Psychosocial concerns Homecommun ity Postnatal wards B Morrison

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

Psychosocial content of current guidelines Mothers Fathers • 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

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

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

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

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

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)

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

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

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.

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

Implementation issues & costs • Education Mother, 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)

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

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

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.

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

• 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