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By Cathy Daub, PT, founder of BirthWorks International & Horatio Daub MD, MPH “Separating mothers from small and sick newborns adds stress for both mum and baby at a time when they often both need close contact – immediate Kangaroo Mother Care overcomes this barrier. Keeping the mother and the baby together helps the baby to survive and thrive.”1 I have had the honor of knowing someone who is a pioneer, changing the way we think about birth, creating a new paradigm.   His name is Nils Bergman MD.  About ten years ago, we drove together visiting a number of hospitals in New Jersey and New York where he gave lectures on Kangaroo Mother Care to doctors and residents in hospitals.  During our long talks in the car, two words continue to ring in my ears to this day – ZERO Separation.

Zero Separation

One such place we visited was in the NICU at Stoney Brook Hospital in Long Island where he gave a fireside chat in the NICU itself.  This was a typical NICU set up with incubators for the babies.  It was fascinating to watch the expressions on the faces of the supervisors, nurses, and doctors who had gathered to listen.   The statistics he showed and explained for both premature and low birthweight babies, made them realize that the NICU babies put immediately on their mothers’ skin, had significantly improved chances of survival as compared to those put into incubators at birth.  In other words, incubators are life threatening for babies. His work along with wife Jill, is now receiving world-wide attention due to the recent publication of his research supported through the Bill and Melinda Gate’s Foundation through a grant to the World Health Organization, and now published in the New England Journal of Medicine on May 27, 2021.  This randomized, controlled trial in five tertiary -level hospitals involved a total of 3211 infants and their mothers in Ghana, India, Malawi, Nigeria, and Tanzania.  Those studied were “infants with a birth weight between 1.0 kg (2.2 lbs) and 1.799 kg (3.96 lbs) who were randomly assigned to receive immediate kangaroo care, or conventional care in an incubator or a radiant warmer until their condition stabilized and kangaroo mother care thereafter (control).  The primary outcomes studied were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life.”2

Kangaroo Mother Care started immediately after birth is shown to be critical for saving lives.

Even though it has been shown previously that there is a 40% reduced mortality in hospitalized infants with a birth weight less than 2.0 kg (4.4 lbs) who received skin-to-skin Kangaroo Mother Care, once they are clinically stable, “this new important study shows new evidence that a further 25% reduction is found when mother (or surrogate) /baby skin-to-skin contact is initiated immediately after birth,”3 helping the baby to survive and thrive. The results showed that “Among infants with a birth weight between 1.0 and 1.799 kg, those (infants) who received immediate kangaroo mother care had a lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization.”4   Interestingly, though the difference in mortality in the intervention and control groups favored immediate kangaroo mother care in the first 72 hours, it was not enough to achieve significance. It was at 28 days that the results favoring the intervention group became significant in reducing infant mortality in premature and low birthweight infants. In fact, the results were so significant at 28 days, that “the trial was stopped early on the recommendation of the data and safety monitoring board owing to the finding of reduced mortality among infants receiving immediate kangaroo mother care.” The most recent World Health Organization (WHO) guidelines from 2015, recommend that kangaroo mother care begin only after the baby is stabilized in an incubator or warmer which averages three to seven days.  This new study directly contradicts this recommendation in its findings that it is the immediate skin-to-skin contact with the mother and exclusive breastfeeding that dramatically improves survival.  In a recent May 27, 2021 statement by the World Health Organization, the research results were summarized as “Immediate kangaroo mother care for preterm and low birthweight babies requires dedicated Mother-Newborn Intensive Care Units.”6   What exactly does this mean?

Dedicated Mother-Newborn ICUs required for the global paradigm shift for zero separation of mothers and babies

For a mother to give skin-to-skin care for her baby immediately after birth, the NICUs need to be re-designed with beds for the mothers so they can have ZERO separation from their babies.  WHO goes on to say, that these “Mother-Newborn Intensive Care Units (ICUs) will be critical to support the mother, or a surrogate, in providing this immediate, ongoing skin-to-skin contact from birth.”7   Such a simple and cost effective intervention, according to WHO, suggests that implementing this new practice globally, can save up to 150,000 more lives each year.   Dedicated Mother-Newborn ICUs is the new terminology for the global paradigm shift that will revolutionize how premature and low birthweight babies are cared for in both high and low income countries around the world.    Additional potential benefits of Kangaroo Mother Care are reduced infections and hypothermia, two big killers of small babies.  Skin-to-skin contact with their mothers, also gives babies more opportunities to breastfeed earlier, which strengthens their own immune systems including the microbiome.  It is also one of our most cost-effective ways to protect small and sick newborns.  However, creating a global paradigm shift requires coordinated effort from both the public health and medical systems.  In our work with birthing parents through childbirth education, birth doula and postpartum doula trainings, we must all convey the importance of this study to those giving birth so they can seek facilities who have made the decision to develop mother newborn Intensive Care Units.  We are all united in our effort to help birthing parents receive the highest quality of care for both mother and baby.  Now we have the evidence-based science to do it. References 
  1. Dr. Queen Dube, Director of health Services in Malawi. “Kangaroo mother care started immediately after birth critical for saving lives, new research shows, World Health Organization, Geneva, 26 May, 2021. 
  2. Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight, N Engl J Med 2021; 384;2028.  DOI: 10.1056/NEJMoa2026486
  3. Kangaroo mother care started immediately after birth critical for saving lives, new research shows, World Health Organization, Geneva, 26 May, 2021. 
  4. Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight, N Engl J Med 2021; 384;2028.  DOI: 10.1056/NEJMoa2026486
  5. Ibid.
  6. Kangaroo mother care started immediately after birth critical for saving lives, new research shows, World Health Organization, Geneva, 26 May, 2021. 
  7. Ibid.