Piel a piel es cuando el bebé se coloca inmediatamente sobre el abdomen desnudo de su madre y permanece allí sin interrupción durante al menos una o dos horas o hasta el final de la primera sesión de amamantamiento. Esto debería suceder con todos los bebés, nacidos por vía vaginal o por cesárea. Tiene un impacto positivo en los parámetros fisiológicos y psicosociales en la madre y en el bebé, facilitando la expresión del comportamiento previo a la alimentación, al amamantamiento y el vínculo.
Iniciativa Hospitales Amigos de la Niñez (IHAN) de la Organización Mundial de la Salud/UNICEF
- Paso 4: Facilitar el contacto piel a piel inmediato e ininterrumpido y ayudar a las madres a iniciar la lactancia lo antes posible después del nacimiento.
- Paso 7: Permitir que las madres y sus bebés permanezcan juntos y practiquen el alojamiento conjunto las 24 horas del día.
El contacto piel a piel debe practicarse en condiciones seguras para garantizar el bienestar del bebé durante estas horas críticas de la vida.
Condiciones seguras en la clínica, hospital o maternidad
Así como la enfermera supervisaba al recién nacido en la sala de recién nacidos ahora debe hacerlo mientras el recién nacido está sobre la madre en la sala de partos o en el quirófano. La observación se realiza para la madre y el bebé juntos en lugar de hacerlo por separado. Los profesionales de la salud son responsables de comprobar que el recién nacido respire adecuadamente, que la coloración sobre su piel sea adecuada y que pueda mover libremente la cabeza y el pecho.
Inmediatamente después del nacimiento
- Quitar la bata para tener el mayor espacio posible para que el bebé expanda su cuerpo sobre el pecho de mamá.
- Colocar inmediatamente el bebé desnudo sobre el pecho desnudo de mamá, sin secarlo, ya que esta es la transición más segura desde el útero. Esto facilita la armonia fisiológica en la transición ex útero, mantiene la energía del bebé y reduce su estrés al nacer.
- El bebé se coloca verticalmente en medio de los senos de la madre (después del parto vaginal) u horizontalmente sobre los senos de la madre (en la cesárea). Asegurar de que la mayor parte del cuerpo del bebé esté en contacto con el pecho de la madre. Esto ayuda a las hormonas a activarse, evita la presión sobre el pecho y facilita la respiración.
- Evitar la posición lateral, ya que impide una respiración óptima.
- Asegurar de que el recién nacido pueda respirar fácilmente por la nariz y la boca y que sus secreciones se muevan libremente sin aspirar las vías respiratorias.
- Asegurar que el bebé pueda levantar fácilmente la cabeza y el pecho por sí mismo en todo momento.
- Secar completamente la espalda y la cabeza del bebé.
- Todas las mantas mojadas se quitan y se reemplazan por una sola manta tibia y seca para evitar el sobrecalentamiento de la díada madre/bebé y para minimizar la evaporación de la piel del bebé. También se puede colocar un gorro al bebé y así no cubrirle la cabeza con la sábana.
- Dejar el cordón umbilical largo para que las pinzas no queden entre la madre y el bebé.
- Si es cesárea, la pareja coloca la mano directamente en el trasero del bebé o sujeta firmemente su muslo para evitar que se resbale.
- La mamá y su pareja observan a su bebé: respiración, coloración de la piel, respuesta a la estimulación.
- Para una mejor transición del bebé ex útero, suavizar las luces y mantener los ruidos al mínimo.
Seguridad del contacto piel a piel después del periodo del nacimiento
- Superficie para dormir o descansar: sin colchón blando; sin cama de agua; sin sofá o silla de descanso a menos que esté completamente despierto
- La superficie de descanso/sueño de mamá/papá debe elevarse entre 30 y 45 grados.
- Quitar la ropa de cama suave alrededor del bebé: almohadas; cojines, barandillas, que no haya espacio cerca la pared
- Es de riesgo si la mamá o su pareja tienen obesidad; si los senos de la madre son muy grandes; fumar incluso si no está en presencia del bebé; uso de drogas o medicamentos; mamá/pareja muy cansada que corre el riesgo de falta de vigilancia.
- Quien sostiene al bebé está despierto.
- No envolver al bebé (swaddling).
- Tomar siestas durante el día para no estar demasiado cansada durante la noche.
Piel a piel entre madre y bebé en la cesárea
Efectos fisiológicos
- La temperatura del bebé: siempre óptima, muy diferente a si el bebé está envuelto, si está debajo del calentador o en pijama en una cuna.
- La temperatura de la madre: siempre en reciprocidad con la temperatura del bebé.
- Bebé hipotérmico: piel a piel con la madre calienta al bebé mejor que el calentador o isolette
- Los pies del bebé están más cálidos, estadísticamente significativo; una indicación de la reducción del estrés de nacer
- Mejor oxigenación durante los primeros 90 minutos de vida
- Glucemia del bebé óptima
- Expulsión placentaria rápida
- Organización neuromotora: los bebés son más estables
- Analgésico: reducción del dolor durante procedimientos dolorosos, por ejemplo, inyección de vitamina K
Efectos psicosociales
- El bebé llora menos: durante los primeros 90 minutos de vida y durante los primeros 3 días y los primeros 3 meses
- Interacción temprana: más posiciones de frente, más contactos visuales, más comunicaciones verbales maternas; los recién nacidos están más tranquilos y más alertas después del primer llanto y vocalizan más
- Comportamientos afectivos maternos: observados con mayor frecuencia; las madres sostienen a su bebé más cerca, son más suaves en sus intentos de agarrar y sostener a sus bebés, hablan en voz suave y responden más a las señales de su bebé
- Facilita el bienestar materno; el nivel de gastrina es menor, el nivel de oxitocina mayor
- Apego: se observa fácilmente, probablemente después de la activación repetida de oxitocina y
opioides - Reducción significativa de negligencia de los padres en poblaciones vulnerables; menos abandono infantil
- Estado de ánimo de la madre: mejor en los días 3 y 4 que en las madres que no experimentaron piel con piel inmediata e ininterrumpida al nacer
- Al año de edad, más interacción madre-hijo; mayor sensibilidad materna hacia su hijo; el niño se autorregula más fácilmente
- Mayor satisfacción materna
Efectos sobre la lactancia materna
- Comportamientos previos a la alimentación: se facilita la secuencia innata del recién nacido
- Inicio del amamantamiento: la lengua se coloca espontáneamente cuando abre la boca
- Masaje de los senos con la barbilla o los puños del bebé: aumenta el nivel de oxitocina y la cantidad de
succión al seno - Olores de los senos: reconocimiento temprano del olor materno por parte de los bebés
- Mejor succión: después de una hora de contacto piel a piel inmediato e ininterrumpido; menos congestión mamaria.
- Producción de leche adecuada en el día 3, cuando la primera toma ocurre durante las primeras 2 horas después del nacimiento.
- Pérdida de peso del bebé: menos en comparación con los bebés envueltos; El peso al nacer se recupera en 3 a 5 días.
- Exclusividad de la lactancia materna: vínculo significativo entre la duración del contacto piel con piel y lactancia materna exclusiva al alta
- Duración de la lactancia materna: demostrada estadísticamente hasta los 6 meses, posiblemente relacionada con un mejor comienzo.
Los bebés que han sido separados de sus madres al nacer y luego reunidos 2 horas después se comportan como si todavía estuvieran en la sala con las enfermeras. Las evidencias muestran un período sensible dentro de las primeras 2 horas después del nacimiento; La separación inicial seguida de la reunión después de 2 horas no compensa la falta de contacto piel con piel inmediato al nacer.
Cuando las madres permiten que sus bebés vayan a la sala de cuidados infantiles, ellas entendieron que esa era la norma, al parecer debido a que el personal hospitalario sugirió que no era importante que mamá y bebé permanecieran juntos. En cambio cuando la madre comparte la habitación con el bebé y es asistida por el personal de salud, se encontró una diferencia significativa en el éxito de la lactancia.
La separación de la madre y el bebé
- Aumenta la depresión posparto
- La madre muestra menos respuesta a las necesidades del bebé
- Aumenta el abandono del bebé
- El efecto negativo de dos horas de separación seguido al nacimiento no se compensa con practicar el alojamiento conjunto dos horas después
- El bebé ingiere menos leche materna y más fórmula artificial
- El bebé pierde más peso
El cuidado canguro y el piel a piel
Forma natural de cuidar bebés en el que bebé se coloca piel con piel contra el pecho de la madre (o del padre) debajo de la ropa o una manta. Si el bebé es prematuro se llama canguro porque se practica mas allá de las primeras dos horas, si el bebé está ingresado lejos de mamá, preguntar a los médicos y al personal de enfermería cuando puede abrazar su bebé.
Ayuda a regular
- el ritmo cardíaco
- la frecuencia respiratoria
- la temperatura
- el estrés
- los niveles de saturación de oxígeno
Promueve
- nutrición óptima
- protección de infecciones
- estimulación de los 5 sentidos
- en la transición a la lactancia: mientras está siendo abrazado, el bebé puede intentar acariciar, lamer o mamar
Cargar al bebé
la mayoría de los bebés necesitan estar pegaditos a su madre y otras personas de confianza por diversas razones: calor, seguridad, amor. Le podrían decirle que no lo acostumbre a los brazos, pero es totalmente ilógico ya que el bebé al nacer tiene 40 semanas cargadito en el vientre de su mamá. Los primeros 3 meses se les llama el cuarto trimestre o periodo de exterogestación. Estos tres meses todavía el bebé es inmaduro y sostenerlo en brazos es imprescindible para su desarrollo.
Envolver al bebé (Swaddling)
Envolver al bebé es usado por algunos para lograr que el bebé duerma más tiempo, pero estudios han encontrado que esta práctica tiene efectos negativos en cuanto al peso ganado al comparar estos bebés con los que están con sus madres en vez de envueltos. Y es que la madre de un bebé envuelto no puede seguir las señales de hambre que muestra el bebé. Esto causa que a la madre se le llenen demasiado los senos y que la producción de leche disminuya.
Aunque esta técnica favorece la continuidad del sueño, se asocia con mayor respuesta al estrés ambiental auditivo y la circulación del bebé también se puede ver afectada. Su temperatura se afecta también.
Se ha relacionado envolver al bebé con tasas elevadas de neumonía, especialmente durante el período neonatal.
Un estudio en ratas neonatales encontró un aumento en la prevalencia de displasia congénita de cadera.
Si la han separado de su bebé y se lo traen envuelto, póngalo piel a piel contra su cuerpo y ahí todo el mundo del bebé cambia a un mundo amigable para el, con el cuerpo de su madre contra el suyo en “su” mundo. Un cuerpo suave, calientito, con los sonidos ya conocidos de su corazón y de su voz, su piel, su olor, sus ojos amorosos, su leche.
El swaddling o envolver al bebé restringe sus movimientos y le dificulta ser parte activa del proceso, toma menos leche en 24 horas, no puede proteger su vía aérea ni mover su cabeza para protegerse; solo en Estados Unidos se reportaron 17 muertes causadas por el swaddling entre el 2004 y 2011 (Consumer Product Safety Commission).
Referencias sobre alojamiento conjunto
En inglés
Academy of Breastfeeding Medicine Clinical Protocol Committee. ABM Clinical Protocol #2 (2007 revision): guidelines for hospital discharge of the breastfeeding term newborn and mother: «the going home protocol» Breastfeed Med. 2007 Sep;2(3):158-65
So Yoon Ahn, M.D., Sun Young Ko, M.D., Kyung Ah Kim, M.D., Yeon Kyung Lee, M.D. and Son Moon Shin, M.D. The effect of rooming-in care on the emotional stability of newborn infants Korean Journal of Pediatrics Vol. 51, No. 12, 2008
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Bystrova K, Widström AM, Matthiesen AS, Ransjö-Arvidson AB, Welles-Nyström B, Vorontsov I, Uvnäs-Moberg K. Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg. Int Breastfeed J. 2007 May 8;2:9.
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Referencias en inglés sobre el apego
5 Reasons Attachment Theory is Important for Professionals and Parents. «I Matter» Project
Behrens KY, Hesse E, Main M. Mothers’ attachment status as determined by the Adult Attachment Interview predicts their 6-year-olds’ reunion responses: a study conducted in Japan. Dev Psychol. 2007 Nov;43(6):1553-67.
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Resource Library Attachment Treatment and Training Institute, PLLC
Sitios en internet
Portal de Formación en Método Madre Canguro
Referencias sobre método canguro y piel con piel
Bebés canguro. Nathalie Charpak, 2010
El Método Canguro no es solo para prematuros. El parto es nuestro.
Estudios y articulos científicos en castellano. El parto es nuestro.
Gómez Papí A: El poder de las caricias Video Liga de la Leche Euskadi, 8 octubre 2011
Gómez Papí A, Pallás CR, Aguayo J. El método de la madre canguro. Unidad Neonatal. Hospital Universitario Tarragona “Joan XXIII”.
Gómez Papí A, Pallás CR, Aguayo J. El método de la madre canguro. Acta Pediatr Esp. 2007; 65: 286-291
Método madre canguro, guía práctica, OMS. 2004
Mi mamá es un canguro , José Benlliure y Susana Ramirez
Organización Panamericana de la Salud. Más allá de la supervivencia: Prácticas integrales durante la atención del parto , beneficiosas para la nutrición y la salud de madres y niños. Washington, D.C.: OPS ©2007
En inglés
Sitios en internet
Libros
Dr. Adolfo Gómez Papí: El poder de las caricias. Liga de la Leche Euskadi
Jill Bergman, Nils Bergman, Hold Your Prem
Susan Ludington-Hoe, Kangaroo Care: The Best You Can Do to Help Your Preterm Infant
Otras referencias piel con piel y cuidado canguro
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VIDEOS:
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- Skin_to_Skin Angus L. Macdonald Library
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