The impact of Kangaroo Care on Psychological Bonding, Placental Separation, and Maternal Anxiety among primiparas women

Background: Providing maternal affection with kangaroo mother care (KMC) is an efficient method. After birth and when the mother is just starting to nurse, this is a common practise. Women who give birth vaginally or via caesarean section can benefit from this easy technique . Aim : Assess the impact of kangaroo care on psychological bonding, placental separation, and maternal anxiety among primiparas women. Design: A quasi-experimental research design. Setting: It was conducted at normal labor units, obstetrics and Gynecology department, Kafrelsheikh general hospital. Subjects: The subjects of this study included 100 mothers divided into a study group (50) & control group (50). Tools: Five tools were used to collect data for this study, Tool I: Structured interviewing questionnaire. Tool II: LATCH breastfeeding assessment tool. Tool III : Apgar score. Tool IV: Maternal -to-Infant Bonding Scale. Tool V: Postpartum Specific Anxiety Scale-Research Short-Form Item (PSAS-RSF). Results: There is a high statistically significant difference regarding the duration of the third stage of labor between the study & control groups at p= .000*. There was a statistically negative correlation between Mothers’ bonding to Infants and mothers’ level of Postpartum Anxiety at p= .000*. Conclusion: Kangaroo care proved benefits for mother and babies, represented in increased level of psychological bonding between mothers and their babies, early successful breastfeeding initiation, easily placental separation, and decreased level of maternal anxiety among primiparas women. Recommendations: Dissemination of the KMC applications in all hospitals and raising awareness about KMC between the nurses and physicians.

this method because it is "an effective and simple strategy for promoting health and well-being" (Moore et al., 2016). KMC includes "early, constant, and prolonged skin-to-skin touching base between mother and baby," exclusive nursing (ideally), and rapid hospital release.
Birth is a vulnerable and monumental event for mothers and their families; it can be a period of excessive joy and keenness, or it can be fraught with anxiety, pain, and even tragedy. It's also a delicate time because that's when healthy breastfeeding habits should be established. Several As soon as the mother lays eyes on her newborn, they engage in a natural interaction pattern that lays the groundwork for secure attachment, rapid nursing, and confident mothering. Increased levels of oxytocin, endorphins, and other bonding chemicals are produced when breastfeeding with skin-to-skin contact (Tahir, 2021). The contraction of the uterus and the subsequent delivery of the placenta are aided by the elevated amounts of oxytocin produced by the mother. Therefore, oxytocin prevents bleeding and develops the strong bond that assures a mother's care and safety with the other hormones, allowing the newborn to live (Mehrpisheh, 2022).

Significance of the study:
There are 5 million neonatal deaths annually There are various benefits for both the mother and the newborn suggested by the evidence for  Mcdonald (2007); that incorporates information on gestational age, duration of third stage of labour, uterine position, and uterine atony. Beginning with the birth of the neonate, the duration of measurement includes the placenta, umbilical cord, and membranes.

Scoring system:
When the duration of placental separation was less than 5 minutes, the score was 1, between 5 and 10 minutes, the score was 2, and between 11 and 15 minutes, the score was 3. The higher the score, the longer the placental separation from the uterus. The letters in the acronym LATCH stand for five distinct assessment parameters: "L" for how well the infant latches onto the breast, "A" for the audible swallowing amount, "T" for the mother's nipple types, "C" for the comfort level of mothers, and "H" for the support given to the mother to breastfeed her infant.

Scoring system:
Each parameter is assigned a numerical value of 0, 1, or 2. The total score goes from 0 to 10, with higher scores indicating more effective nursing approaches. A total score of greater than 7 indicates successful breastfeeding, whereas less than 7 indicates failed breastfeeding. Appearance (

Tool v: Postpartum Specific Anxiety Scale-Research Short-Form Item (PSAS-RSF):
The PSAS-RSF is the first brief research tool Very Often, 3= Often, 4= Almost Always.

Tools validity
The tools sheets were reviewed and validated by a Jury committee of 5 experts in Obstetrics, Gynecological, and Psychiatric Nursing professors.
The committee looked at the tool to ensure it was clear, relevant, comprehensive, understandable, and applicable, and fulfilling the study's purpose.

Tools reliability
Cronbach's alpha value for the reliability (internal consistency) of the Maternal-to-Infant -The infant's Apgar score was determined, his or her nose and mouth were suctioned and dried while the infant was lying on the mother's bosom, and the mother and infant were wrapped in a preheated blanket.
-The cranium of the infant was covered with a drying hood, which was replaced when it became wet to prevent heat loss.
-The baby will not be dressed or measured until two hours after birth.
-The researchers observed the neonates biting, licking, sucking, and suckling by standing behind or to the side of the bed and approaching the infants to observe their movements.
The time of onset of lactation and the first feeding were recorded, and the LATCH scale was used to evaluate the efficacy of the first feeding in the two groups. Additionally, greater than three-quarters of both the study and control groups were employed (76% and 78%, respectively). There was a highly statistically significant difference in educational level between the studied samples, with nearly two-thirds of the study group being highly educated (64%) and nearly half of the control group being secondary educated (46%). & less than three quarters of control group (72%), had rapid initiation of breast-feeding.   showed a high statistically significant negative correlation between study group & control group at p=.000.

Table (1): Distribution of socio-demographic characteristics of the studied mothers (study and control group)
The studied mothers (      Studying how kangaroo care influences psychological bonding, breastfeeding initiation, placental separation, and maternal anxiety in firsttime mothers is the focus of this study.

Regarding socio-demographic characteristics,
The current study's findings made it clear that no statistically significant differences existed

Regarding duration of third stage of labor,
in this study, there was a highly statistically significant difference. As more than half of the control group had duration from 11 to 15 minutes.
Meanwhile, more than of the study group had duration less than 5 minutes. More than half of the study group & nearly three quarters of the control group, the position of their uterus was below level of umbilicus. Meanwhile, more than three quarters of the study group & more than two thirds of the control group, uterus contracted immediately after using methergine. In addition to, most of the study group & more than three quarters of the control group, the condition of the uterus was not atonic.

Consistent with these findings, Essa & Ismail
(2015) reported that all women in the study group had a contracted uterus immediately following birth, with a full placenta, no uterine atony, and no excessive blood loss, whereas only about twothirds, three-quarters, and more than three-quarters of the control group did. The uterus was at or below the level of the umbilicus in nearly all of the study group, whereas in less than a quarter and in more than three quarters of the control group, respectively, methergine was not necessary. The majority of the study group had a successful first breastfeeding experience, but more than half of the control group did not (p .01).
Consistent with these results, Safari et al.

Conclusion
Based on this study's results, Kangaroo care is proven as a simple and effective technique that produced many benefits for mother and child.