40 years ago we started the Kangaroo Mother Care (KMC) Method as a light of hope and since then it has been and will continue to be a light of hope for nearly 20 million boys and girls who are still born and will continue to be born prematurely or with low birth weight, despite the fantastic advances of the medicine.
Today, as I believed 40 years ago, love is the strongest engine that moves the world. For me, Kangaroo Mother Care Method is the act of FAITH, the one that I have seen and trusted, as a living being that I am, that has seen life grow and that has touched it in all its splendor, as I was procreated by a couple in an act of love, or at least passion that is only seen between human beings.
I have not seen or have not known in any medical book that love, emotions and feelings and their repercussions are properly treated in the texts and transmitted equally to students as important concepts in the exercise of the medical profession. On the contrary, it is generally recommended in order for decisions to be corrected, that we must try to be cold in order not to get emotionally involved. What a serious mistake as we know that emotions and feelings surround all human actions, which have occurred in human history, for 10 million years or more. A human being - a child - today is as equal as the one who was born millions of years ago.
The Kangaroo Mother Care Method is for me an act of FAITH since skin-to-skin contact is a tremendous force, which not only acts physically and emotionally but also intellectually. The protagonism of a mother, is and always has been crucial in the development of the child. As a result of this belief, mother in skin-to-skin contact with her child initiates a fascinating biochemical, hormonal and emotional stimulation of great transcendence for the best development of the human being without any technology, as even advanced and expensive technology, cannot ever replace it. It has always been like that and it will ever be like that.
At the Maternal and Child Institute of Bogota in Colombia, we announced to the world, in 1979, that we had REDISCOVERED a new FAITH: skin-to-skin contact between the mother and her newborn child. The act of faith or a milestone in the history of humanity, where skin-to-skin contact becomes the best proposal for life to continue flourishing. It is the way to empower love, by reducing stress, to feel that life is worthwhile, no matter the difference of age among the actors and for me to feel the most wonderful spectacle of the world: life in all its shades, the vulnerability and the apparent simplicity and passivity of the recipient.
Skin-to-skin contact is the best approach to reduce both the stress of the mother and the stress of the newborn. It is favoring an adequate use of energy: anabolism; is to stimulate in the most important way, the neurological reorganization of the preterm newborn and at the same time the emotional balance of both, mother and child, and also it is very important for her close and distant family members.
The skin-to-skin contact equally favors mother-child thermal synchrony, in such a way that the temperature of the mother increases or decreases in direct relation to the child’s temperature, maintaining its temperature within a physiological range. In these special skin-to-skin contact conditions, it fosters deep sleep, which favors the maturation of the central nervous system, decreasing by 30% baby’s motor activity, increasing the resting state fundamental to the periods of maximum mother- child interaction, reducing significantly the baby's cry, which improves their health status and, equally, decreases mother’s anxiety.
It is an act of Faith to observe how the mother when having the baby naked on her thorax, feels naturally motivated to caress her baby, initiating the somatosensory stimulation in this way. With this stimulus the levels of gastrin, insulin, growth hormone and cholecystokinase increase.
There are energy savings produced by the baby staying in the longest time in a state of low caloric consumption, such as alertness, deep sleep, less muscle activity, shorter period of crying, thus allowing greater weight gain and anabolism.
Breathing during skin-to-skin contact is more regular and deep with decreased periods of apnea. The heart rate remains stable. Skin-to-skin facilitates movement, maturation of the cerebellum, temporal-spatial location.
The intimate mother-baby proximity helps to feed the baby with the best milk, the incomparable mother's milk, the guarantee for the best development and also the prevention of infections which is the main cause of the higher mortality among premature babies.
The Kangaroo Mother Care Method has been and continues to be the light of hope that in 40 years, under the principles of LOVE, WARMTH and MOTHER’S MILK, has allowed us to have had and lived truly with joy.
Among many, let's look at this example: At the time of birth a young mother, about 22 years old, dies. Her preterm baby survives at the Maternal and Child Institute of Bogotá. The baby’s father, who was also a young father, working as a security guard in a factory in Bogotá, with 24-hour shifts and a day of rest in between, was responsible for the care of his son. Every third day he went to our clinic, where we monitored the growth and development of the baby. There, during these visits, he used to collect mother’s milk from the other mothers, who also brought their premature babies to the consultations.
The next day, after completing his 24-hour shift, he was coming with her baby to attend the Kangaroo Mother Care Program. Unbelievable! The baby’s father, the companion was also the caregiver, working with day and night shifts. He followed the same pattern, arriving with his baby in kangaroo position, collecting the mother’s milk from other mothers, so a “coworker” that assumed the care and feeding tasks of the baby, as the biological father did. This real-life story of high human content of countless social value, it shows us what the Kangaroo Mother Care means, the enormous sense of human that is involved in each one of the partners.
Unfortunately, we have no room to count so many stories and cases as the testimony of the achievement over the last 40 years.
THE BEGINNING OF KANGAROO MOTHER CARE METHOD
It all started when Dr. Edgar Rey Sanabria (in memoriam) commented to me that the best way to tackle the high morbidity and mortality that we observed in the Maternal and Child Institute was to use the mothers' milk. Until then, we used to feed babies, with infant formulas, seemingly recognized in the world as the ideal food. In those times, Pediatricians and neonatologists used to follow the parameters of nutrition that equally were taught in the so-called first world countries.
Similarly, following the developed countries which, since the beginning of the twentieth century, had used warmth and care of premature and low-weight newborns, what Pierre Budin did - I repeat – in the beginning, when using the invention of Tarniere, incubators, called at that time: hatchery or hatcheries for children. Nevertheless, this meant contradicting nature’s experience of 10 or more millions of years: that the mother herself took care of her own child. It is now understood that by placing the baby inside an incubator the baby will be separate from the most precious treasure: the mother.
Nevertheless, we understand it is like that, thinking and trusting in the advances of medicine, with the advances of technology. But, according to the human philosophy, can it be considered as an advance to separate a child from its mother? In the Maternal and Child Institute, wanting to be good students, in addition as well qualified, we had no other alternative: and we were part of the developing countries.
However, our condition as a low-income country with poor health services, with lack of technologies and using infant formulas, which did not contain defense cells, without any immunological, protective or functional factors, the survival of these babies, was a miracle. However, the miracle existed, but it was not achieved by substituting an "expensive modernity": the modified powdered milks.
Today thinking with common sense, why has the situation changed at this time? How has the status quo changed so easily? Did nobody stop to think about it? Did nobody raise their voice? Did nobody think of millions and millions of years of growth and development of the human being, to fall, as we are still falling, although for human profit aspects, for the economic advantage of modified cow’s milk which often blinds the view and understanding of current neonatologists.
Dr. Edgar Rey proposed that mothers would bring their own milk to feed these little newborn babies. Then, we began to use human milk, the mothers' own milk. Thus, the change started: with the decrease of morbidity and consequently the decrease of infant mortality. It was our scientific knowledge, it was the study of the components of human milk that secured, protected and cared for the newborn baby, the premature baby.
Then there was another change, a transformation that also involves the human component: We also opened the doors of our Neonatology Departments to allow the mothers to enter to breastfeed their preterm and low birth weight babies.
But here is a historical fact, a historical fact of global repercussion: not only did we open the doors of our Maternal and Child Institute of Bogotá but we opened ours, and gradually all the doors of all the neonatology services of the world. Something transcendent, indisputable, which the whole world accepted, but which has not yet been fully recognized.
At a crucial moment of this beginning, in relation to the credibility not only of world, but in our own city, we had not just difficult times, but sometimes it was cruel, when there came to our support a "beautiful angel" and the whole team: Dr. Teresa Albanez Barnola, UNICEF Regional Director for Latin America and the Caribbean. She quickly understood, acknowledged and FELT the importance of supporting this Method that would not only revolutionize the Neonatology, but also the health of premature babies. I cannot say to what extent this work would be a FRAMEWORK in global health. That is why I want to emphasize the gift of her enormous unconditional help, her vision, and prestige which managed to persuade UNICEF to literally become committed to supporting us.
UNICEF started by bringing pediatricians, neonatologists, nurses and health managers from neighboring countries to Colombia to see what we were doing. Subsequently, their staffs were trained by me and the professionals of the Kangaroo Mother Care Program from the Maternal and Child Institute.
Thus, began the teaching-learning process of the magical principles: LOVE, WARMTH AND BREAST MILK, which only a mother can give and which these pediatricians and nurses would later go and reproduce in their countries of origin - Peru, Bolivia, Ecuador, Guatemala, Honduras and others, as "pioneers" replicating the experience and originating the current Kangaroo Mother Care Method in the world.
Within this support group, Dr. Juan Aguilar arrived as an employee of UNICEF, who become one of the greatest collaborators of the Kangaroo Mother Care Program: enthusiastic, equally visionary, big and resolute, a "brilliant character" for the consolidation and success of growth in structure and technology of the program, promoting the local and overseas dissemination, which undoubtedly made it possible to reach the place that the Kangaroo Mother Care Method occupies in global health today. Part of this effort was the result of the scientific documentation of the Kangaroo Mother Care Method, the publication in recognized scientific journals, as well as the organization of the First International Meeting of the Kangaroo Mother Care Program in Bogotá in November 1990 and the edition and publication of the papers presented in this event. Also, we have to mention another valuable aid provided by the Italian Cooperation and many members who were sent to Colombia to follow the growing work and dissemination of the program worldwide.
THE EXPANSION OF THE KANGAROO MOTHER CARE METHOD IN THE WORLD
With the important support of UNICEF, we have been traveling around the world, sharing experiences, solving doubts, opening up paths, convincing skeptics, pledging our word, clarifying doubts and leaving seeds of hope, whose fruits are gathered today in the mountains in the 5 continents.
The Kangaroo's dream came true, the truth of love, the love from mothers, the love of parents and the unsettling love of their little brothers which exploded the biggest illusion: that this little beginning could become the most beautiful reality.
Henceforth we can only hope that this greatness will not be converted into vassal opportunism, unscientific, but full of profitable embellishments, covering with multitude of unnecessary medical acts or what is worse, depriving the mother and her child of the method, to assume it by unnecessary personnel with full pockets.
Tributes and awards
We received with gratitude and modesty the following awards:
- SASAKAWA Health Prize, awarded during the 44th Plenary Assembly of the World Health Organization in Geneva, Switzerland, by creating of a Methodology for better development of the human being.
- Order Jose Celestino Mutiz, highest distinction from the Republic of Colombia Ministry of Health and Social Protection.
- Honorary member of the Colombian Association of Public Health for contribution to the global public health.
- Tribute to Life and Work, granted by the Colombian Society of Pediatrics, Bogota Branch
- PASION Cafam Award - Family Compensation Fund, Bogota, Colombia.
40 YEARS HAVE PASSED, ALL OF THEM CONSTANTLY STRUGGLING TO NOT DISTORT THE SIMPLEST NATURAL ACT: THE LOVE OF PROCREATION, THE PAIN OF BIRTH, THE LOVE OF BOUNDLESS SURRENDER AND BREASTFEEDING.
I cannot miss to highlight what Brazil has done, what pediatricians and health professionals are striving to improve and continue with this precious initiative. I have to mention, among others, Prof. Marcus Renato de Carvalho, for his dedication, integrity, knowledge and his advocacy always in favor of breastfeeding and the best for all children. Similarly, I express my immense appreciation to Dr. Luis Alberto Mussa Tavares, Neonatologist, “Kangurologist”, who not only managed to bring his knowledge to the care of the tiny premature infants, but also filled with his soul and heart, as he revealed and described in beautiful poems the universe that nourishes itself with the message of love, which flows from skin-to-skin contact between mother and child.
English translation by Regina Da Silva and Pamela Morrison (IBCLC UK) as the English reviewer, July 2019.