Sensitive Midwifery - Issue 43 - July2019

Mom & Baby Benefits to the mother: • Increased sense of bonding with her infant • Increased confidence in caring for her infant • Continuation of her interrupted nurturing role as a mother and the empowerment to become the primary caregiver again KMC’s South African story The first KMC unit in South Africa was opened in 1997 at Grootte Schuur Hospital, Cape Town after a clinical trial conducted in 1996 convinced the hospital management of the advantage of opening such a unit. Kalafong Hospital, a Pretoria provincial tertiary teaching hospital serving a mainly black urban indigent population, is now synonymous with KMC in South Africa. It is a referral hospital and manages high-risk pregnancies, and a large number of high-risk preterm and LBW infants are delivered annually. In the late 1990s, due to limited number of step-down beds, increased numbers of high-risk preterm and LBW infants, outbreaks of severe nosocomial infections in the HCU and the general lack of resources and equipment, it became necessary to consider an alternative method of caring for the infants at Kalafong Hospital. Much research on the best way to implement KMC was done with the assistance of the Medical Research unit situated at Kalafong Hospital under the guidance of Professor Bob Pattinson. KMC requires a paradigm shift from conventional nursing practices of washing, cleaning and feeding to a supportive role where the mother is assisted and supported to become the primary caregiver of her infant. The campaign for KMC implementation and establishment of a unit at Kalafong Hospital was launched in January 1999. After role-players (hospital management, medical, nursing, general administrative and supportive staff) attended a general information session about KMC and its benefits, everyone was enthusiastic about the change. A multidisciplinary KMC implementation workgroup was established. Needs and resources for a KMC unit were identified and hospital managers gave their full co-operation in providing facilities for the establishment of a unit. The hospital managers allocated ward space in a ward that also housed the existing low-care step- down unit for stable preterm infants. The existing nursing staff took over the responsibility for the running of the KMC unit. The rollout of KMC at Kalafong The ward space that was allocated used to be a paediatric ward and the bathroom facility was not adequate for a large number of mothers. Still, while waiting for the structural changes that were necessary to practise KMC, the implementation process continued with educational and information sessions about KMC and its benefits. Successful implementation could not take place before all the medical and nursing staff involved had received a thorough grounding in the new intervention. The nursing management’s full commitment to the cause and support of the nursing staff was also of vital importance. The implementation process was open and transparent, which enabled the nursing staff to take part in the decision- making process and take ownership of the KMC concept. A philosophy was developed, noting that: • KMC should be conducted in a caring environment • The staff of the unit should be empowered by continual education and skills development to help mothers become the primary caregivers of their infants • The rights of the mothers, which include respect, honesty, openness, transparency and informed decisions, should be considered at all times and be an essential part of the patient care in the unit After opening the unit on 6 July 1999, formal written guidelines and policies were developed by consensus for each role-player to enable a uniformity of care in the unit. These policies ensured consistent, standardised methods of assessment, progression of care, and management of the unit so that the full benefit of KMC could be experienced. Since the implementation of KMC at Kalafong Hospital, the flow of patients between the High Care (HCU) and KMC units improved. This relieved the pressure for beds in the HCU, allowing for more infants to be accommodated in the HCU since 1999. Continued on page 20 The KMC ward at Kalafong Hospital 19 eSensitive Midwifery Magazine Issue 43