- freely available
Healthcare 2016, 4(4), 94; https://doi.org/10.3390/healthcare4040094
2. Materials and Methods
3.1. Newborn Care around the Time of Birth in Health Centers
If I am by myself, I would take the newborn, hand it to the mother to hold on her abdomen and then I would clean the face, the space around the eyes, inject oxytocin to the mother to make the placenta come out and then clamp the umbilical cord. Then I will clean the baby and weigh them before wrapping. The same cloth (sarong) for wiping and cleaning can be used to wrap the baby after.(Primary midwife, 24 years old, Takeo Province)
If the baby is weak then they cannot breastfeed. Sometimes, the baby can’t breastfeed because of problem with mom’s breast. They give formula milk in this case. The mother buys the formula. The mother and the grandmother prepare.(Primary midwife, 26 years old, Takeo Province)
I advise them not to put anything on the cord except for betadine (povidone iodine). I have heard that some of them use the insect nests, spider nest, ash, or other things on the cord. But other than that I don’t really advise them on how to take care of the newborn.(Primary midwife, 24 years old, Takeo Province)
It is rare for them because after the baby is born, after 1 day they go home. So if they are sick they might go to the referral hospital.(Primary midwife, 26 years old, Takeo Province)
Very few (come for illness), such as the eye. A few, their umbilical cord after the cord drops is not cured yet and they bring it here. The babies are brought to the OPD (Outpatient Department).(Primary midwife, age unknown, Takeo Province)
If there is no problem the newborn goes home. A few days later they come for BCG (Bacillus Calmette-Guerin immunization). One and a half months later come for immunizations. Health center only gives BCG on Mondays so if baby is not born on Monday then it has to wait a few days to receive BCG.(Primary midwife, 44 years old, Takeo Province)
Yes we have some, but not dying. Out of a hundred, maybe 5–6 (are low birth weight). They survive. From time to time there is a death. One woman had 10 children and the baby was weak and could not breastfeed. There’s another case also, of underweight. The first 3 days the baby was ok. But on the 4th day after baby’s bath, the baby stopped breathing. A fire was lit below the bed and newborn was wrapped to keep it warm so it survived.Mothers don’t know that low birth weight babies need special care. Sometimes we tell them but they still want to give baths to the baby.Low birth weight newborns easily get cold body temperature and then stop breathing. Aside from temperature they have cough, fever, runny nose diarrhea.(Focus Group Discussion with Midwives 28–46 years old, Takeo Province)
3.2. Health Facility Conditions around Newborn Care
The post delivery room building is too old. Even if we try to clean it’s not clean. Also, (it is) too small. Can only fit 2 mothers. If there are 3, then one has to stay outside.(Primary midwife, 46 years old, Takeo Province)
This month there were fewer deliveries, 13 only, but in some months with many more, there is a shortage of gloves… If there is low supply the health center buys from the market.(Primary midwife, 46 years old, Takeo Province)
We do not have any spray to kill the germs (in the delivery and post-delivery rooms) but we use soap, “eau de javel” [liquid bleach].(Primary midwife, 28 years old, Takeo Province)
But now “eau de javel” [liquid bleach] is not allowed, we were told to use dishwashing soap.(Primary midwife, 46 years old, Takeo Province)
We do not use bleach as of now.(Primary midwive, 44 years old, Takeo Province)
3.3. Newborn Care Practices at Home Following Delivery
I breastfed one day after the birth. The baby cried a lot when I first started breastfeeding with colostrum. I bought canned milk to give the baby. When the white milk came in I then gave the baby only the breast milk. I had problems breastfeeding. Nipples became cracked, I felt pain. I did nothing, just endured the pain and kept breastfeeding.(Mother, 26 years old, housewife, Takeo Province)
Women don’t want their breasts to be out of shape. If they can afford formula, some won’t breastfeed baby.(Mother, 36 years old, housewife, Takeo Province)
To bathe the baby the grandmother puts the newborn in a container with warm water. The water is then poured over the baby. We did not use soap to bathe the baby because I was afraid of the baby having an allergic reaction since the baby’s skin is “young.”(Mother, 27 years old, housewife, Takeo Province)
3.4. Danger Signs
I have heard about and seen convulsions in other babies. It happens after giving birth. With the convulsion I witness, nothing was done as the family believed it’s a natural thing. Let the baby be. It was born like this.(Mother, 26 years old, housewife Takeo province)
At the hospital we did not receive any special instructions on how to take care of the small baby (or any instructions at all on any newborn care). I did not think there was any special care for smaller babies versus normal babies, only just did whatever came to my mind to care for the baby. I stayed for 1 full week at the Hospital. The doctor gave my wife some pills to take after the birth. While staying at the Hospital, I did feel that if I called them they would come and help with the baby. I did call for help when it seemed to me that the baby had “short of breath”. I thought that something was caught in her throat or she was choking, so I called them and the staff suctioned the baby’s throat. She continued to be “short of breath” all the while they stayed in the hospital.(Father, 30 years old, farmer, Takeo province)
3.5. Care seeking and Referral
I would go to the Health Center if baby was sick. The reason is that it is close to his home, also it is cheap. If the baby wasn’t cured for a few days after the Health Center visit and getting more serious, I would go to the private doctor.(Father, 30 years old, farmer, Takeo province)
If my baby got sick, I will go to somewhere near the market, there is a private cabinet. Not to the Health Center, because I don’t need to wait at the private cabinet, and I believe that it is more effective to see in private. It costs me 5000 to 10,000 riels in the private cabinet, and only 1500 riels at the Health Center. If my baby gets seriously sick I would go straight to Kantha Bopha Hospital in Phnom Penh because I was told that at Kantha Bopha Hospital the services is very good, the quality of the doctors also good and the medicine is also effective to cure the baby illness. I don’t think there is someone specialized in newborn illness around here.(Mother, 23 years old, housewife, Takeo Province)
For care seeking, mothers usually go to the nearest place. Usually they would go to the Health Center because as mothers we may not know the diseases of babies but they at the Health Center are experts so we will go there. The reason to go to another place than the Health Center is if the other place (such as a cabinet) is very near to the home, nearer than the Health Center. I know Takeo Referral Hospital and I would go there if my baby was severely ill but so far I have never been there. I would go there instead of Phnom Penh because it is closer.(Mother, 29 years old, housewife, Takeo Province)
Conflicts of Interest
|Newborn Care around the Time of Birth/Health Facility Conditions||Newborn Care Practices at Home Following Delivery|
|Standard precautions and cleanliness:|
Protect yourself from blood and other body fluids during deliveries
Practice safe disposal of sharps
Practice safe waste disposal
Deal with contaminated laundry
Sterilize and clean contaminated equipment
Change gloves (if possible) prior to cutting the cord. Have sterile kit to tie and cut cord (protection)
|Wash your hands with soap and water before and after handling your baby, especially after touching her/his bottom. Wash hands before and after cord care. Put nothing on the stump. DO NOT apply any substances or medicine to stump. Wash baby’s bottom when soiled and dry it thoroughly. Practice safe disposal of infant feces and household waste.|
|Warmth (Temperature control)|
|Have clean warm towels/covers/cloths ready for newborn baby at delivery.|
Thoroughly dry the baby immediately. Discard wet cloth. Skin-to-skin contact: Leave the baby on the mother’s abdomen (before cord cut) or chest (after cord cut) after birth for at least 2 h. Cover the baby with a soft dry cloth.
Help mother to wear clothes which make immediate skin contact easy.
|Keep baby warm and covered. Avoid frequent bathing, changes in baby’s temperature. Newborns need more clothing than other children or adults. If cold, put a hat on the baby’s head. During cold nights, cover the baby with an extra blanket.|
|Assess the newborn. Have resuscitation equipment near delivery bed. Keep equipment in good condition. Monitor the baby every 15 min after delivery.||Advise the mother to seek care for the baby as needed, to observe baby and note danger signs for care seeking, especially difficulty breathing, fast or slow breathing, grunting, or chest in-drawing.|
|Encourage immediate breastfeeding. Keeping mother and baby in skin-to-skin contact from birth encourages early breastfeeding. Counsel the mother on breastfeeding. Help the mother to initiate within one hour. Assess breastfeeding. Encourage breastfeeding on demand, day and night, as long as the baby wants.|
→ A baby needs to feed day and night, 8 or more times in 24 h from birth. Only on the first day may a full-term baby sleep many hours after a good feed.
→ A small baby should be encouraged to feed, day and night, at least 8 times in 24 h from birth.
Teach correct positioning and attachment. Show the mother how to hold her baby.
→ make sure the baby’s head and body are in a straight line
→ make sure the baby is facing the breast, the baby’s nose is opposite her nipple
→ hold the baby’s body close to her body
→ support the baby’s whole body, not just the neck and shoulders
Show the mother how to help her baby to attach.
→ touch her baby’s lips with her nipple
→ wait until her baby’s mouth is opened wide
→ move her baby quickly onto her breast, aiming the infant’s lower lip well below the nipple. Look for signs of good attachment and effective suckling (that is, slow, deep sucks, sometimes pausing). If the attachment or suckling is not good, try again. Then reassess
|Advice for mother: Start breastfeeding within 1 hour of birth. The baby’s suck stimulates your milk production. The more the baby feeds, the more milk you will produce. Give your baby the first milk (colostrum). It is nutritious and has antibodies to help keep your baby healthy. At each feeding, let the baby feed and release your breast, and then offer your second breast. At the next feeding, alternate and begin with the second breast. Exclusive breastfeeding for the first 6 months. Seek care for problems around breast feeding. Immediately after birth, keep your baby in the bed with you, or within easy reach. At night, let your baby sleep with you, within easy reach. While breastfeeding, you should drink plenty of clean, safe water. You should eat more and healthier foods and rest when you can.|
|Danger signs||Care seeking and referral|
|Stopped feeding well, history of convulsions, fast breathing (breathing rate ≥ 60 per minute), severe chest in-drawing, no spontaneous movement, fever (temperature ≥ 37.5°C), low body temperature (temperature < 35.5°C), any jaundice in first 24 h of life, or yellow palms and soles at any age. The family should be encouraged to seek health care early if they identify any of the above danger signs in between postnatal care visits.||Return or go to the hospital immediately if the baby has:|
difficulty breathing, convulsions, fever or feels cold, bleeding, diarrhea, very small, just born, not feeding at all. Go to the Health Center as quickly as possible if the baby has: difficulty feeding, pus from eyes, skin pustules, yellow skin, a cord stump which is red or draining pus, feeds <5 times in 24 h.
During transportation: Keep the baby warm by skin-to-skin contact with mother or someone else. Cover the baby with a blanket and cover her/his head with a cap. Protect the baby from direct sunshine. Encourage breastfeeding during the journey.
If the baby does not breastfeed and journey is more than 3 h, consider giving expressed breast milk by cup.
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|Inquiry||Semi Structured Interviews||Observation in the Home||Photo and Video Documentation||Focus Group Discussions|
|Data Collected||Perceived newborn health problems (including danger signs); Local understanding of illnesses; Newborn care practices; Care seeking behaviors; Referral practices||Newborn care practices||Hygiene and infection control practices in Health Centers and related equipment and supplies||Hygiene and infection control practices in Health Centers; Newborn care practices; Perceived newborn health problems (including danger signs) and referral|
|Participants||27 Mothers/Caregivers; 16 VHSG volunteers||4 newborns (less than 29 days old)||10 health facilities and 4 homes of newborn babies||2 FGDs (8 participants)|
|Newborn Care at Health Center||Newborn Care at Home|
|Routine cleaning of delivery and labor rooms||Emphasizing dry cord care or chlorhexidine|
|Hand hygiene in HC||Limiting bathing and using clean, warm water|
|Clean dry cloth to wrap baby after delivery||Exclusive breastfeeding (no water or supplemental formula)|
|Encourage skin to skin contact following delivery||Hand hygiene at home|
|Postnatal assessment of newborn prior to discharge||Environmental hygiene at home|
|Improved counseling and support for breastfeeding initiation, timing/frequency of feeds, assessment of positioning and latch||Improved recognition of danger signs at community/household level|
|Guidance and counseling on newborn danger signs and care seeking||Clear referral processes for families to seek prompt and appropriate care for newborn illness|
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