Kangaroo Mother Care

This is a brief insight into my ongoing work in Stung Treng and is typical of the  work I have come out to Cambodia to do:

I was asked by the Stung Treng lead for Maternal and Children’s health to run a workshop for midwives. After some discussion I decided on three topics which may make a difference, decreasing the number of babies who die at birth or in the first few days of their lives. The neonatal death rate in Cambodia is 22 babies per 1000, in Western countries it is 3 babies per 1000.

I wanted the day to be very interactive and participatory with all attending midwives joining in rather than me standing at the front just teaching. This was the first of many challenges as the midwives are used to being told things, not asked questions or asked to do anything.

I called the day Helping Babies Live and this topic was split into three parts:

The first was a regular skill drill covering resuscitating a newborn baby. After a demonstration every midwife was able to practice the skill drill of resuscitation and when confident could do a test with either of two senior midwives who helped facilitate.

Part two was practicing the daily neonatal check which we did in groups of three as a role play, again with the more senior midwives showing the way first, then everyone taking a turn.

Finally we had a quick question and answer session in two groups about Kangaroo Mother Care (KMC).

KMC has now been fully recommended for healthy premature babies as being 41% more successful than babies being cared for in an incubator. The 2012 report Born Too Soon by World Health Organisation (WHO), and others promotes KMC over incubators.

In my work so far I have had little success in persuading midwives and mums to use KMC, so at the study day we did a game looking at the barriers to KMC and what we could do to overcome them.

I brought the workshop to a close; the day went well with midwives seeming to enjoy the participatory style.

The next day on the Labour ward was extremely busy and included care of a young sixteen year old brought in from home with a retained placenta and bleeding. As the hospital midwife competently removed the placenta, I looked and saw it was very small and asked where the baby was and how big it was. At that moment the Dad arrived by motorbike with the baby wrapped up in a blanket, the baby weighed 1.4 Kg (3.1lbs) and was cold and grunting. The midwives who speak little English looked at the baby and said - Kangaroo Mother Care and proceeded to explain this to the parents.

Twenty Four hours later he is still lying on Mums chest and his breathing is normal. He has had two hourly tiny amounts of colostrum expressed from Mum and this afternoon he suckled for three minutes at the breast. His parents are both young and very keen to help him live. Dad has already had a go at KMC too, whilst Mum had a shower and rest.

 In England being a healthy premature baby at 1.4 kg, he would most likely live and become a healthy child. In Cambodia who knows? But I think the midwives and parents greatly increased his chances of survival by practicing KMC.

  Update Monday 11^th June.

Before leaving for a weekend in Phnom Penh I sat with one of the midwives, as she again talked the parents through the principles and positive benefits of KMC: warmth, less infection risk, and frequent breast feeds. Three days later, on arriving back from Phnom Penh, I found the parents had taken the baby home, still doing KMC. The baby had been mostly breast fed with a few breast milk top-ups by spoon. He still has a long way to go, but so far so good.

Right, now, what's my next challenge.......?