Prematurity – coping with the unexpected
A tiny baby … born too early.
Sudden scurry, more people, more equipment.
Positive pressure is better than oxygen.
Pre-warmed cloths are better than towels.
Dabbing and squeezing is less stressful than rubbing.
Fresh dry and warm cloth replaces damp one.
Containment in fetal position is calming.
Soft voices, eyes covered from bright light.
Slow and gentle movements.
The Kangaroula has training in these simple and practical skills. But above all, the smaller the baby is, the more it needs mother’s skin-to-skin contact. The Kangaroula transfers the small baby with its positive pressure mask to mother’s chest. She checks that the eyes are shielded from bright light. The kangaroula makes sure the baby is safe and secure.
The baby is smelling the breast.
Hearing mother’s heart beat and voice.
Calming and relaxing.
The eyes open!
The hands find the nipple.
The mouth opens
This premature baby has not read the textbook that says it is too small to suckle. The baby is in the right place, and perfectly able to suckle on the breast. The Kangaroula checks that the baby’s airway is always clear, and prongs in place. She ensures that the baby will never fall off. The Kangaroula explains the baby’s movements and actions to the mother, helps the mother to respond in the right way. When the first suckle is successful it makes it easier ever after. If the baby suckles very weakly, the Kangaroula will help mother express colostrum within the first hour.
The Kangaroula brings the father right in to that time and space. The Kangaroula explains to the dad how to protect the airway and support the feeding. He may be better at remembering the advice from the kangaroula. Father’s chest is perfectly good alternative for skin-to-skin contact when mother is ill or unable for any reason.
This small baby still needs medical help. It must be monitored, and might require oxygen in addition to pressure. It may require intravenous fluids. The care does not change, only the place of care changes. The Kangaroula is focused on the baby, and is often the first to pick up instability that needs medical support. After some hours, father should take over from mother, between the two of them and maybe with help from another family member, baby will have safety of continuous skin-to-skin contact. The father is often very good with the technical equipment. The kangaroula is trained to support and facilitate the family togetherness, including explanations of all the necessary hospital care.