In 2022, the World Health Organization (WHO) published a guideline that emphasized the importance of the caregiver (or designated caregiver, in case the mother is not available) immediately after childbirth. This practice, according to scientific evidence, not only helps regulate the body temperature of the newborn and the mother, it also promotes breastfeeding and promotes the bond of the dyad. In addition, it improves the survival of babies weighing less than 1,500 grams.
This is remembered by Salvador Piris Borregas (Badajoz, 40 years old), an associate doctor in the neonatology service at the 12 de Octubre Hospital in Madrid and a member of the Maternal and Child Health research group at the same center. According to the expert, although the fact that – in Spain, they represent 10% of those born, about 30,000 a year – is a complex problem to solve, it is not so complex to improve the arrival into the world of these babies with a simple resource: the mother’s own body. “Immediate kangaroo care is a life-saving intervention,” he says. There are four types of prematurity: late preterm are those born between 34 and 36 weeks of gestation; the moderate ones, between weeks 32 and 33; the very premature or very premature, between 28 and 31; and, finally, there are the extreme premature babies who are those .
ASK. Scientific evidence has confirmed for years that skin-to-skin contact is crucial in the transition to life outside the womb. Why is it important?
ANSWER. In the healthy term newborn, when placed skin-to-skin with its mother, a series of effects occur that helps the baby in this transition to extrauterine life. Among these effects, well-known are the regulation of the temperature of the dyad, both the baby and the mother, so that they have a normal temperature; or a better start, since it has been shown that it is much more successful—both in time and satisfaction—if skin-to-skin occurs. In the case of low weight babies, they tend to regulate blood glucose better when they are on the mother’s body. And here we enter the field of the little ones. Notice that it seems that when we talk about skin-to-skin it can seem like something very complicated, given how much it is taking for this practice to be normalized in hospitals. But the truth is that it is not. A few years ago it was published in The New England Journal of Medicine one of the first studies [ de 2021] that evaluates it in clinical trial format in premature babies. This immediate method was shown to improve survival in babies weighing less than 1,500 grams. This result has made many hospitals have to take action to implement it not only in the full-term newborn, but also in the premature one because it increases their survival. In this same study, it was also seen that hypothermia decreased, something that is very common, and breastfeeding rates increased.
P. According to , more than 13 million babies are born prematurely in the world. What factors influence these data?
R. Prematurity is a global public health problem that is not controlled and is increasing. On the one hand, technological advances allow us to identify certain problems in pregnancy that sometimes require early delivery. This generates iatrogenic prematurity: a premature birth induced for therapeutic purposes. On the other hand, social changes also play an important role; for example, more and more , which increases the risk of premature birth.
P. a doctor specializing in perinatal neuroscience, insists that there be no unnecessary separations, not even in the case of premature and very premature babies. He usually says something very interesting: .
R. Yes, Bergman is an international reference in this field and I think that what he proposes is where we are going: the Couplet Carewhich is that care of the dyad. When a premature baby is born, it is common to evaluate him or her in the resuscitation crib. But why not do it directly about his mother? If you are evaluated in contact with it, the bacteria that colonize, which could offer you natural protection against the bacteria present in the intensive care unit, to which you will be exposed later.
P. Does this apply to all countries, both high-income and low-income?
R. Yes, without a doubt. There are very few interventions that have been shown to improve survival in babies weighing less than 1,500 grams. However, skin-to-skin contact, a resource without economic cost or need for technology and is often associated only with low-resource contexts, when in reality it is a life-saving intervention.
P. Science has shown that technology alone is not enough, that the mother’s body is essential. But it seems difficult to change the medical paradigm that has prevailed until now.
R. It’s very complicated. I don’t like to use the word “humanization,” but it is true that implementing these interventions in a more humane way is difficult. I think this happens because it strikes a deep chord with professionals, who may react defensively, thinking: “What are you going to tell me, who has the knowledge, who has been doing this like this all my life?” However, if you say that you have to do, for example, an ultrasound after birth, this is implemented very quickly. The results are there and in premature and large preterm infants survival increases, children lose less temperature and breastfeeding rates are better. With the evidence in hand we cannot say that the mother’s body is less advantageous than the latest technology.
P. What difficulties can it entail to implement immediate kangaroo care in a hospital? Is the professional himself a barrier?
R. In many cases, yes. Sometimes, it’s not so much a resistance to change as a lack of information. If the professional has not been informed of the benefits of skin-to-skin contact for premature babies in their context. Another difficulty is adapting the resources and means to the mother; although this is not so complicated because it is a matter of equipment.
P. Where do you think the change begins?
R. Looking for people sensitive to change. You have to start by forming a group, because a single person does nothing, and from there you start training. Above all, it is very important not to get worn down by the potholes that may arise in the process due to different sensitivities, points of view, reluctance… And it is also important to have the support of the leaders of the units and the teams that are doing it wrong, that is It is essential to have someone you can turn to for this to change.
P. How do families experience it?
R. The expression of the families when they receive their child in their arms, when they have him skin to skin, says it all. That moment in which they can hold their baby, even if it is so small, makes everything else—the equipment, the prematurity, the clinical situation—. I believe that one of the most significant impacts of this practice is precisely that it takes care of the mental health of the entire family and the baby.
