Piloting Kangaroo Mother Care in the Community: Dyadic Responses to a Novel Innovation Facilitating Skin to Skin Contact

Introduction
Skin-to-skin contact between a mother and her baby may first occur straight, or soon after birth, where the naked baby is dried and placed prone on the mother’s bare chest. The maternal chest is regarded as the ideal evolutionary habitat for the fulfilment of the baby’s immediate and long-term biological needs through its own neurodevelopment, such as the establishment of feeding (Moore et al 2016).........
A novel innovation
A novel health innovation has been designed to facilitate dyad-led KMC in the context of a population of healthy mothers, and their healthy, term babies. This aims to counteract the routine separation of the dyad on a non-medical basis both in acute settings, and within the community. It constitutes a specially-designed soft, cotton top with an in-built pouch to support the baby against the mother’s chest. This can be used at home or within the hospital or birth centre, and as frequently, or for as long as, the mother wishes.
The garment was commissioned by Dr Helen McIntyre, Senior Midwifery Lecturer at Birmingham City University, and has been developed as part of a joint enterprise between the midwifery and fashion departments. The garment is currently pending patenting, prior to further production.
This pilot study is part of a larger PhD research project, and opens a growing research focus with Birmingham City University, investigating the effects of a facilitation strategy of KMC on maternal and neonatal health and well-being........
Discussion
In the 11 episodes of trialling the innovation, no adverse outcomes occurred; there was no deterioration perceived in neonatal behaviour, no clinically significant fluctuations in neonatal temperature, and no unsafe positioning of the infant in the garment pouch. Pilot findings suggest the design maintains neonatal temperatures in a thermo-neutral range, with no clinically significant fluctuations in temperature.
Further research is required with an adequately powered sample size to compare neonatal temperature fluctuation in the garment to that in conventionally facilitated skin-to-skin contact. A mixed method, randomised, controlled trial is planned, involving the recruitment of a larger sample of mother-infant dyads meeting the same inclusion and exclusion criteria. Recruitment for the randomised controlled trial will take place at the same NHS trust in England, targeting an ethnically diverse and socio-economically disadvantaged urban population.
The unanticipated use of the garment to support a breastfeed in skin-to-skin contact has emerged from the pilot observations, as mothers used and adapted the garment to support their preferred positioning for breastfeeding. Further research is needed to understand the garment’s potential role in breastfeeding uptake, continuation, and exclusivity, in order to guide breastfeeding support practices.
Positive maternal experiences conveyed in this pilot study warrant further exploration of the mother’s voice in providing KMC. Experiences of using skin-to-skin contact at home in the
postnatal period will be explored in small focus groups, providing woman-centred data to guide facilitation strategies to support ongoing skin-to-skin contact.
This pilot study supports further exploration into the potential effect skin-to-skin facilitation may have on neonatal thermoregulation, breastfeeding, dyadic bonding, and the mother’s experience of caring for her baby through the postnatal period.