1. Psychosocial concerns, Home/commun ity & Postnatal wards B.Morrison María Tingvall Rejean Tessier Ann Bigelow Ragner Olegard Leslie Wolft Lucia Geneson Aisha Saifi Bernie Endyami Erero Djiengwe

2. Psychosocial content of current guidelines MothersFathers Leas Stressed More relaxed Increased confidence Contened Increased self-esteem Comfortable Sense of fulfillment While providig Empowerment/empowers KC Can do something + for preterm infants Increases confidence in handing & feeding Enhances bonding

3. NAME Kangaroo Care to denote care given to infants are placed chest to chest (infant always on top of mom) with their mother or other primary care giver KC may be intermittent or continously Breastfeeding is the preferred means of providing nutrition to the infant but KC should be provided to ALL infants regarless of their means of obtaining nutrition

4. Assumptions All intrapartum and postnatal care should be given in a paradigm of non-separation of babies and their mothers/family. Infants should be considered exterogestate foetuses needing close contact/skin to skin for up to 4 to 6 months to promote/enhance maturation. KC should begin as soon as possible after birth and continue as often as possible for as long as possible

5. Question 1 Should KC be implemented to nurture psychological development in the infant, mother, father, and family development.

6. Considerations Birth KC essential for the initiation of breastfeeding & increasing the duration of exclusive breastfeeding & any breastfeeding. KC enhances bonding ans attachment Infants Mothers Fathers Families –Abandonment –Abuse –Divorce

7. Considerations 2 Place attachment KC helps reduces postpartum depression symptoms KC increases maternal sensitivity to infant cue. KC increases infant sensivity to maternal cues. KC enhances levels of oxytocin Dues oxytocin influence bonding, future mothering and social relationships? (indirect )

8. Considerations 3 KC enhances comunication language development/understand social recognition. Brain development Cognitive development Interactive competence & style Parenting stress Family home environment improved. Psychological development Baby Mother Father

9. Home/Community Should KC he done outside the hospital? Should KC be done in the community?

10. Issues to be considered Co-sleeping on vs beside Garments for KMC Easy contact with health care facilities Frequent visits to health care facilities Care/support for the mother Multi-family homes Grandmothers Logistics travel,finances etc Criteria for home KMC Social situation Drug use Home environment Someone who can help No smoking while carryingbaby Education re KMC for extended family member.

11. Postnatal Wards Should KC be promoted and encouraged on the postnatal wards?

12. Implementation issues & costs Education Mother, Father, Family How Stabilization of head Warmth Minimum of 1 hour for sleep cycles Comfort infant-move Avoid infection Education about breastfeeding (Family & staff) Education about non-breastfeeding mothers (HIV) (Family & staff)

13. Implementation issues & costs Education of policy makers importance of KC for psychological development of all Hospital State National International Staffeducation Doctors Midwives Nurses First line persons

14. Costs Chair & pillows Quiet Privacy Undisturbed Mirror Garments Follow-up Transportation Support

15. Concerns & Harm When to not do KC needs to be individualized Moms with mental illness Moms who are drug dependant Baby in unstable condition depending on circumstances Psysical impairments to mother that don´t allow mother to carry infant safely. Harm Forcing against mother´s will Skin & mucous infection if incorrectly apply.

16. Outcome assessment Up to 18 years Nothing in literature past 2 years Social-emotional development Denver Bayley Cognitive development WISC Attachment – Strange situation Youth Attachment interview Attention What are the psychological effect of separation? Deprivation Depression-decrease vulnerability Suicide rates Addiction rates

17. School age & teenage adaptation Criminality Pregnancy Drug abuse School drop-out Bullying Self-confidence Family Divorce rates Family function Breastfeeding & nutrition Obesity/malnutrition/undernutrition Diabetes