Ojuma Ekhomon knew at first glance that her first birth would be difficult. No sooner had she had an ultrasound examination in her sixth month of pregnancy, until Nigeria imposed quarantine measures. But it did not occur to her that she would return to the hospital in less than a month to deliver her baby in the 31st week of pregnancy.
Her baby, who was born by Caesarean section prematurely, weighed 700 grams at birth, had not fully developed organs, and was extremely weak due to his small weight. Doctors at the Amu Udovin Mother and Child Care Center in Lagos, to which her baby was taken, said he was the youngest child to receive care at the center ever.
In the following days, the weight of the newborn, which she called Akahumheen, decreased until it reached 600 grams, and his life became threatened. In Nigeria, about 205 children die every day due to preterm birth, which accounts for 31 percent of all newborn deaths in the country.
Although Nigeria is the largest economic power in Africa, it is witnessing the highest rates of newborn deaths, due to poor spending on health infrastructure and the lack of access to health services for many mothers in some areas. In rural areas, the rate of maternal and neonatal mortality is highest.
Fortunately, the center, which is one of the most advanced medical centers in the country, placed Akahumhin in an incubator, and the baby gradually gained weight. But as soon as he reached one kilogram, the doctors took him out of the nursery.
And the doctors decided to place it on his mother’s chest so that the baby’s skin and skin come into direct contact with the mother’s skin and skin, then wrapped them with a cover together. Ekhumon carried him this way wherever she went over the following weeks, taking off the cover only to breastfeed him or to let him sleep.
Her son’s weight gradually increased, until his weight reached 1.8 kilograms when he was two months old. At first, Ekhomon gave her son milk via a syringe, so that he was able to breastfeed over time. But she carried it close to her skin until he was healthy and at a healthy weight.
“It was safe there,” says the 26-year-old mother, “enjoying the heat generated when my skin touches my baby’s skin.”
This method of caring for the newborn is known as the kangaroo method, in relation to the way in which the mother carries her baby, and it is one of the best alternatives to incubation in the care of premature babies and infants of low weight.
Joy Lone, Professor of Maternal and Child Health and Reproductive Health at the London School of Hygiene and Tropical Medicine says: “About 19 trials conducted around the world have proven that (kangaroo care) reduces mortality, although most of these studies focused on premature babies who do not suffer. Of serious complications. “
Studies conducted by Loon for more than a decade concluded that the kangaroo-style mother’s care may be a lifesaver for premature babies in rural and remote communities where nurseries are not available.
But she believes that this method has not taken its right to spread, although it may contribute to reducing pressure on neonatal intensive care units in developed countries.
Newborns with low birth weight face many problems at birth. They may find it very difficult to regulate their body temperature due to the lack of stored body fat, and they lose heat quickly. This is why nurseries help maintain their body temperature.
But care based on direct contact between the skin of the mother and the child contributes to maintaining the body temperature of the child because it draws heat from the body of the mother, and reduces the risk of developing hypothermia after birth.
The idea of kangaroo care was proposed by two pediatricians in the maternity unit of San Juan de Dios Hospital in the Colombian capital Bogotá in 1978, due to the hospital’s inability to accommodate the large numbers of premature babies born there. About 11,000 babies were born in the hospital annually, and death rates were high among newborns.
To reduce the demand for incubators, the two doctors suggested direct and continuous contact between the mother’s skin and the skin of a low-weight newborn. Mortality rates have decreased among infants receiving this method of care, and doctors have been able to focus on infants with severe complications.
When the results were published in 1983, they caused a global sensation, and were promoted by the United Nations Children’s Fund (UNICEF). Research around the world has supported the results of the preliminary studies.
And I discovered with time the potential advantages of this method of newborn care with the expansion of its use in various countries of the world. Lone noted that experiments have shown that kangaroo care also significantly reduces the risk of complications resulting from premature birth in later years, not just death rates.
The number of premature babies around the world is estimated at 14.8 million annually, equivalent to about 11 percent of all births. The number of premature births appears to be increasing, at least between 2000 and 2014, according to global estimates.
Complications related to preterm birth account for about 18 percent of deaths among children under the age of five and 35 percent of deaths among infants less than 28 days old.
The rates of preterm births vary from one country to another. While the Kingdom of Saudi Arabia and Belarus have the lowest rates of preterm births, and they may reach about four percent of births, the rates of premature birth in Bangladesh reach 19.2 percent of births.
Low and middle-income countries, especially in sub-Saharan Africa and South Asia, bear the greatest burden of preterm birth, with 80 percent of premature births worldwide.
However, despite the abundance of evidence supporting kangaroo care, this method of care has not become widespread in hospitals and medical centers in some areas, such as Kebbi State in northeastern Nigeria, where UNICEF cooperates with local midwives to teach mothers and traditional birth attendants methods of caring for the newborn on Kangaroo way.
Mothers in many remote communities rely on traditional birth attendants to help mothers deliver. These midwives rarely receive medical training, but women often turn to them due to a lack of trained midwives.
Nyam Musa, a UNICEF midwife, says that traditional birth attendants play a very important role in the care of the mother and the child, but they do not have the appropriate tools to enable them to help the mother and the child in the event of complications during childbirth.
Musa and her team show the mothers ways to care for the baby in the kangaroo way and how to fix it tightly by cutting the cloth so that its skin touches the skin of its mother, and they provide advice on how to clean it in the event of urination or defecation.
However, the team faced several pitfalls in convincing traditional birth attendants of the kangaroo care methods. Musa says: “Some believe that the death of the mother or the child is the will of God, and others in many societies see that giving birth outside the hospital is a symbol of strength and status.”
Despite the challenges, the team found that most mothers are willing to use this method of caring for a newborn. The team cited inspiring examples from the past to convince traditional birth attendants who expressed concerns about this method.
Linda Ethel Nassatime Akkonding, Health Director of the UNICEF Department of Maternal and Child Health in Nigeria, says that caring for a mother the kangaroo style is just as important in crowded city hospitals. The nurseries in areas where there are many health care centers and hospitals may become useless in light of the constant power cuts.
In a country that ranks third in the world after India and China in preterm birth rates, where about 803,000 babies are born prematurely annually in Nigeria, kangaroo care may save many lives and relieve the tremendous pressure on health care facilities.
Uyjuk Uyapiro, head of pediatrics department at the Amu Udovin Center in Lagos, believes that placing the child close to his mother has many advantages.
Uyapiro says that the child (through contact between the skin of the mother and the child) does not use energy in his body or calories for heating, and in return benefits from these calories to gain weight, because the mother gives him warmth.
She believes that the mother will replace all the monitoring devices in the incubators, such as the breathing monitors that monitor the apnea of the child during sleep.
Caring for a low-weight baby in this way requires direct and constant contact for 18 hours a day. Antin Ihi, 40, from Lagos, used this method to care for her daughter, who was born prematurely, and since her daughter’s condition stabilized, she learned how to place her close to her chest and wrap her in a linen cloth.
She says that her daughter: “may remain in place all day, as soon as you put it on your chest will remain calm and will not make noise.”
Increasing research has indicated that the father may also participate in the care of the newborn through direct contact with the newborn’s skin. Studies have shown that skin-to-skin contact between father and newborn leads to the same results as direct contact between mother and newborn.
Lone is carrying out trials in The Gambia with colleagues to assess the extent to which premature infants with moderate or moderate complications benefit from direct skin-to-skin contact until their condition stabilizes.
The experiments concluded that kangaroo care reduces death rates among premature newborns whose health condition has stabilized, but whose weight is less than two kilograms, by between 36 and 51 percent. The researchers hope it will also help newborns who suffer from complications or be used from the first hours after birth.
Lone says that direct contact between mother and baby skin reduces the chances of the baby becoming infected in hospitals, improves growth, improves the baby’s ability to breastfeed, and promotes the infant’s brain development.
Premature babies have difficulty breastfeeding at first, possibly because they have not yet developed the ability to coordinate breathing and swallowing during feeding. On the other hand, some mothers after a preterm birth do not produce enough milk to breastfeed the baby, so premature babies are fed through tubes in incubators.
But research has shown that low-weight infants who are cared for by kangaroo-style mothers start breastfeeding up to two and a half days earlier than others who receive care in nurseries or other mechanical heating devices.
This method of care has gained wide acceptance in rich industrialized countries due to the sense of empowerment it gives to the mother to participate in the development of her premature baby instead of foster care. Studies have shown that direct skin contact between mother and child improves bonding between them, especially because it prevents the mother from being separated from the newborn to be placed in the nursery after birth.
Studies have indicated that direct skin contact between the mother and the infant helps him sleep peacefully for longer hours. A study linked brain development with kangaroo care, and a study indicated that feeling the mother’s impulses helps to synchronize the mother’s breathing with the child.
However, despite the increasing evidence supporting the benefits of caring for a newborn through the kangaroo method, it is not yet applied in some regions around the world, including developed countries. But according to Lone, things have changed now.
Lone says that the governments that spend the most on kangaroo care research are the Scandinavian countries, and this method of care has been adopted in various parts of Europe and North America, whether for premature babies whose health condition has stabilized or infants with complications.
Ojuma Ekhomon says direct skin-to-skin contact with her newborn helped her protect and nourish him during the most difficult periods of his life. Even though he has passed the danger stage, she will still carry him on her chest until he can walk.