Bakgrund: Det finns stora fördelar för både barn och föräldrar med vård hud-mot-hud. I akuta situationer har det länge varit norm med separation, trots en strävan efter nollseparation inom förlossnings- och eftervården.  Syfte: Att undersöka barnmorskors erfarenheter och tankar kring akut omhändertagande av nyfödda barn hud-mot-hud med modern inne på förlossningsrum.  Metod: Kvalitativ design. Semistrukturerade intervjuer med nio barnmorskor med erfarenhet av akut omhändertagande av nyfött barn hud-mot-hud med modern. Data analyserades med en kvalitativ innehållsanalys. Resultat: Innehållsanalysen resulterade i tre kategorier: en strävan att inte skilja mor och barn åt, omgivande faktorer samt individuella förutsättningar hos den enskilda barnmorskan. Barnmorskorna som intervjuades upplevde att arbetssättet med neopelare gav fördelar för både barn och föräldrar i form av möjlighet till nollseparation, hud-mot-hud och sen avnavling. För att kunna använda arbetssättet i en högre omfattning och med mer trygghet krävs mer träning. Arbetssättet upplevdes generellt ta mer plats jämfört med barnbord och krävde mer anpassning av barnmorskorna. Det upplevdes vara svårare att optimera barnets position vid ventilering. Vid mycket dåliga barn ansågs barnbordet nödvändigt.  Slutsats: Den generella uppfattningen var att arbetssättet med neopelaren var fördelaktigt och kunde utvecklas för användning i högre grad. Barnmorskorna hade en gemensam strävan efter nollseparation. Studiens resultat överensstämmer med tidigare forskning kring vinster med nollseparation och värdet av löpande utbildning för personal. Vidare forskning i ämnet kan ge ökad kunskap hos vårdpersonal vilket i framtiden kan hjälpa i arbetet med minskad separation. / Background: Both parent and infant enjoy many benefits from skin-to-skin care. The norm has previously been to separate the mother and infant in emergency situations, even though there is a consensus to strive for zero-separation during birth and postpartum care.  Aim: To explore midwives’ experiences about resuscitation of newborn infants skin-to-skin to the mother in the birthing room.   Method: A qualitative design. Semi structured interviews with nine midwives with experience of emergency care of newborn infants skin-to-skin. Data was analyzed with a qualitative content analysis.  Results: The content analysis resulted in three categories: a strive to not separate mother and infant, surrounding factors and individual prerequisites of the midwife. The midwives experienced benefits in the form of ability to practice zero separation, skin-to-skin and late cord clamping. More practice is needed to expand the use of the work procedure and sense of security. It was perceived as more space consuming and demanded adaptation. It was more difficult to optimize the infant’s position during ventilation. A separation was perceived as necessary when taking care of very sick infants.  Conclusion: The general comprehension was that the work procedure was beneficial and there was room for improvement. The midwives had a mutual strive for zero separation. The results of the study are consistent with earlier studies about the benefits of zero separation and continuous education for health workers. More studies on the topic can increase awareness among health workers, which in turn can help to reduce separation.

Kangaroo Mother Care (KMC) is an evidence-based intervention, recommended by the World Health Organization, with the potential to prevent neonatal deaths and morbidity among low-birthweight and preterm babies. In Bangladesh, where the number of neonatal deaths is high, KMC is identified as a priority intervention to be scaled up in the country. Our aim was to explore the experiences of caregivers and healthcare providers (HCPs) of KMC in Bangladesh. We conducted semi-structured interviews in two hospitals in Dhaka, where KCM service was provided. In Study I, we interviewed fifteen caregivers. The results showed conducive conditions for caregivers to perform KMC at the hospital and at home, but support is needed from both healthcare providers and their families. Caregivers felt empowered and motivated when they observed improvements in the child's well-being. However, there are challenges to KMC implementation due to the struggle to keep the baby skin-to-skin, pain after caesarean section, delayed initiation of KMC, and routines that promote an initial separation between the mother and baby. In Study II, we interviewed eleven HCPs. The results showed that HCPs experienced KMC as a continuous process that requires both support and counselling, adapted to caregivers’ needs. Commitment, supervision, and training are necessary. However, there are structural conditions that challenge KMC implementation, including clinical routines that promote the initial separation of the mother and baby, staff shortages, and incomplete follow-up. In conclusion, the findings from this exploratory research can inform the design of interventions for scaling up KMC in Bangladesh. Caregivers' and HCPs' experiences show that continuous support, counselling, and family involvement are essential in the care, and that providing KMC empowers caregivers. Their experiences also indicate that KMC is sub-optimally implemented due to structural conditions and routines that need to be addressed to scale up KMC in the country by avoiding the initial separation of mother and baby, meeting the mothers' needs for care and support, and strengthening the follow-up. Our results also suggest a need to update clinical practices in line with the new WHO recommendations. / <p></p><p></p><p></p>

SAMMANFATTNING Bakgrund: Kängurumetoden, även kallat Kangaroo Mother Care (KMC) är en omvårdnadsmetod som främjar hudkontakten mellan förälder och barn, särskilt prematura eller underviktiga. KMC har positiva effekter för både föräldrar och barn. Därför är det väsentligt att ta reda på föräldrars upplevelse av KMC för att kunna optimera vården då metoden är essentiell för det nyfödda barnet.  Syfte: Syftet med denna litteraturöversikt var att undersöka föräldrars upplevelser av kängurumetoden med barn som vårdas på neonatalavdelningen.  Metod: En litteraturöversikt med kvalitativ design där 10 kvalitativa artiklar samlades in från databaserna PubMed och Cinahl.  Resultat: Föräldrars upplevelse av KMC uttrycktes i fyra kategorier och åtta subkategorier. Kategorierna som presenteras är Insikten om att ha blivit förälder, Emotionell upplevelse av kängurumetoden hos föräldrarna, Växande ansvar som förälder och Kommunikation med vårdpersonal under KMC. Upplevelsen av KMC var i helhet positiv, inklusive ökad lycka och lugn men även negativa upplevelser av KMC uttrycktes, såsom rädsla för att skada sitt barn och att kommunikationen med vårdpersonalen var påverkad.  Slutsats: Resultaten visar en mångfald av mestadels positiva men även negativa erfarenheter, däribland; förstärkt föräldraroll, ökad känsla av kompetens och ansvar för barnet. KMC kunde ge känslan av att känna sig som ett verktyg, men deltagandet i vården möjliggör för föräldrar att känna sig betydelsefulla vilket gör en positiv skillnad för sitt barn. Genom att lyssna på och integrera föräldrarnas perspektiv kan neonatalvården fortsätta att utvecklas och anpassas för att möta både barnets och föräldrarnas behov. / ABSTRACT Background: Kangaroo method, also called Kangaroo Mother Care (KMC) is a nursing method that promotes skin-to-skin contact between parent and child, especially for children born prematurely or underweight. KMC has positive effects for both parent and child. Therefore, it is important to find out parents' experience of KMC to optimize the care as the method is essential for the newborn child. Aim: The purpose was to investigate parents’ experience of Kangaroo Mother care with children in the neonatal unit. Method: A literature review with qualitative design where 10 qualitative articles were collected in databases PubMed and Cinahl.  Results: Parents' experience of KMC was expressed in four categories and eight subcategories that answered the purpose of this literature review. The categories presented are The realization that one has become a parent, Emotional experience of the kangaroo method by the parents, Increasing parental responsibility and Communication with healthcare staff during KMC. The experience of KMC was overall positive, including increased happiness and calmness but also negative experiences of KMC, such as fear of harming their child and that communication with healthcare professionals was affected. Conclusion: The results show a diversity of mostly positive but also negative experiences, including; strengthened parental role, increased sense of competence and responsibility for the child. KMC could give a sense of being used as a device, but participating in the care enables parents to feel meaningful for their child. By listening to parents' perspectives, neonatal care can continue to develop and adapt to meet needs of both children and parents

Studier har visat att hud-mot-hud har flera positiva effekter för modern och det nyfödda barnet. Trots detta upplever barnmorskor hinder för kontinuerlig hud-mot-hud under föräldraparens BB-vistelse.  Syftet med arbetet var att beskriva barnmorskors tankar kring hinder och möjligheter för kontinuerlig hud-mot-hud på barnbördshus (BB). Forskning finns om hud-mot-hud men inga specifika studier om barnmorskors tankar kring vilka hinder och möjligheter som finns för kontinuerlig hud-mot-hud under BB-vistelsen.  En intervjustudie utfördes och materialet bearbetades med kvalitativ innehållsanalys för att lyfta fram de viktigaste aspekterna. Resultatet som framkom belyser barnmorskors tankar om hinder och möjligheter vid implementering av kontinuerlig hud-mot-hud under barnets första dygn på BB. Resultatet av studien visade att barnmorskorna största hinder var brist på riktlinjer, förekomsten av barnsängar, bristande föräldrainformation, platsbrist, samt föräldrarnas kulturella bakgrund och personalens attityder. De möjligheter som lyftes fram var enkelrum, bärhjälpmedel såsom tubtopp eller bärsjal, samt att utbilda föräldrarna under graviditeten. Vårdhandlingen införlivas lättast om de blivande föräldrar deltar i förberedande föräldrakurser under graviditeten, samt att personalen är välutbildade och uppmuntrar till hud-mot-hud. / Studies have shown that skin-to-skin care has several positive effects for both the mother and the newborn. Despite this, midwifes experience that it can be difficult to get parents to implement the skin-to-skin care continuously during its stay the maternity ward.  The aim of the thesis is to describe midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care at the maternity ward. There are studies on skin-to-skin care but no specific studies regarding midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care during maternity stay. An interview study was conducted, and the material was processed using qualitative content analysis to highlight the main points. The result highlighted midwives’ thoughts on the obstacles and opportunities in the implementation of continuous skin-to-skin contact during the child's first days in the maternity ward. The results of the study showed that midwives biggest obstacles are the hospital baby beds, as well as lack of guidelines, parental information, private rooms, and the parents' cultural background and the staff attitudes. The opportunities that arouse were private rooms, aids such as tube tops or slings, and prenatal parental training during pregnancy. Skin-to-skin care can most easily be implemented when parents participate in preparatory parenting training, and when the staff is well trained and encourage implementing skin-to-skin care.

Introdução: O contato pele-a-pele (CPP) ao nascimento consiste no posicionamento imediato do recém-nascido (RN) sobre o abdome ou tórax desnudo da mãe. Idealmente, o binômio mãe-filho deve permanecer em CPP continuamente por 1 hora para que benefícios como a promoção do aleitamento materno, estabilidade térmica, hemodinâmica e respiratória, organização comportamental, entre outros, sejam alcançados. Apesar de ser uma prática recomendada, a adesão ao CPP é insuficiente nas instituições brasileiras. Objetivo: Analisar a prática do CPP ao nascimento no hospital. Método: Estudo transversal realizado em um Hospital Amigo da Criança do município de São Paulo, SP. Foram inclusas puérperas de gestação única e seus RN de termo. Foram excluídos RN por cesariana e binômios mãe-filho que apresentaram complicações clínicas, obstétricas ou neonatais. A amostra foi composta por 78 binômios com erro de prevalência estimada em 10%. A coleta foi realizada no período de 1 mês, nos horários da manhã, tarde, noite e madrugada. Os dados foram obtidos dos prontuários da puérpera e do RN e por observação não participante da prática do CPP ao nascimento. Foi registrado o CPP ao nascimento, sua duração e interrupção e a efetivação da pega da mama materna na 1ª hora de vida do RN. Os dados foram analisados de modo descritivo e inferencial. Resultados: O CPP foi realizado em 94,9% (n=74) dos nascimentos, 73% (n=54) dos RN permaneceram menos de 60 minutos em contato e 50% (n=27) destes, menos que 15 minutos. A duração média do CPP foi de 29 minutos. O principal motivo para a interrupção do CPP foi a prestação de cuidados de rotina ao RN. Houve diferença significativa no tempo de CPP, com duração maior em relação às seguintes variáveis: Apgar no 5º minuto com índice 10 (p=0,003); condição perineal (mulheres com períneo íntegro; p=0,022); partos assistidos por enfermeira obstétrica (p=0,027); RN sem aspiração de vias aéreas superiores (AVAS) (p<0,001), com aplicação de vitamina K (p=0,048) e vacina da hepatite B (p=0,030); assistência neonatal prestada por médico residente (p=0,028). Os RN que receberam a AVAS ficaram, em média, 27 minutos a menos em CPP. Houve diferença significativa em relação às seguintes variáveis, com maior proporção de RN que efetivaram a pega da mama na 1ª hora de vida: índice de Apgar mais elevado no 1º e 5º minuto (p=0,035 e p=0,009, respectivamente); sem AVAS (p=0,015); posicionamento no colo materno (p=0,011); ajuda profissional para efetivação da pega (p<0,001). A condição perineal materna com integridade mostrou tendência à efetivação da pega (p=0,053). Não houve associação significativa entre a efetivação da pega, que ocorreu em 64,1% (n=50) dos RN, e o maior tempo de CPP (p=0,142). Conclusão: O CPP foi realizado na quase totalidade dos nascimentos, mas com duração inferior a 1 hora, na maioria dos casos. Os fatores que facilitaram o prolongamento do CPP e a pega efetiva da mama materna relacionam-se à boa vitalidade ao nascer e à integridade perineal. A assistência ao parto por enfermeira obstétrica favorece o CPP. A ajuda profissional na pega da mama e a permanência do RN no colo materno favorecem a amamentação precoce, independentemente da duração do CPP. As barreiras ao CPP e à efetivação da pega relacionam-se com os cuidados neonatais de rotina prestados ao RN durante a 1ª hora de vida, em especial, a AVAS. / Introduction: Skin-to-skin contact (SSC) at birth consists in positioning the newborn (NB) on the mothers abdomen or naked chest immediately. Ideally, the mother-child binomial should remain in SSC continuously for 1 hour, so that benefits such as the promotion of breastfeeding, thermal, hemodynamic and respiratory stability, behavioral organization, among others, are achieved. Although it is a recommended practice, SSC adherence is insufficient in Brazilian institutions. Objective: To analyze the SSC practice at birth in a hospital. Methods: A cross-sectional study, which was carried out in a Child-Friendly Hospital in the city of São Paulo, SP, Brazil. Single-term postpartum women and their full-term NBs were included. NBs by caesarean section and mother-child binomials that presented clinical, obstetric or neonatal complications were excluded. The sample consisted of 78 binomials, with an estimated prevalence of error in 10%. Data collection was performed in the period of 1 month, in the morning, afternoon, night and dawn hours. Data were obtained from the medical records of the postpartum women and NBs and by non-participant observation of the SSC practice at birth. The SSC practice was recorded at birth, its duration and interruption, as well as the accomplishment of the maternal breast latching in the 1 hour of life of the NB. Data were analyzed in a descriptive and inferential manner. Results: SSC was performed in 94.9% (n=74) of births, and 73% (n=54) of NBs remained less than 60 minutes in contact, of which 50% (n=27) for less than 15 minutes. The mean SSC duration was 29 minutes. The main reason for SSC discontinuation was the provision of routine care to NB. There was a significant difference in SSC time, with a longer duration in relation to the following variables: Apgar at the 5th minute with score 10 (p=0.003); perineal condition (women with intact perineum; p=0.022); births assisted by nurse-midwife (p=0.027); NB without upper airway aspiration (UAA) (p<0.001) and with application of vitamin K (p=0.048) and hepatitis B vaccine (p=0.030); neonatal care provided by a resident physician (p=0.028). The NBs that received UAA remained, on average, 27 minutes less in SSC. There was a significant difference, with a higher proportion of NBs with effective breast latching in the 1 hour of life in relation to the following variables: higher Apgar score at the 1st and 5th minutes (p=0.035 and p=0.009, respectively); without UAA (p=0.015); positioning in the mothers lap (p=0.011); professional help to perform the latching (p<0.001). The intact maternal perineum showed tendency in favor to effective breast latching (p=0.053). There was no significant association between the accomplishment of the latching, which occurred in 64.1% (n=50) of NBs, and the highest SSC time (p=0.142). Conclusion: SSC was performed in almost all births, but lasting less than 1 hour in most cases. The factors that have facilitated the SSC prolongation and the accomplishment of the maternal breast latching are related to good vitality at birth and perineal integrity. Birth care provided by nurse-midwives favors SSC. The professional help in latching the breast and the stay of NB in the mothers lap favor early breastfeeding, regardless of the SSC duration. The barriers to SSC and to the accomplishment of the latching are related to the routine neonatal care provided to NB during the 1 hour of life, especially the UAA.

Introduction: Close emotional bands develop between mother and child and begin already during pregnancy, several factors affect how this band develops. Fetal life and the first few hours after childbirth are important for the infant's emotional development. Purpose: The purpose of this study is to investigate how midwives in post-natal care pay attention to emotional reactions in the mother, which these reactions are and how the midwives consider themselves to promote the relationship between mother and child. Issues: How do midwives describe that they pay attention to emotional reactions in the mother after childbirth, and what reactions are described? And how do midwives describe that they are working to promote the relationship between mother and child during the aftercare? Method: Five midwives working in the aftercare were interviewed based on a qualitative approach. The data collection method that has been used for this study is a semi-structured interview. The study material has been processed using an inductive thematic analysis. Result: What appears in the study is that midwives find it central to identify the woman's way of thinking about the child's needs and her ability to interpret the child's signals. The participants pay particular attention to those women where the emotional stress has been great after giving birth and can be assumed to need support. Discussion: Most studies and literature support what emerged from this study on the midwives' knowledge and experience about emotional reactions and its influence on the relationship between mother children. The mother's care for the child's needs and the midwife's work in promoting the relationship between these two can be interpreted as the concept of mentalization. / Inledning: Nära känslomässiga band utvecklas mellan mor och barn och påbörjas redan under graviditeten, flertalet faktorer påverkar hur detta band utvecklas. Fosterlivet och de första timmarna efter förlossningen är av betydelse för spädbarnets känslomässiga utveckling. Syfte: Syftet med denna studie är att undersöka hur barnmorskor inom eftervården uppmärksammar känslomässiga reaktioner hos modern, vilka dessa reaktioner är och hur barnmorskorna anser sig främja relationen mellan mor och barn. Frågeställningar: Hur beskriver barnmorskorna att de uppmärksammar känslomässiga reaktioner hos modern efter förlossningen, och vilka reaktioner beskrivs? Samt hur beskriver barnmorskorna att de arbetar för att främja relationen mellan mor och barn under eftervården? Metod: Fem barnmorskor verksamma inom eftervården intervjuades utifrån en kvalitativ ansats. Datainsamlingsmetod som har används för denna studie är en semistrukturerad intervju. Studiens material har bearbetas med hjälp av en induktiv tematisk analys. Resultat: Det som framkommer i studien är att barnmorskorna finner centralt att identifiera är kvinnans sätt att tänka om barnets behov och hennes förmåga att tolka barnets signaler. Deltagarna uppmärksammar särskilt de kvinnor där den känslomässiga påfrestningen har varit stor efter förlossningen och kan antas behöva stöd. Diskussion: Flertalet studier samt litteratur stödjer det som framkom i denna studie om barnmorskornas kunskap och erfarenhet om känslomässiga reaktioner och dess påverkan på relationen mellan mor barn. Moderns omsorg om barnets behov samt barnmorskans arbete i att främja relationen mellan dessa två kan tolkas till begreppet mentalisering.

Abstract This study describes skin-to-skin contact, initial breastfeeding, rooming-in, and exclusive breastfeeding in accordance with the Baby-Friendly Hospital Initiative (BFHI) program. Furthermore, it addresses the connection of these factors in Finnish maternity hospitals and gathers information about the daily work of maternity ward staff, which is useful to develop ways to increase exclusive breastfeeding of infants and to plan the introduction of BFHI. The study uses a cross-sectional design that includes questionnaires. Random data came from mothers (n=111), midwives (n=272), and maternity ward staff (f=1554) in maternity hospitals during the spring of 2014. The questionnaires include background questions, questions concerning the implementation of skin-to-skin contact, initial breastfeeding, rooming-in, exclusive breastfeeding according to the BFHI, and open-ended questions about implementation barriers. The analysis used statistical methods to interpret the data and content specifications to explain the answers to open questions. In Finland, successful skin-to-skin contact, initial breastfeeding, and rooming-in results in multiparas and vaginally births women. After vaginally births, exclusive breastfeeding increases when skin-to-skin contact, initial breastfeeding, and rooming-in starts at an early stage. Rooming-in does not take place for many different reasons. Maternity staff state that 72% implement exclusive breastfeeding, and mothers state that 55% exclusively breastfeed. Primiparous mothers and those who underwent cesarean are the populations that least use exclusive breastfeeding mostly due to infant medical issues and to non-medical reasons. The results of the study bring to light that practices with skin-to-skin contact, initial breastfeeding, and rooming-in in Finnish maternity units are similar to BFHI steps. Exclusive breastfeeding during hospitalization, as well as implementation barriers, should receive special attention. Furthermore, maternity staff should have a clearer medical understanding. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata äitien ja hoitohenkilökunnan näkökulmista ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumista Vauvamyönteisyysohjelman mukaisesti ja niihin yhteydessä olevia tekijöitä Suomen synnytyssairaaloissa. Tavoitteena oli tuottaa synnytysosastojen henkilökunnan päivittäiseen hoitotyöhön tietoa, jota voidaan hyödyntää kehitettäessä menetelmiä vastasyntyneiden täysimetyksen lisäämiseen ja Vauvamyönteisyysohjelman käyttöönoton suunnitteluun. Tutkimus oli poikkileikkaustutkimus, joka toteutettiin kyselytutkimuksena. Aineisto kerättiin satunnaisesti valituissa synnytyssairaaloissa äideiltä (n=111), synnytyssalikätilöiltä (n=272) ja vuodeosastojen hoitajilta (f=1554, f=hoitoraporttien/kyselylomakkeiden määrä) keväällä 2014. Kyselylomakkeessa oli taustatietokysymysten lisäksi ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumisesta Vauvamyönteisyysohjelman mukaisesti mittaavia kysymyksiä sekä avoimia kysymyksiä niiden toteutumista estävistä tekijöistä. Aineisto analysoitiin tilastollisin menetelmin ja avoimet kysymykset sisällön erittelyllä. Ihokontakti, ensi-imetys ja vierihoito toteutuivat Suomessa hyvin alateitse synnyttäneillä uudelleensynnyttäjillä. Täysimetys lisääntyi ihokontaktin ja ensi-imetyksen alkaessa varhain ja vierihoidon toteutuessa. Vierihoidon toteutumista estivät useat eri syyt. Täysimetys toteutui Suomessa hoitajien arvioimana 72 %:lla ja äitien arvioimana 55 %:lla. Se toteutui vähiten ensisynnyttäjillä ja keisarileikatuilla ja estyi enimmäkseen lääketieteellisistä syistä. Tutkimus osoittaa, että Suomen synnytyssairaaloiden hoitokäytännöt ihokontaktin, ensi-imetyksen ja vierihoidon toteutumisessa eivät poikkea suuresti Vauvamyönteisyysohjelman suosituksista. Täysimetys sairaalassa vaatii lisätarkastelua ja sen osalta sairaaloissa tulee kiinnittää huomiota lisäruoan antamisen syihin ja selkiyttää hoitohenkilökunnalle sen antamisen lääketieteellisiä syitä.

<p>Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005 / Bergman &amp / Jurisco, 1994 / Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.</p>

<p>Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005 / Bergman &amp / Jurisco, 1994 / Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.</p>

Introdução: O contato pele-a-pele (CPP) ao nascimento consiste no posicionamento imediato do recém-nascido (RN) sobre o abdome ou tórax desnudo da mãe. Idealmente, o binômio mãe-filho deve permanecer em CPP continuamente por 1 hora para que benefícios como a promoção do aleitamento materno, estabilidade térmica, hemodinâmica e respiratória, organização comportamental, entre outros, sejam alcançados. Apesar de ser uma prática recomendada, a adesão ao CPP é insuficiente nas instituições brasileiras. Objetivo: Analisar a prática do CPP ao nascimento no hospital. Método: Estudo transversal realizado em um Hospital Amigo da Criança do município de São Paulo, SP. Foram inclusas puérperas de gestação única e seus RN de termo. Foram excluídos RN por cesariana e binômios mãe-filho que apresentaram complicações clínicas, obstétricas ou neonatais. A amostra foi composta por 78 binômios com erro de prevalência estimada em 10%. A coleta foi realizada no período de 1 mês, nos horários da manhã, tarde, noite e madrugada. Os dados foram obtidos dos prontuários da puérpera e do RN e por observação não participante da prática do CPP ao nascimento. Foi registrado o CPP ao nascimento, sua duração e interrupção e a efetivação da pega da mama materna na 1ª hora de vida do RN. Os dados foram analisados de modo descritivo e inferencial. Resultados: O CPP foi realizado em 94,9% (n=74) dos nascimentos, 73% (n=54) dos RN permaneceram menos de 60 minutos em contato e 50% (n=27) destes, menos que 15 minutos. A duração média do CPP foi de 29 minutos. O principal motivo para a interrupção do CPP foi a prestação de cuidados de rotina ao RN. Houve diferença significativa no tempo de CPP, com duração maior em relação às seguintes variáveis: Apgar no 5º minuto com índice 10 (p=0,003); condição perineal (mulheres com períneo íntegro; p=0,022); partos assistidos por enfermeira obstétrica (p=0,027); RN sem aspiração de vias aéreas superiores (AVAS) (p<0,001), com aplicação de vitamina K (p=0,048) e vacina da hepatite B (p=0,030); assistência neonatal prestada por médico residente (p=0,028). Os RN que receberam a AVAS ficaram, em média, 27 minutos a menos em CPP. Houve diferença significativa em relação às seguintes variáveis, com maior proporção de RN que efetivaram a pega da mama na 1ª hora de vida: índice de Apgar mais elevado no 1º e 5º minuto (p=0,035 e p=0,009, respectivamente); sem AVAS (p=0,015); posicionamento no colo materno (p=0,011); ajuda profissional para efetivação da pega (p<0,001). A condição perineal materna com integridade mostrou tendência à efetivação da pega (p=0,053). Não houve associação significativa entre a efetivação da pega, que ocorreu em 64,1% (n=50) dos RN, e o maior tempo de CPP (p=0,142). Conclusão: O CPP foi realizado na quase totalidade dos nascimentos, mas com duração inferior a 1 hora, na maioria dos casos. Os fatores que facilitaram o prolongamento do CPP e a pega efetiva da mama materna relacionam-se à boa vitalidade ao nascer e à integridade perineal. A assistência ao parto por enfermeira obstétrica favorece o CPP. A ajuda profissional na pega da mama e a permanência do RN no colo materno favorecem a amamentação precoce, independentemente da duração do CPP. As barreiras ao CPP e à efetivação da pega relacionam-se com os cuidados neonatais de rotina prestados ao RN durante a 1ª hora de vida, em especial, a AVAS. / Introduction: Skin-to-skin contact (SSC) at birth consists in positioning the newborn (NB) on the mothers abdomen or naked chest immediately. Ideally, the mother-child binomial should remain in SSC continuously for 1 hour, so that benefits such as the promotion of breastfeeding, thermal, hemodynamic and respiratory stability, behavioral organization, among others, are achieved. Although it is a recommended practice, SSC adherence is insufficient in Brazilian institutions. Objective: To analyze the SSC practice at birth in a hospital. Methods: A cross-sectional study, which was carried out in a Child-Friendly Hospital in the city of São Paulo, SP, Brazil. Single-term postpartum women and their full-term NBs were included. NBs by caesarean section and mother-child binomials that presented clinical, obstetric or neonatal complications were excluded. The sample consisted of 78 binomials, with an estimated prevalence of error in 10%. Data collection was performed in the period of 1 month, in the morning, afternoon, night and dawn hours. Data were obtained from the medical records of the postpartum women and NBs and by non-participant observation of the SSC practice at birth. The SSC practice was recorded at birth, its duration and interruption, as well as the accomplishment of the maternal breast latching in the 1 hour of life of the NB. Data were analyzed in a descriptive and inferential manner. Results: SSC was performed in 94.9% (n=74) of births, and 73% (n=54) of NBs remained less than 60 minutes in contact, of which 50% (n=27) for less than 15 minutes. The mean SSC duration was 29 minutes. The main reason for SSC discontinuation was the provision of routine care to NB. There was a significant difference in SSC time, with a longer duration in relation to the following variables: Apgar at the 5th minute with score 10 (p=0.003); perineal condition (women with intact perineum; p=0.022); births assisted by nurse-midwife (p=0.027); NB without upper airway aspiration (UAA) (p<0.001) and with application of vitamin K (p=0.048) and hepatitis B vaccine (p=0.030); neonatal care provided by a resident physician (p=0.028). The NBs that received UAA remained, on average, 27 minutes less in SSC. There was a significant difference, with a higher proportion of NBs with effective breast latching in the 1 hour of life in relation to the following variables: higher Apgar score at the 1st and 5th minutes (p=0.035 and p=0.009, respectively); without UAA (p=0.015); positioning in the mothers lap (p=0.011); professional help to perform the latching (p<0.001). The intact maternal perineum showed tendency in favor to effective breast latching (p=0.053). There was no significant association between the accomplishment of the latching, which occurred in 64.1% (n=50) of NBs, and the highest SSC time (p=0.142). Conclusion: SSC was performed in almost all births, but lasting less than 1 hour in most cases. The factors that have facilitated the SSC prolongation and the accomplishment of the maternal breast latching are related to good vitality at birth and perineal integrity. Birth care provided by nurse-midwives favors SSC. The professional help in latching the breast and the stay of NB in the mothers lap favor early breastfeeding, regardless of the SSC duration. The barriers to SSC and to the accomplishment of the latching are related to the routine neonatal care provided to NB during the 1 hour of life, especially the UAA.