Maternal and Child Health Care in Thailand: Importance of Skin-to-Skin Contact - Case Study

Skin-To-Skin Contact

Introduction: Skin-To-Skin Contact

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1. Thailand Profile Country (brief)

The Royal Thai Government has shown prioritising implementing maternal and child health (MCH) by influencing the concept of a continuum of care. This quantum concept of health care service in Thailand is associated with developing MCH policies that emphasise reducing mortality rates and mobility for children and mothers. This concern of governments toward healthcare leads to enhancing safety and security for children and mothers from skin-to-skin contact and other cranial diseases by providing them adequate treatments and care. As opined by Regan et al., (2021), "Universal Health Coverage" and “fifth Multiple Indicator Cluster Survey" in 2015 helped to analyse "National Statistical Office and UNICEF Thailand"  that health care commotion MCH policies developed by Thai governments enable to deliver of remarkable  MCH outcomes through delivering antenatal care, and vaccination. Apart from that, it can be identified that mortality rates in Thailand can be maintained by providing efficient MCH policies for pregnant women.  

2. Maternal Health Care And Childbirth In Thailand 

Pregnant women are generally offered prenatal care that is accessible free of charge at clinics in public hospitals in Thailand. Pregnant women are concerned to contract primary care centres that include regular checkups, ultrasounds and tests.  (Axaglobalhealthcare.com, 2020) . Ultrasound in every appointment and clinical check-up helps to learn about the condition of the baby. Regular massage of baby bumps is important because it is recognised as a skin to skin care for both child and mother.  As cited by Raghupathy (1996), the health care commission of Thailand is concerned with female education because they believed that female education affects maternal and child health care during pregnancy. The use of "tetanus toxoid vaccinations", assistant and prenatal care is important for the formal delivery process. Health workers in Thailand are concerned about delivering proper care and increasing awareness. According to MCH policies, pregnant women in Thailand prefer to ask prenatal care that has provided free of cost in a public hospital. Primary care for pregnant women in Thailand is delivered by public hospitals. 

3. Labour Room In Thailand

Maternal care for mother and child health is normally accompanied by relatives of these female patients. Female relatives are present as her traditional birth attendants, in the labour room such as the baby's father, family relatives and other neighbours and they encourage her to eat and drink, returning to the observation process of the labour room. As observed by Kruekaew and Kitcharoen (2018), during normal labour of pregnant women hospital authorities keep them in the maternity unit and at that time each woman prefers to care for their baby bump and health condition considering skin-to-skin contact with a locally trained midwife.  Management of pain in the delivery room is associated with massage and several local applications of walking, heat, showering and other forms of pain are providing medication. The second stage of labour for a pregnant woman is associated with attending continuously by a midwife and trying to encourage her to maintain fluid intake and remain upright and passing urine frequently.  The cord is cut baby after passing urine frequently and placed and dried on a warmed surface after delivery. This dried and worm surface for immediate newborn baby care involves with wrapped a  large thin cotton swaddling cloth whole body including the head of the baby that is skin to skin care in the labour room. As stated by Barbaglia et al., (2019), skin-to-skin contact in the delivery room is concerned with minimising "Unexpected Postnatal Collapse" by managing and promoting infant care in the labour room such as providing care of midwives, encouraging them to fluid intake and placing a wormed surface to wrapping with a large cloth.  

4. The First Hour After Birth

Skin-to-skin contact after birth signifies robustness that helps to indicate different benefits for both baby and mother that including breastfeeding. As researched by Widström et al., (2019), skin-to-skin contact during breastfeeding for mothers is associated with earlier expulsion of placenta which is beneficial for the mother's health because it contributes to reducing bleeding and maternal stress levels. Breastfeeding helps to increase the self-sufficiency of mothers through rising oxytocin and decreases negative factors of a child such as the stress of birth that leads to minimising the crying of a baby. Most of the time babies stop crying during breastfeeding which signifies that breastfeeding helps to influence optimal thermoregulation. On the other hand, skin-to-skin contact between baby and mother within the first hours of birth helps to establish a bonding between child and mother that is beneficial for both mother and child. During birth and the first hours of birth child and mother goes through a sensitive time period in this time skin to skin care helps to benefit them biologically and psychologically through increasing oxytocin levels of the mother and catecholamine levels of a newborn baby. 

Skin-to-skin contact during the first hours of a newborn baby goes through nine instinctive stages namely birth cry, activity, rest, relaxation, familiarisation, awakening, crawling, suckling and sleeping. As understood by Karimi et al., (2019), increasing the crying of babies after birth is concerned to ensure the transition of breathing air and relaxation state involves providing infant rest concerning no movements of arms, head, legs and other parts of the body. Awaken stage includes showing movements of the body parts of a baby up, down, and from side-to-side with shoulders and limbs. As researched by Santos et al., (20921), movements of limbs and head are associated with the rooting activity of a child that is known as an active stage for skin-to-skin care for the baby. Mouth activity and sucking hand are recognised as the resting stage for newborn babies and the next stage of familiarisation is breastfeeding which helps to establish a bond between baby and mother. Moreover, during breastfeeding, it can be observed that the baby shows sucking activity that is known as the sucking stage of skin to skin contact for newborn babies and mothers. During breastfeeding children stop caring due to the reduction of birth stress that helps to lead a baby to the sleeping stage. 

5. Skin-to-skin contact

Mother?infant detachment post-birth is general. Newborns are kept covered or wrapped in the infant's mother’s arms and are put in or underneath warmers or in open cribs. "Skin?to?skin contact (SSC)" starts ideally at childbirth and lasts constantly until the first breastfeeding ends. Skin-to-skin contact concerns include putting the dried and naked infant tending on the mother's uncovered chest (Moore et al. 2016). As per the suggestion of several neurosciences, the inseparable contact innate in this place stimulates "neuro-behaviours" assuring the fulfillment of fundamental biological requirements. 

"Thailand's national health insurance" is based on three major schemes that include

•  "the civil servants’ medical benefits scheme"
• "the social security scheme" (Wisconsin.gov, 2022)
• "the universal coverage health scheme (72.0% of the population)"

Women who are practising Skin to skin contact after cesarean delivery are likely to be more to breastfeed infants of post-birth within one to four months or breastfeed successfully based on "The IBFAT score". Skin-to-skin contact could enhance breastfeeding, which can be done some other time after cesarean. 

Early "skin-to-skin contact (SSC)" by placing the naked infant, head wrapped with a cap and wrapped into a warm blanket across the back, prone on the mother’s uncovered chest at delivery can be indicated as the physiological standard and it can be recommended in a world-wide range as standard practice and as part of "UNICEF" baby friendly health initiative. The introduction of Skin-to-Skin contact into the standard care of healthy newborns has been established to contribute to both instantaneous and elongate-term health consequences for the baby and mother. 

6. Problem Statement

Managing pain is a huge problem that women suffer during the time of delivery required precautions are required to be taken during that moment including massage, heat application locally, walking and showering narcotics and additional conditions of pain remedy that are required are not available in this surroundings. However, after the cutting of the cord an infant is dried and the baby is put on a heated cover for instantaneous aborning care and then surrounded in cotton swaddling materials that also protect the head of the baby. Skin-to-skin contact is not presently rehearsed in the Thai population. The period of separation between the mother and baby is brief that can be usually 15–20 minutes and both the baby and mother stay together in the same room. 

As per the data analysed over the last five years in Thailand "Infection and dermatitis" can be considered as the two considerable common skin contact in the preliminary care ground in the total population of Thailand (Hemachandra et al.2016). "Atopic dermatitis, psoriasis, seborrheic dermatitis, and decubitus ulcers" affected people are lessly found in Thailand.  

There are several other initiated problems based on skin-to-skin contact between mother and baby that includes Mostly the mother and baby going back home within 24 hours after delivery and are facilitated to return the case of experiencing problems.

There is another raised problem in the rural areas of Thailand due to the lack of appropriate knowledge the gap in the basic knowledge that is required to be taken after the delivery procedure and returning back home causes inappropriate treatment with the mother and the infant that can raise various serious issues. 

References

Journals

Barbaglia, M., Finale, E., Noce, S., Vigo, A., Arioni, C., Visentin, R., Scurati-Manzoni, E. and Guala, A., 2019. Skin-to-skin contact and delivery room practices: a longitudinal survey conducted in Piedmont and the Aosta Valley. Italian journal of pediatrics, 45(1), pp.1-7. DOI: https://doi.org/10.1542/peds.2016-1889

Hemachandra, A., Puapornpong, P., Ketsuwan, S. and Imchit, C., 2016. Effect of early skin-to-skin contact to breast milk volume and breastfeeding jaundice at 48 hours after delivery. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet, 99, pp.S63-S69. DOI: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/abstract

Karimi, F.Z., Sadeghi, R., Maleki-Saghooni, N. and Khadivzadeh, T., 2019. The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis. Taiwanese Journal of Obstetrics and Gynecology, 58(1), pp.1-9. DOI: https://doi.org/10.1016/j.tjog.2018.11.002

Kruekaew, J. and Kritcharoen, S., 2018. Thai traditional Midwifery care. Songklanagarind Journal of Nursing, 38(1), pp.103-110. 10.7763/ IJSSH.2014.V4.394. DOI: 10.1002/14651858.CD003519.pub4

Moore, E.R., Bergman, N., Anderson, G.C. and Medley, N., 2016. Early skin?to?skin contact for mothers and their healthy newborn infants. Cochrane database of systematic Reviews, (11). DOI: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/abstract

Raghupathy, S., 1996. Education and the use of maternal health care in Thailand. Social science & medicine, 43(4), pp.459-471. DOI: https://doi.org/10.1016/0277-9536(95)00411-4

Regan, L., Wilson, D., Chalkidou, K. and Chi, Y.L., 2021. The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review. BMJ Global Health, 6(8), p.e005842. DOI: http://dx.doi.org/10.1136/bmjgh-2021-005842

Santos, A. P. D. S., Lamy, Z. C., Koser, M. E., Gomes, C. M. R. D. P., Costa, B. M., & Gonçalves, L. L. M. (2021). Skin-to-skin contact and breastfeeding at childbirth: women’s desires, expectations, and experiences. Revista Paulista de Pediatria, 40. DOI: https://doi.org/10.1590/1984-0462/2022/40/2020140 

Widström, A.M., Brimdyr, K., Svensson, K., Cadwell, K. and Nissen, E., 2019. Skin?to?skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatrica, 108(7), pp.1192-1204. DOI: https://doi.org/10.1111/apa.14754

Wisconsin.gov, 2022. Skin Infections: Prevention and Disinfection Available at: https://www.dhs.wisconsin.gov/skin-infection/prevention-disinfection.htm#:~:text=The%20easiest%20and%20most%20effective,infection%20from%20spreading%20to%20others. [Accessed on: 02/11/2022]

Website 

Axaglobalhealthcare.com (2020), A guide to pregnancy and giving birth in Thailand Available from: DOI: https://www.axaglobalhealthcare.com/en/wellbeing/pregnancy/thailand/#:~:text=In%20Thailand%2C%20pregnant%20women%20are,find%20out%20you're%20pregnant. Accessed on: 03.11.2022