THE MIDWIFE'S ACTIVITY IN OPERATIONAL DELIVERY

U povijesti su operativne zahvate u porodima obavljale i vodile primalje, koristeći primitivne instrumente uz velike stope mortaliteta i morbiditeta majke i novorođenčadi. Danas je primaljska skrb tijekom poroda sastavni dio perinatalne zaštite. Operativno dovršenje poroda obuhvaća vakuum ekstrakciju i porođaj kliještima odnosno forcepsom i carski rez. Uz brojne indikacije, carski rez je zahvat koji se radi samo u krajnje potrebnim slučajevima. Metoda izbora je zasigurno vakuum ekstrakcija, jer je forceps izbačen iz upotrebe u hrvatskim rodilištima. Metode carskog reza mijenjale su se s vemenima, skupa s tehnikama i vrstama rezova trbušne stijenke. Još uvijek se usavršavaju tehnike takvog kirurškog zahvata. Komplikacije carskog reza iznose 12-15% i češće su kod hitnih carskih rezova. Veliku ulogu u preoperativnoj pripremi za operativno dovršenje poroda vodi primalja, koja se brine o informacijama, edukaciji, fizičkoj pripremi – otvaranju venskog puta, kateterizaciji mokraćnog mjehura, pripremi operativnog područja, identifikaciji, prevencija komplikacija... Postoperativno doba je doba najvećih komplikacija u kojem je nužno intenzivnije nadziranje pacijentice i prevencija postoperativne boli. Ozljede i komplikacije moguće su kako u prirodnom vaginalnom porodu tako i u operativnom. S obzirom na veliki napredak porodništva i primaljstva u današnje doba, educirani i specijalizirani tim primalja i porodničara svakim danom vodi računa o što sigurnijem i manje rizičnijem dolasku novorođenčeta na svijet.Throughout history surgical procedures have been done by midwives, using primitive instruments along with high mortality rates of both pregnant women and newborn children. Today the recieving care during birth is a main component of perinatal protection. The operative completion of birth includes vacuum extraction and forceps with Caesarean section. With numerous indications, Caesarean section is a procedure that is only done in most needed cases. The method of choice is surely the vacuum extraction because the forceps has been banned from use in Croatian maternity hospitals. Methods of Caesarean section have changed with time, together with techniques and variations of cuts on the stomach wall. Techniques for that surgical procedure are still being developed. Complications during Caesarean section are 12-15% and are more common in emergency cases. During pre-operative preparations midwives have an important role, and that is to chek the informations, education levels, physical condition- opening the vein path, catetherisation of the urinary bladder, preparing the operative area, identification and preventing complications. Post operative time is a period when most complications occur during which is necessary to start more intensive patient overseeing, and preventing post operative pain. Injuries and complications are possible both in vaginal delivery and operative delivery. Due to big improvements in pregnancy care and birht assistance in todays age, educated and specialised teams of midwives and birth attendants take count every day to perform a safer and less risky child birth