breastfeeding, physiologic, social and psychological care for both the mother and the child that is born preterm. The country hospitals advocates for the immediate skin to skin care on the mother’s chest after birth. The baby should remain there without interruption unless there are other specific medications to be administered. These sentiments were echoed by Charpak, N., Ruiz-Peláez, J.G. and Charpak, Y., who, in their research, found out that kangaroo care can be more beneficial to an infant because it helps in the stabilization of the body temperature. The stabilization of the child’s temperature which begins during pregnancy can continue if the mother provides a skin-to-skin care to the newborn. Although the same service can be provided by an artificial incubator, the researchers believe that the mother or father’s skin is much better because it cannot be compared to electrical warmers in any way. It brings a natural setting that cannot be replaced by any innovation.

Literature on Kangaroo Mother Care and Incubation

The supremacy of skin-to-skin over the incubation care was reported by Worku, B. and Kassie, A., who, in their studies, found out that kangaroo care is much better because it enables the mother to initiate the breastfeeding process. The research revealed that immediately after birth, the mother should organize to breastfeed the newborn because breast milk is the best food for the child at that time (Worku & Kassie 2005). Although the child has instincts that naturally enable it to identify the mother’s breast, it can be much better if it happens when the two have a direct skin contact.  Once such a contact is made, the mother would not struggle to initiate the breastfeeding process because it would have been enabled by the contact. And rapport so far established between the mother and the newborn. Ibe, O.E., Austin, T., Sullivan, K., Fabanwo, O., Disu, E. and Costello, A.D.L., relate this benefit when they link it to the transmission of bacteria from the mother to the newborn. Although a child also has an opportunity of getting vaginal bacteria from the mother during birth, the same can e acquired through a direct skin-skin contact (Ibe, Austin, Sullivan, Fabanwo, Disu & Costello 2004). Such bacteria are important because, just like the breast milk’s antibodies, they can help in protecting the infant from diseases and allergies that might be a bother to the child as it grows up.  

The significance of kangaroo care was also reported by Bergman, N.J., Linley, L.L. and Fawcus, S.R., who, in accordance to their research, discovered that skin-to-skin care can be benefiting the newborn by preventing them from crying. According to this study, the skin contact between the mother and the child helps in creating some communication that prevents the child from crying (Bergman, Linley & Fawcus 2004). Crying, according to this research is a distress kind of call that a child gives in the absence of the mother. Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., Haksari, E., Osorno, L., Gudetta, B., Setyowireni, D. and Quintero, S., say that crying helps in calling the mother especially at a time when the child feels insecure and requires the protection and company of the mother. That is the funny way through which the newborn babies communicate. Apart from the prevention of crying, skin-to-skin care can create a favorable environment for the child to reduce the pain that is experience following birth (Cattaneo,, Davanzo, Worku, Surjono,, Echeverria, Bedri, Haksari, Osorno, Gudetta, Setyowireni & Quintero 1998). It fastens the recovery process.

The studies that were reviewed in this paper provide invaluable information on the care of the newborn babies. Low-birth weight is a challenge that should be addressed because it does not mean well for the new born children. In this section, a thorough comparison is made on the publications whose findings have been analysed above. The comparison is based on the similarities and differences that appear in the research and findings of each of the scholars. It also goes ahead to analyse the limitations of the literature. The limitation that I identified in the resources is that most of the resources do not have enough evidence to prove their claims. The research design and methodology used by most of the writers was not sufficient enough to enable them produce extensive and reliable results. The use of Randomised Controlled Trial might not be efficient enough in providing evidence because some of them used a small sample size. For example, in the “A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants< 2000 g in Nigeria using continuous ambulatory temperature monitoring,” the authors only used a sample of 13 infants. The same limitation was identified in “Randomized controlled trial of skin?to?skin contact from birth versus conventional incubator for physiological stabilization in 1200?to 2199?gram newborns” in which a sample of 34 infants was used to participate in the study. The use of such a small sample size was inappropriate because it might have compromised the results. This might have affected the generality of the findings. 

The first major similarity between the articles is that they all acknowledge that the care of low-birth weight children is a major issue that should be taken so seriously. The researchers agree that all the low-weight born children should be provided with appropriate care that can enable them to overcome their challenges and be able to catch up with life in the new environment to which they are introduced (Baley 2015). The other similarity that was noticed in the publications is that each of them acknowledges the significant contributions of kangaroo and incubation care. Each of the scholars says that the care is essential to a child because it means a lot for them. Articles like “Kangaroo Mother Care: A Randomized Controlled Trial on Effectiveness of Early Kangaroo Mother Care for the Low Birth-weight Infants in Addis Ababa, Ethiopia,” “Kangaroo mother care for low birth-weight infants: a randomized controlled trial in different settings,” and “A Randomized, Controlled Trial of Kangaroo Mother Care: Results of Follow-Up at 1 Year of Corrected Age” established that kangaroo mother care is superior to the incubation care.  Similar assertion was made in “Randomized controlled trial of skin?to?skin contact from birth versus conventional incubator for physiological stabilization in 1200?to 2199?gram newborns” where the researchers established that kangaroo care is superior when it comes to the stabilization of the child’s conditions. This clearly demonstrates that without it, it might not be possible for the newborn to survive, get used to the new environment, and grow as expected. Moreover, the researchers did an extensive study because they were mainly based on the collection of data from the secondary sources. Meaning, the research methodology was more or less similar because it was based on a similar design and methodology. For example, in their research, Charpak, Figueroa, Ruiz-Pelaez, and Charpak used a randomized study of kangaroo care. The same style was replicated by Fawcus and Bergman who also used the same approach to conduct a comparative study of the skin-to-skin and the incubator care. In fact, all the studies used the same approach to collect analyse and present their data.

However, despite all these similarities, these publications had different findings. The findings were different because each of them was aimed are providing the desired answers to the respective research question and objectives that had been pre-set by the researchers. Although all studies were based on the kangaroo and incubation care, each of them was touching on a specific concept that was apparently not falling within the scope of another research. For example, in “A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants< 2000 g in Nigeria using continuous ambulatory temperature monitoring,” the main focus of the study was on the concept of thermal regulation. Meaning, it mainly centered on the issues to do with the control of the infant’s body temperature. This differs from what other scholars reported in their articles. These differences vary from one writer to the other because each of them was seeking to address a certain audience which suit the kind of message to be delivered.

According to the research that I undertook, I decided to make the following conclusions. One, newborn children require a specialized care which can be given through the use of kangaroo or incubation care. Two, kangaroo care should be used by Australian mothers because it is better than the incubator (Charpak, Tessier, Ruiz, Hernandez, Uriza, Villegas, Nadeau, Mercier, Maheu, Marin & Cortes 2016). I made these decisions because the evidence I got proves me right. The rationale for my conclusion is, therefore, based on the fact that scientific evidence proves that skin-to-skin care can bring more benefits than the incubation (Worku & Kassie 2005). Although an incubator also provides the child with appropriate warmth and the temperature that it needs, it cannot outweigh the mother’s skin (Seidman, et al. 2015). My decision was purely based on the assertion that kangaroo care does much better in as far as the stabilization of the child’s temperature is concerned. At the same time, the studies convincingly expressed that kangaroo care can benefit the child because it prevents pain and crying (Johnson 2008). Further still, the kangaroo care can give the mother an ample opportunity develop a strong bond with the newborn and initiate the breastfeeding exercise. All these cannot be effectively done in the incubator.

Author, Year	Title / Key words	Aims/ Objectives	Methods	Sample	Key Findings	Limitations
Bergman, N.J., Linley, L.L. & Fawcus, S.R., 2004.	Randomized controlled trial of skin?to?skin contact from birth versus conventional incubator for physiological stabilization in 1200?to 2199?gram newborns.	To compare the effectiveness of skin-to-skin contact and incubator care	Randomised controlled trial	34 infants used as a sample	Skin-to-skin care is more effective in the stabilisation of the infant’s physiological growth	Small sample size used
Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., Haksari, E., Osorno, L., Gudetta, B., Setyowireni, D. & Quintero, S., 1998	Kangaroo mother care for low birth weight infants: a randomized controlled trial in different settings	To study the skin-to-skin care for the newborns with low-birth weight	Randomised controlled trial	570 sample size drawn from Ethiopia, Indonesia and Mexico	Kangaroo care is advantageous because it helps in creating favourable development condition for the infant during the early stages of growth	Possibility of biasness in the findings
Charpak, N., Tessier, R., Ruiz, J.G., Hernandez, J.T., Uriza, F., Villegas, J., Nadeau, L., Mercier, C., Maheu, F., Marin, J. & Cortes, D., 2016	Twenty-year follow-up of kangaroo mother care versus traditional care	To find out the effectiveness of skin-o-skin and the other conventional care that has been in use	Randomised controlled trial	716 participants used in the study to represent the target population	Skin-to-skin care is more effective than the conventional incubation care	Possibility of biasness in the findings
Charpak, N., Ruiz-Peláez, J.G. & Charpak, Y., 2001	A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age	To study the effectiveness of skin-to-skin care	A randomized, controlled trial	A sample of 746 infants born at at≤ 2000 g was used for the study	Skin-to-skin care is more effective in providing the child with good conditions for growth.	Possibility of biasness in the findings
Ibe, O.E., Austin, T., Sullivan, K., Fabanwo, O., Disu, E. & Costello, A.D.L., 2004	A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants< 2000 g in Nigeria using continuous ambulatory temperature monitoring	To establish the effectiveness of skin-to-skin care and incubator in the stabilisation of body temperature	Randomised controlled trial	13 infants with a birth weight of < 2000 g	Although both methods are good, the research proved that skin-to-skin care is more effective in thermal regulation of the infants	Study only based in Nigeria. So, it might not be applicable to other contexts
Worku, B. & Kassie, A., 2005.	Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birth weight infants in Addis Ababa, Ethiopia	To study the effectiveness of early kangaroo mother care for the low birth weight children	Randomized controlled trial	A total of 123 low birth-weight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) case	Skin-to-skin care is more effective for the low-birth weight children	Study based in Ethiopia and might not be generalised to other areas

 

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