Here is an article that appeared in todays Sydney morning herald about prem babies.
Babies fed on alcohol, food dye
Prematue babies in neonatal units could be consuming up to seven standard alcoholic drinks a week and ingesting a food colouring which has been banned in three countries because some common medications contain high doses of toxic additives.
A study of babies in Britain who were up to 13 weeks premature found that those prescribed the diuretic furosemide, which contains ethanol, could be ingesting between 0.2 millilitres to 1.8 millilitres of alcohol a week, the equivalent of a 70-kilogram man consuming up to seven standard drinks.
Most authorities, including the Australian Medical Association, advocate a “no alcohol during pregnancy” policy, as exposure has been linked with central nervous system problems, low birth weight, mental retardation and abnormal facial features.
The study also found that neonates given syrup-based iron supplements were exposed to artificial cherry flavourings and the red food colouring ponceau, which has been banned in the US, Britain and Norway after being linked to attention deficit hyperactivity disorder.
Public pressure forced Nestle to remove ponceau from Smarties in Australia last month.
Researchers found that none of the babies in the study, published in the journal Archives Of Disease in Childhood: Fetal And Neonatal Edition, had been exposed to toxic levels of ponceau but pushed for the additive to be removed from all medications designed for preterm infants.
More than half were exposed to high levels of sorbitol, a sugar substitute used in iron supplements, and dexamethasone, a medication for inflammation. Many babies in the study were exposed to up to 3.5 grams per kilogram of sorbitol a week, 1.5 grams per kilogram more than the recommended dose. Sorbitol can cause nausea and gut malabsorption.
Those given the diuretic spironolactone were exposed to raspberry flavouring and aspartame, the same sweetener used in diet drinks.
Medications designed for premature babies should be made available free of colourings and flavourings, a Sydney University nutritionist, Jenny O’Dea, said yesterday.
“These chemicals could certainly have an adverse impact on a baby and if parents can choose in a pharmacy to have a drug without additives, they should be able to make the same choice in hospital,” she said.
This type of care is in complete opposition to the gentle and effective Kangaroo care which has sense and mother love running through it.
baby being born at 33 weeks
I could ramble on about Kangaroo care, but why bother when this article has already said it all so well.
Kangaroo Care: Why Does It Work?
by Holly Richardson© 1997 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 44, Winter 1997.]
By the early 1980s, the mortality rate for premature infants in Bogota, Colombia was 70 percent. The babies were dying of infections and respiratory problems as well as lack of attention paid to them by a bonded parent. “Kangaroo care” for these infants evolved out of necessity. Mothers of premature infants were given their babies to hold twenty-four hours a day-they slept with them and tucked them under their clothing as if in a kangaroo’s pouch. If a baby needed oxygen, it was administered under an oxygen hood placed on the mother’s chest.
Doctors who conducted a concurrent study of the kangaroo care noticed a precipitous drop in neonatal mortality. Babies were not only surviving, they were thriving. Currently in Bogota, babies who are born as early as ten weeks before their due date are going home within twenty-four hours! The criteria for these babies is that they be alive, able to breathe on their own, are pink and able to suck. However, their weight is followed closely, and they can be gavage-fed if necessary.
Dr. Susan Ludington is one of the people who have been most instrumental in bringing kangaroo care to the United States. She has been intimately involved in many research projects, and her work is having a powerful, positive impact on premature babies and their families. In the United States, the few hospitals that regularly use kangaroo care protocols have mothers or fathers “wear” their babies for two to three hours per day, skin-to-skin. The baby is naked except for a diaper, and something must cover his or her back—either the parent’s clothing or a receiving blanket folded in fourths. The baby is in a mostly upright position against the parent’s chest.
The benefits of kangaroo care are numerous: The baby has a stable heart rate (no bradycardia), more regular breathing (a 75 percent decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of “purposeless” activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge. Benefits to the parents include “closure” over having a baby in NICU; feeling close to their babies (earlier bonding); having confidence that they can care for their baby, even better than hospital staff; gaining confidence that their baby is well cared for; and feeling in control—not to mention significantly decreased cost!
Why does kangaroo care work? Why are Dr. Ludington and others seeing such phenomenal results with babies in kangaroo care? What is happening to the baby and the mother during this time?
One of the first things to happen is that maintenance of the baby’s body temperature begins to depend on the mother, requiring the baby to use fewer calories to stay warm. Mothers naturally modulate the warmth of their breasts to keep their infants at the optimal temperature where babies sleep best, have the best oxygen saturation levels, the least caloric expenditure, and so forth. Maternal breast temperature can rise rapidly, then fall off as baby is warmed. As the baby starts to cool, the breasts heat up again—as much as 2 degrees C in two minutes!
Being next to morn also helps the baby regulate his or her respiratory and heart rates. Babies experience significantly less bradycardia and often, none at all. The respiratory rate of kangarooed infants becomes more stable. The depth of each breath becomes more even, and apnea decreases four-fold and often disappears altogether. If apneic episodes do occur, the length of each episode decreases. In my own experience with a baby in NICU for bradycardia and apnea, I found that both problems disappeared completely when I was home kangarooing my baby.
During kangaroo care, a premature baby’s overall growth rate increases. This is in part due to the baby’s ability to sleep, thus conserving energy and putting caloric expenditure toward growth. According to Dr. Ludington, during the last six weeks of pregnancy, babies sleep twenty to twenty-two hours per day. In a typical NICU, however, they spend less than two hours total in deep, quiet sleep. Most of that comes in ten or twenty second snatches. With kangaroo care, the infant typically snuggles into the breast and is deeply asleep within just a few minutes. These babies gain weight faster than their non-kangarooed counterparts, and it is interesting to note that they usually do not lose any of their birthweight.
Researchers have gained significant insight into what happens to an infant’s brain during kangaroo care. Any baby’s heart rate and respiratory rates can be plotted as a sort of artistic drawing. Because premature infants lack the ability to coordinate their breathing and heart rates, the rates “plot out” as chaotic. This means with increased demand on the cardiovascular system, as with crying or fussing, the system does not respond with a related increase in cardiac output. In other words, the baby’s respiratory rate may increase while crying, but the heart rate does not. As premies mature, these rates become synchronized, or “coupled,” resulting in an orderly drawing when the rates are plotted together. The drawing no longer looks random.
In infants in kangaroo care, researchers found that coupling takes place after only ten minutes. This hardly seemed possible because it equaled four weeks of brain development in the “normal” premie. As researchers studied brain wave patterns of infants in kangaroo care, they found two significant things. First, there was a doubling of alpha waves—the brain wave pattern associated with contentment and bliss. Second, they found that “delta brushes” were occurring. Delta brushes happen only when new synapses are being formed. So holding the infant skin-to-skin allows his or her brain to continue its work of developing neural synapses.
Imagine the implications if all infants “at risk” were kangarooed. Dr. Ludington sums up kangaroo care very aptly by saying “Separation is not biologically normal.”
Helping our clients understand their options, including risks, benefits and alternatives, is a very important part of being “with woman.” Knowing enough about kangaroo care to help them make informed decisions is another important tool for the caregiver’s birth bag. All infants benefit from skin-to-skin contact, breastfeeding, shared sleep and so forth, but some babies very seriously need kangaroo care. They include premature infants, infants with low muscle tone or disabilities, high-needs infants, those with intrauterine growth retardation or those who have a hard time gaining weight. Midwives would do well to learn the basics of kangaroo care, and where to turn for further information. Adding Dr. Ludington’s book Kangaroo Care to one’s library is a good first step. Being supportive of parents and giving encouragement and positive reinforcement is also very helpful. Remember that in some instances, kangaroo care has meant the difference between life and death.
This highlights the thoughless scientific attitude to mothers and babies that the majority of western medicine has. Forgetting the importance of the essential bond of a mother and her baby can be fatal. Kangaroo care should be standard practice at the hospital, instead it’s poo poo’d in favour of a clear plastic box and an array of potentially lethal drugs.
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This is so great — I’d never thought about the additives before; and while I’ve heard of kangaroo care, I’d never read much about it. Thanks for the article!
-Kathy
fantastic article and pics lisa. thanks.
I am ALL for kangaroo care and did a LOT of it with my son, and IUGR 28 weeker. But, the idea of doing any kind of a homebirth (as pictured above) at only 33 weeks gestation seems completely crazy to me. I know work on a parent advisory committee for a NICU and there are plenty of 33 weekers who really do need to be in a NICU and not born in a bathtub.
I think the ideal environment for a preemie was the one we were fortunate enough to have. The hospital where he was born was a level 3 NICU. He needed serious respiratory support in the beginning and was ventilated for 7 weeks.
But it is a quiet unit with minimal stim from the staff. Vitals on sick but stable babies are done fairly infrequently. It is a private room NICU unit where each baby’s isolette is in a singular room to minimize light and noise. The room has a bed for mom and/or dad to sleep in at any time they wish and an adjacent bathroom for mom/dad to clean up. Infants on ventilators have a nurse that has only that baby in her charge that shift.
I was able to begin kangarooing as soon as my son was stable at only 5 days of age. And he was only 1.5 lbs.
The ability to have such a balance of thoroughly appropriate medical care and kangarooing does exist.
Hey Lisa could you tell us a little more about the mother and baby being born at 33 weeks? (the people in the first photo) Was it a homebirth and were you the midwife?
I ask this because I have never even realised that a homebirth – if it is – could be apparently safe at 33 weeks!!! If that is right then I am astounded! How are they both going these days?
I just completely thought that any baby born under 37 weeks was at risk and MUST be in a hospital! I’m just so shocked!!! In a good way!!!
I was shocked at the additives in neonate medicines – why do they even NEED flavouring?!
That article on Kangaroo-care is fascinating, I’m off to share it with others now, thankyou!
Thanks for posting this information – it is surprising and shocking yet heartwarming to know that there are people who care, people who advocate kangaroo care and people speaking up about these important issues for our mothers, babies and families all round.
Interesting point made about the high-needs baby. Had I not been so sore with a C/S and tired and led to believe that my baby needed to be rocked to sleep in a cot rather than carried around in ‘my pouch” and/or breastfed to sleep, maybe my first baby needn’t have suffered hours from his mummy, and even now had a closer bond. My next one, also quite overdue, had to a degree kangaroo care in the form of lots of connected mummy time as I constantly breastfed, for hunger, comfort and sleep. Looking back now, I’m sure their personalities were (and still are) quiet different (serious and reserved and a little distant vs outgoing, carefree and snuggly) but I can’t help think that more kangaroo care with the first would have made the world of difference to both of us. Go Lisa, great info, keep it coming. I’m passing this on too.
What a glorious picture of birth! I am a little biased, as that’s my arm to the right of the picture…
The article you posted, plus my vicarious experience of seeing my nephew kangaroo-cared from 33wks only highlights to me how much of the ‘care’ hospitals can provide can actually serve to damage, disturb and pathologise the baby and its condition. The basic principle of assuming all is normal (or near enough) and only intervening when indicated has been soundly supported in this situation; I hope others can see it that way too.
And, I am stunned that medicines etc. for premature babies are flavoured and coloured!! Why? What purpose does it serve? If hospitals better understood and supported the provision of breastmilk to premature (and all others) babies, I’m sure their health would be significantly improved.
Lisa,
Is this a birth you attended? I love the expression on the woman’s face!
Great post Lisa.
What baby wouldn’t want kangaroo care if the circumstances allow? I get quite concerned when babies are needlessly put in those cribs without much physical contact. Such a distressing contrast to being all snuggly in the womb. Great pictures. Look how content he is!
Rixa, mine is the head in the corner.
I thought so–so was this at home? In hospital?
homebirth. Total Kangaroo Care, some donated ebm but not much needed. Woman was fantastic baby totally brilliant.
Wow, that is amazing. I wrote on my blog last month that my cutoff for a home birth was 36-37 weeks, but frankly I would probably push it earlier; it’s finding a supportive midwife that would be nigh to impossible. I feel that for a baby able to breathe and suck on its own, a hospital NICU can be a very hostile environment.
I agree, a drip, tube and incubator, all standard practice for a 33 week baby is horrible. Pain and the constant stimulation of the gag reflex causes more stress than anything, plus the attitude that you shouldn’t “over handle” a baby but he should sit in a plastic box all alone. These acts are inhumane on so many levels.
All that said, hospitals are fantastic if there is a problem nd in this day and age we are lucky to be able to access acute care if required. We would at a heart beat have taken this baby for medicalised care if we needed to.
I needed a brush up on the research of KC, thanks Lisa. I am currently pregnant with my 10th no.5 miscarried. My first was a planned homebirth but when she was born at 32 weeks the midwife told us to go to hospital. I wish I haden’t…I had even read Dr Odents books and was aware of some of what you just posted. That was my only hospital birth. My great-grandmother used to say to people when they questioned her four homebirths (in the UK) “why would I want to go there (hospital) they’ll just make me sick”, wish I could have met her she sounds awesome. Anyway, I post this comment as an encouragement. Our first three were premmie (32w, 36w, 35w) the 2nd and 3rd being born unassisted at home. The second came quickly after three weeks of spiritus labor…took 5 mins after waking up with membranes ruptured. I had always read heaps even with my first (I was 19 yo and my husband 24) so we just figured with the third that unless something wasn’t “quite right” we could “do this.” Then all my babies had been full-term until the last one who was born while we were on holiday (in the holiday appts…that’s what the birth certificate says…Centerpoint Holiday Appartments.) at Caloundra, Queensland at 34 weeks. I felt like I needed to go to hospital so we called the Ambos but he’d been born by the time they arrived. They then took us to Nambor b/c he was so small (we said no but they then asked my mum who said he looked underdone, thanks mum.) Nambor, after much explaining on our part and them trusting because we had so many children, the first three prem, that we could take him that day (against hosp protocol) as long as we came back if anything changed. No worries we said. So yes (as you know) prems can do much better generally with KC and most likely a home environment. I have to say I love your site. I’m sure we’d disagree on spiritual matters, but I have to say I love your spunk…can I say that?? Keep up the good fight.
I’ve been a nurse for about five years and have worked in 2 different NICUs for approximately two of those five years. I must say that although I find a lot of your work very touching and wonderful, I also feel you’ve overly portrayed hospitals and hospital staff as terrible places, with non-caring workers. While this is sometimes true, one cannot generalize that all are that way. One thing that I can certainly attest to is that we’ve saved the lives of countless babies. Something that stuck out to me was when you implied that all 33 weekers in NICU get a “drip, tube and incubator ” This is simply not true. We’ve had countless 33 weekers that do well and don’t need any of this. We’ve also had countless 33 weekers that do need all of this. I’ve seen 24 weekers do kangaroo care, and also never get a single dose of Lasix in their entire NICU stay. I’ve also seen countless term babies with anoxic brain injuries, pneumonia, severe hypoglycemia, and congenital birth defects, all unexpected but lucky enough to be able to be immediately treated in the NICU. We’ve seen over and over how much time can influence the outcome of the baby. Although we often expect and want the birthing process to go smoothly and without problems, I am reminded everyday why I will be having my own children in a hospital. I’ve seen the worst of the worst, when all was supposed to fine. I encourage you to shed light on the goodness that many nurses and doctors do on a daily basis.
My son’s birth was a planned homebirth. We transferred to hospital because his heart rate was dropping while I was pushing. He was born via vacuum assistance at the hospital. Apgar at 1 min was 5 and at 5 mins was 8. He was full term seemed well initially, but he is in the category that Kathleen mentioned where the unexpected happens. *Something* happened to him while he was in utero and he suffered a brain injury as a result (Hypoxic-Ischaemic Encephalopathy). He was also severely hypoglycaemic. Honestly, I am not over the fact that I didn’t get the birth that I wanted and I still hope that I will get my homebirth next time, but I do know that if my son was born at home, he would probably be dead now. As a result of his brain injury he started having seizures at about 5 hours old, and needed to be resuscitated several times before being ventilated, and he required every bit of intervention he received in the NICU. I don’t think I will ever get over the injustice I feel at things not being how they were *supposed* to be, but will remain eternally grateful for the modern medicine that was available when we needed it. I would like to say though, that my homebirth midwife was my number one BEST support person throughout our entire ordeal, despite the fact that we didn’t end up birthing at home and despite the fact that my son was hospitalised for 12 days after his birth. He is now 9.5 months old, and is not without challenges but is doing extremely well and we are still in contact with our homebirth midwife.
Thank you for sharing this with us. However 60 lb of pressure to suck your baby out of your uterus often causes a low Apgar. We have lots of evidence that this procedure causes many problems in the baby both short and long term. also with the suction and stress on the baby the brown fat is used up at the birth and the drop in blood sugar is caused simply by the stress.
I do understand that some babies are better off being born at the hospital as a section can be life saving and thank god we have the skill. However the interventions used often cause as many problems as they solve.
Eg. baby with apgar of 1 had cord cut, when we know that leaving the cord intact will keep stimulating the heart, baby is removed to resus machine. We know that when baby isn’t put on the chest the oxytocin receptors for the mother do not work as efficiently so the woman is more likely to bleed. etc etc.
We all need to go back to the start and see what is physiologically normal and THEN work out how we can really help.
Karissa – If you ever see this (and I hope that you will), please email me at: olivia_j_greenham@hotmail.com . I also have a baby with HIE (III, for what it’s worth) and I am always interested in other HIE babies. My LO’s apgars were 2 and 7, born blue with the cord wrapped around his neck. He had seizures starting at 36 hours old, and apneic episodes prior to that…long story short, although we prepared to say goodbye at 5 days old, he is 10 months old now and has global developmental delay and all that goes along with that. He is a very happy baby and is on the side of “doing very well” compared to his initial diagnosis. I’d love to hear how your baby is doing….again, I hope that you see this some day.
I am intrigued by the very preterm birth at home. KC and some EBM is all that was needed for this baby? How is s/he now? How many preterm babies have you delivered at home and how many were totally fine with just KC? How many transferred to NICU? What is your cutoff gestation for delivery at home? Is there evidence or research to support this practice?
I am asking because I really seek to understand and expand my knowledge base as I work with preterm births myself.
Thanks, Cara
My last baby was born at 33 weeks gest (pprom @32 weeks), as gorgeous as homebirth is I for one am grateful I was in hospital on bed rest for the week as I ended up with Chorioamnionitis, putting both myself and bub in harms way, after a horrible attempt at an induction I was taken for an e/c-section.. My little one was in hospital for 4 weeks, spent less then a week in a “plastic box” the rest of the time was in an open cot…. She is now a healthy almost 11 month cheeky baby….
Hospital is a great place if you need it. I am sure that sitting in a hospital for a week would give you an infection for sure, and a horrible induction and c section on a 33 weeker isn’t ideal. You always have to weigh up the pro’s and cons.
Nice post. Have you seen the video about the mother who brought her premature child back to life. Doctors tried to revive him for some time but finally he was pronounced dead, and given back to his mother. Once in her arms he “came back to life” over time. A mothers touch is more powerful than modern medicine.
http://www.youtube.com/watch?v=hMAzOjExKMw
I Love what you are doing , by the way ,am a Medical student, Keep it going on
I know each birth, woman and baby are unique but what would be a cut off date that you would advise a woman to go to a hospital since kangaroo care has shown effective is babies born up to ten week early? Before 32 weeks? Before 30 weeks?
I suggest a woman attends the hospital any time she is unhappy or wants advice. Lots of clients attend hospital appointments even when deciding if and when they are birthing at home