Carmela Torres was 18 when she became pregnant for the first time. It was 1987 and she and her now-husband, Pablo Hernandez, were two idealistic young Colombians born in the coastal region of Montería who moved to the capital, Bogotá, in search of freedom and a better life. When Torres told her father she was expecting, so angered was he by the thought of his daughter having a child out of wedlock that they didn’t speak to each other for years.
Torres remained undaunted. Her pregnancy was trouble-free and she had a new life in Bogotá to get on with. But one December afternoon, suddenly, out of nowhere, her body began to convulse with sharp contractions. It was more than two months before her due date. She called Hernandez and together they rushed to the Instituto Materno Infantil (Mother and Child Hospital) in eastern Bogotá. Not long after arriving she gave birth naturally to a baby boy weighing just 1,650 grams (3 lb 10 oz).
Before she had a chance to hold him, her baby was whisked off to a neonatal intensive care unit. Torres was simply told to get dressed and go home. “I didn’t even get to touch him,” she says. “They said I could come back and see him but the visiting times were very restricted – just a couple of hours a day. When I did visit I was allowed to look but not touch.”
On the third day she was at home preparing for her next visit when the phone rang. “It was the hospital,” she says. “They called to say my baby was dead. They didn’t tell me the cause of death or give me any diagnosis. Just that he was dead. I hadn’t even named him yet.”
Torres was traumatised. She became gripped with an acute feeling of isolation and started spiralling into depression. She knew she needed to do something to pull herself back so she enrolled on a teacher-training programme and immersed herself in her studies. “It gave me something to focus on,” she says. “It saved me.”
A decade passed before Torres was ready to become pregnant again. This time round it was different. By now she was married to Hernandez and well settled in Bogotá. Her father had even started talking to her again. She was so excited about giving birth that, a couple of months before her due date, she decided to throw a big baby shower. But on the day of the party, familiar, severe contractions ripped through her body, stopping her in her tracks. She smiled, told no one and pretended it wasn’t happening. By evening, once all the guests were gone, she could hide it no longer. She told Hernandez who again rushed her straight to the Instituto Materno Infantil.
“When we got there the doctor was furious with me for not coming earlier. He said I was ready to give birth,” says Torres. “I was petrified, I didn’t want another premature baby. I was taken to the exact same ward as where I had my baby which died. Memories came flooding back. I was extremely stressed.”
At one o’clock the next morning Torres gave birth to another boy. She named him immediately, calling him Julian. He weighed almost the same as her firstborn and just like then, he was whisked straight into intensive care. History, it seemed, was repeating itself.
“I spent a very frightening night panicking that I was about to lose another baby,” she says. “But the next morning a doctor came to see me. She told me about a thing called Kangaroo Mother Care – how I could act as a human incubator and carry my own baby and take it home with me. It was a ray of light at the end of the tunnel. Anything rather than leave my baby there.”
That day Torres was taught how to hold her baby under her clothing, upright between her breasts with his airways clear. She was taught how even the finest layer of fabric between her and her baby wasn’t allowed – it had to be continuous and direct skin-to-skin contact. She was taught how to breastfeed, how to sleep on her back propped up by cushions, and strictly never to bathe him as this would waste his precious energy. Remarkably, the very next afternoon, with her tiny baby strapped to her chest under a blanket, Torres walked out of hospital.
“Julian was very small and fragile but I was much happier taking him home with me than leaving him there, where my other baby had died,” she says. “Feeding him wasn’t easy, but I had a lot of help. At first I had to go back every day for follow-up appointments and I was given a cellphone number that I could call any time I needed. We had to go back in when Julian got an infection on his umbilical cord and for phototherapy when he got jaundice, but in all I carried him for a month 24 hours a day, sharing shifts with my husband, until he hit his target weight of 2,500 g. Once he’d reached that we didn’t have to do it any more and finally he got his first bath.”
Learning from kangaroos
Kangaroo Mother Care is the brainchild of Colombian paediatrician Edgar Rey, who introduced it to the Instituto Materno Infantil in 1978. It was an idea born out of desperation. The institute served the city’s poorest – those who lived crammed in the rickety makeshift dwellings in the foothills of the surrounding mountains. At the time this was the biggest neonatal unit in all of Colombia, responsible for delivering 30,000 babies a year. Overcrowding was so bad that three babies would have to share an incubator at a time and the rate of cross-infection was high. Death rates were spiralling and so too was the level of abandonment as young, impoverished mothers, who never even got to touch their babies, found it easier just to take off.
Scouting around for a solution to these problems, Rey happened upon a paper on the physiology of the kangaroo. It mentioned how at birth kangaroos are bald and roughly the size of a peanut – very immature, just like a human pre-term baby. Once in its mother’s pouch the kangaroo receives thermal regulation from the direct skin-to-skin contact afforded by its lack of hair. It then latches onto its mother’s nipple, where it remains until it has grown to roughly a quarter of its mother’s weight, when finally it is ready to emerge into the world.
This struck a chord with Rey. He went back to the institute and decided to test it out. He trained mothers of premature babies to carry them just as kangaroos do. Working alongside his colleague Hector Martinez, he taught them the importance of breastfeeding and discharged them just as soon as their babies were able. The results were remarkable. Death rates and infection levels dropped immediately. Overcrowding was reduced because hospital stays were much shorter, incubators were freed up, and the number of abandoned babies fell.