Document Type : Original Article

Authors

1 MSc of Midwifery, Department of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat‑e Heydariyeh

2 MSc of Midwifery, Department of Midwifery, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran

Abstract

BACKGROUND: Early skin‑to‑skin maternal–neonate contact during the 1st h following birth prepares
both mother and baby to establish a two‑way, interactive pattern of interaction. There are few studies
on the use of kangaroo care method in term infants and maternal postpartum behavior.
OBJECTIVE: The present study aimed to compare abdominal and kangaroo skin contact on maternal
attachment behaviors.
SETTINGS AND DESIGN: This single‑blind randomized clinical trial was performed on 68 eligible
pregnant women in Torbat Heydariyeh in 2015.
MATERIALS AND METHODS: Individuals were randomly divided into experimental groups
(kangaroo skin contact) and control group (abdominal skin contact). Maternal attachment behaviors
were observed for 15 min during 1 h postpartum. Each minute was divided into two 30 s, during
the first and second 30 s of which the maternal behavior was observed and recorded using a
checklist of behavior. Attachment behaviors were assessed using an attachment behavior checklist
(including three types of emotional, proximity‑seeking, and caring behaviors).
STATISTICAL ANALYSIS USED: After data coding, the analysis was performed using Kruskal–Wallis
test, Chi‑square test, t‑test, and Mann–Whitney test in SPSS ver. 14. P < 0.05 was considered the
significant level.
RESULTS: Among emotional, proximity‑seeking, and caring behaviors 1 h and 2 months’
postpartum in the two groups, only proximity‑seeking behaviors were significantly different 2 months’
postpartum (P = 0.033). The attachment behavior of 1 h (0.134) and 2 months’ postpartum (0.051)
did not differ significantly between the two groups.
CONCLUSIONS: Kangaroo skin contact has an effect, similar to the abdominal skin contact, on the
maternal attachment behaviors and has a positive effect on proximity‑seeking behaviors and some
components of emotional behaviors compared to abdominal skin contact.

Keywords

1. Alaei F, SHahabi M, Mohammadi R, Majd A. Evaluation of the
maternal attachment behaviors in the first encounter with the
infant in a hospital affiliated to Shahid Beheshti University of
Medical Sciences and Health Services. J Fac Nurs Midwifery
Shahid Beheshti 2006;15:31‑39.
2. Nemat Bakhsh F, Kordi M, Sahebi A. The effect of skin contact
between mother and baby on maternal attachment. J Mental
Health 2009;8:25‑32.
3. Ludington‑Hoe SM, Anderson GC, Simpson S, Hollingsead A,
ArgoteLA, Rey H, et al. Birth‑related fatigue in 34‑36‑week preterm
neonates: Rapid recovery with very early kangaroo (skin‑to‑skin)
care. J Obstet Gynecol Neonatal Nurs 1999;28:94‑103.
4. Anderson GC, Moore E, Hepworth J, Bergman N. Early
skin‑to‑skin contact for mothers and their healthy newborn
infants. Cochrane Database Syst Rev 2003;30:206‑207CD003519.
5. Vakelian K. Effects of kangaroo care immediately after birth on
attachment behavior of a mother one and three months after birth.
J Nurs Res 2010;4:7‑14.
6. Mellien AC. Incubators versus mothers’ arms: Body temperature
conservation in very‑low‑birth‑weight premature infants. J Obstet
Gynecol Neonatal Nurs 2001;30:157‑64.
7. Bohnhorst B, Heyne T, Peter CS, Poets CF. Skin‑to‑skin (kangaroo)
care, respiratory control, and thermoregulation. J Pediatr
2001;138:193‑7.
8. Carfoot S, Williamson P, Dickson R. A randomised controlled trial
in the North of England examining the effects of skin‑to‑skin care
on breast feeding. Midwifery 2005;21:71‑9.
9. Hatami A, Talebi Touti Z. Patterns of breastfeeding in infants.
Hayat J 2007;13:71‑6.
10. Kareme A, Tara F, KHadeivzadeh T, Agha Mohamadean SH. The
effect of skin contact between mother and infant immediately after
delivery on maternal attachment and anxiety related to baby. Iran
J Obstet Gynecol Infertil 2012;16:7‑15.
11. Nahedi F, Tavafean F, Hedarzadeh M, Haje Zadeh E. Midwives
comments regarding the mother and baby skin to skin contact
immediately after birth. J Med Counc Islam Repub Iran
2014;31:124‑30.
12. Jefferies AL; Canadian Paediatric Society, Fetus and Newborn
Committee. Kangaroo care for the preterm infant and family.
Paediatr Child Health 2012;17:141‑6.
13. Arivabene JC, Tyrrell MA. Kangaroo mother method: Mothers’
experiences and contributions to nursing. Rev Lat Am
Enfermagem 2010;18:262‑8.
14. Curry MA. Maternal attachment behavior and the mother’s
self‑concept: The effect of early skin‑to‑skin contact. Nurs Res
1982;31:73‑8.
15. Svensson KE, Velandia MI, Matthiesen AS, Welles‑Nyström BL,
Widström AM. Effects of mother‑infant skin‑to‑skin contact on
severe latch‑on problems in older infants: A randomized trial. Int
Breastfeed J 2013;8:1.
16. Forster DA, McLachlan HL. Breastfeeding initiation and birth
setting practices: A review of the literature. J Midwifery Womens
Health 2007;52:273‑80.
17. Venancio SI, de Almeida H. Kangaroo‑Mother Care: Scientific
evidence and impact on breastfeeding. J Pediatr (Rio J) 2004;
80:173‑80.
18. Feldman R, Eidelman AI. Skin‑to‑skin contact (Kangaroo care)
accelerates autonomic and neurobehavioural maturation in
preterm infants. Dev Med Child Neurol 2003;45:274‑81.
19. Charpak N, Ruiz JG, Zupan J, Cattaneo A, Figueroa Z, Tessier R,
et al. Kangaroo mother care: 25 years after. Acta Paediatr
2005;94:514‑22.
20. Keshavarz M, Noroze F, Seed Fatemi N, Haghghani H. Effect
of Skin to Skin Contact on Maternal State Anxiety in a Cesarean
Section Ward . 2011;5:2‑6.
21. Messmer PR, Rodriguez S, Adams J, Wells‑Gentry J, Washburn K,
Zabaleta I, et al. Effect of kangaroo care on sleep time for neonates.
Pediatr Nurs 1997;23:408‑14.