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Newborn baby care at childbirth out of health facility
KOHÚTOVÁ, Tereza
This thesis deals with the assurance the necessary care of the newborns at birth outside of health facility. I emphasize that I do not deal with the issue of planned births outside of hospitals, but acute situations that could not be foreseen. I focus on the main principles of newborns care, where conditions are very limited for midwifes. I consider the main principles are the evaluation of risks of newborns based on anamnesis in pregnancy card, which pregnant woman is required to have with her at all times, also minimal disruption neonatal physiology adaptation and evaluation of the newborns after birth. The aim of the thesis was to catch midwive´s awareness to solving of newborns care at birth outside of health facility. I focused on methods, which formidwifes prefer for maintaining the knowledge about midwifery. I focused on their reactions about births outside of health facility, simultaneously that they have to be able to provide adequate care for newborns immediately after birth, including neonatal resuscitation. In the empirical part I used a metodology of structured interview with eight midwives from the South Moravia Region, who have at least two years experience in the practice. The interview took place in a hospital setting, on antenatal courses and home setting. Midwives answered very willingly and they sufficiently developed the questioned issues. They were asked on three research questions. The first research question concerned on the maintenance of knowledge of midwives. The following questions showed that midwives are forced to prioritize self study of literature or attendance on the courses. Specialized courses on my research topic is unfortunately missing in the Czech Republic. The second research question dealt with the issue of care of the newborns at birth outside of health facility and the ability of midwifes deal with this problematic. They are able to handle with childbirth of newborns outside of health facility. After the first frightining, they were be able to handle it as well as in the hospital, but unfortunately without aids, because the necessary aids had prepared with her only one of them. The newborn also should be adequately cared. Great attention should be devoted to thermoregulation. Newborn after birth can not keep warm. They had dried out of newborn and covered him of blanket. Some of them laid the infant on the mother's abdomen and followed by neonatal and maternal vital signs. The last research question related to neonatal resuscitation. The midwifes were not so sure in their answers in this problematic. They were be able to adequately begin of resuscitation, but unfortunately, as I already mentioned, they had not prepare with them the necessary aids, so they have to work without the aids. For the first they would ensure the airways and possible aspiration followed by mouth-to-mouth breathing, in the neutral position of newborn. Neutral position had in mind that the infant laid on a flat surface on the back, head toward to them, so the head was not too backswept or bend over. They would continue by indirect heart massage, where they used technique of using second and third or techniques of using inches. The research showed that the midwifes stand proof during the birth of newborn outside of health facility, but all of them would called the ambulance, due to possible risks incurred. Just would be the necessary to implement courses on this topic, encourage midwives to get a small package "in the pocket" and increase the number of practical training in neonatal resuscitation, becasue the theoretical training midwives is not enough. In my opinion, the results of the research could be used as educational material for working midwives, as information or educational resource for students of midwifery.
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