Doğum Ortamının Düzenlenmesi ve Doğumun Fizyolojisini Desteklemede Ebe Önderliğinde Bakım
Year 2025,
Volume: 8 Issue: 2, 105 - 115, 18.07.2025
Rukiye Sülü Dursun
,
Ebru Gözüyeşil
Abstract
Doğum eylemi, kadınların çevresel ve psikososyal etmenler de dahil pek çok faktörlerden kolayca etkilenebildiği oldukça hassas fizyolojik bir süreçtir. Doğum ortamları, doğum fizyolojisini destekleyebilir ya da engelleyebilir. Doğumun gerçekleştiği yerler ev, doğum merkezi ve hastanelerdir. Sakinleştirici ve stresi azaltan bir doğum ortamı, fizyolojik doğumu destekler. Hareket kısıtlaması olan ve mahremiyete önem vermeyen ortam ise kadının kendini ve bebeğini güvende hissetmemesine neden olmaktadır. Bu durumda kadının yaşadığı stres ve anksiyete düzeyi artar. Kadının stres düzeyi arttığında kortizol ve adrenalin artmakta, oksitosin ve beta-endorfin seviyesi azalmaktadır. Bu hormonal döngü doğum eyleminin ilerleyişini durdurmakta ve medikalize doğum ya da sezaryen oranını arttırmaktadır. Ebeler tarafından verilen eğitim ve danışmanlık ile kadınlar, nasıl bir ortamda doğum gerçekleştireceğine kendileri karar verebilmelidir. Ebeler, kadınların kendilerini güvende ve huzurlu hissedebileceği, aynı zamanda doğal doğumu destekleyen doğum ortamlarının oluşturulmasında gerekli destek ve düzenlemeleri yapabilecek yetkinliktedirler. Ebeler, düşük riskli gebeler için doğum fizyolojisini destekleyen uygulamaları doğum ortamlarında kullanılabilir. Bu derlemede, doğum ortamları ve doğumun fizyolojisini desteklemede ebe önderliğinde bakımın önemini belirtmek amacıyla güncel bilgiler ışığında hazırlanmıştır.
Supporting Institution
Yazarlar, bu çalışma için finansal destek almadığını beyan etmiştir.
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implications of hospital birth room design:
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midw.2013.07.013
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ijerph18010199.
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a positive childbirth experience. World
Health Organization. http://www.who.int/
reproductivehealth/publications/inrapartum-
care-guidelines/en/.
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American College of Nurse-Midwives
(ACNM), Midwives Alliance of North
America; National Association of Certified
Professional Midwives. Supporting
healthy and normal physiologic childbirth:
a consensus statement by the American
College of Nurse-Midwives, Midwives
Alliance of North America, and the National
Association of Certified Professional
Midwives. Midwifery Womens Heal J.
2012;57(5):529-532. doi:10.1111/j.1542-
2011.2012.00218.x
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World Health Organisation (WHO).
Standards for improving quality of maternal
and newborn care in health facilities.
https://iris.who.int/bitstream/handle/
10665/249155/9789241511216eng.
pdf?sequence=1. 2016.
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Cheung NF, Mander R, Wang X, et al.
Clinical outcomes of the first midwife-led
normal birth unit in China: a retrospective
cohort study. Midwifery. 2011; 27(5), 582-
587. doi:10.1016/j.midw.2010.05.012.
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Adams ED. Birth environments: a woman's
choice in the 21st century. J Perin
Neonatal Nurs. 2016;30(3):2224-227.
doi:10.1097/JPN.0000000000000186.
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Howard ED. Optimizing the birth environment
with evidence-based design. J Perin
Neonatal Nurs. 2017;31(4):290-293.
doi:10.1097/JPN.0000000000000287.
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Stark MA, Remynse M, Zwelling E. Importance
of the birth environment to support
physiologic birth. J Obst Gyne Neo
Nurs. 2016;45(2):285-294. doi:10.1016/j.
jogn.2015.12.008.
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Erbaydar PN. Mother-friendly hospital
programme of Turkey: national intervention
to improve the quality of maternity services.
East Medi Heal J. 2021;27(2):202-
210. doi:10.26719/emhj.20.138.
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Stenglin M, Foureur M. Designing out the
Fear Cascade to increase the likelihood of
normal birth. Midwifery, 2013;29(8):819-
825. doi:10.1016/j.midw.2013.04.005
-
Folmer MB, Jangaard K, Buhl H. Design
of genuine birth environment: Midwives
intuitively think in terms of
evidence-based design thinking. Hea
Envi Res Design J. 2019;12(2):71-86.
doi:10.1177/1937586718796654
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Kumru P, Topuzoğlu A. Dünyada Planlı
Ev Doğumlarına Güncel Bakış; Riskler
ve Faydaları. Zeynep Kamil Tıp
Bült. 2019;50(2):82-90. doi:10.16948/zktipb.
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care for healthy
women and babies. Clinical Guideline
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guidance/cg190. 2014.
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Galera-Barbero TM, Aguilera-Manrique
G. (2022). Women's reasons and motivations
around planning a home birth with
a qualified midwife in Spain. J Advan
Nurs. 2022;78(8):2608-2621. https://doi.
org/10.1111/jan.15225
-
Sakuntari MDV, Sanjaya INH, Pemayun
CIM et al. (2022). Planned home birth in
low-risk pregnancies. Indonesian Journal
of Perinatology, 2022;3(1): 8-11.
doi:10.51559/inajperinatol.v3i1.19
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American Association of Birth Centers
(2013). AABC Perinatal Data Registry
(PDR), https://www.birthcenters.org/pdr.
-
Nethery, E., Schummers, L., Levine, A.,
Caughey, A. B., Souter, V., & Gordon, W.
(2021). Birth outcomes for planned home
and licensed freestanding birth center births
in Washington state. Obstetrics & Gynecology,
138(5), 693-702. https://doi.
org/10.1097%2FAOG.0000000000004578
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(2018) TNSA. Erişim: http://www.hips.hacettepe.
edu.tr/tnsa2018/index.htm.
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MacDorman, M. F., Mathews, T. J., & Declercq,
E. (2014). Trends in out-of-hospital
births in the United States, 1990-2012 (No.
2014). US Department of Health and Human
Services, Centers for Disease Control
and Prevention, National Center for Health
Statistics.144, ss:1-8.
-
Forster DA, McLachlan HL, Davey M, et
al. Continuity of care by a primary midwife
(caseload midwifery) increases women’s
satisfaction with antenatal, intrapartum and
postpartum care: Results from the COSMOS
randomised controlled trial. BMC
Pregnancy and Childbirth, 2016;16(28).
doi:10.1186/s12884-016-0798-y
-
Şahin M, Erbil N. Doğum ve medikalizasyon.
Ordu Üniv Hemş Çalış
Derg. 2019;2(2):20-130.
-
T.C. Sağlık Bakanlığı Halk Sağlığı Genel
Müdürlüğü Kadın ve Üreme Sağlığı Dairesi
Başkanlığı 2018a (2018). “Anne Dostu
Hastane Eğitimci Rehberi” Ankara Https://
khgmsaglikhizmetleridb.saglik.gov.tr/
Eklenti/33203/0/annedostu.hasyaneek0a-
6335e-c-4d6f-4c05-a29f-1f0e9bb03241.
-
T.C. Kamu Hastaneleri Genel Müdürlüğü
Sağlık Hizmetleri Dairesi Başkanlığı (https://
khgmsaglikhizmetleridb.saglik.gov.tr/
TR,42835/anne-dostu-hastane-listesi.html.
2024.
-
Diniz CSG, Bussadori JCDC, Lemes LB, et
al. A change laboratory for maternity care
in Brazil: Pilot implementation of Mother
Baby Friendly Birthing Initiative. Medical
Teacher. 2021;43(1):19-26. doi:10.1080/01
42159X.2020.1791319.
-
Ghahramani A, Azh N, Ranjbaran M,
Ranjkesh F. Evaluating the implementation
of Mother-Friendly Hospital
Steps in Qazvin, Iran. J Midw Repr Hea.
2019;7(4):1956-1963.doi:10.22038/
jmrh.2019.36306.1394.
-
Odent M. Journal of Prenatal and Perinatal
Psychology and Health 1 th (Ed.) Childbirth
and the Future of Homo Sapiensiçinde.
London, England: Pinter & Martin.
2013.
-
Zahrah F, Pratama AF, Hartanti, G. Interior
design of mother and child hospital in Jakarta.
In IOP Conference Series: Earth and Environmental
Science, 2021;729(1):012081.
doi:0.1088/1755-1315/729/1/012081.Jenkinson
B, Josey N, Kruske S. (2014). BirthSpace:
An evidence-based guide to birth
environment design. Queensland Centre
for Mothers & Babies, The University of
Queensland. c2014. ss:3-24.
-
Taşkın A, Ergin A. Effect of hot shower
application on pain anxiety and comfort in
the first stage of labor: A randomized controlled
study. Health Care for Women International,
2022;43(5):431-447. doi:10.1080
/07399332.2021.1925282.
-
Rahman SA, Wright KP, Lockley SW, et
al. Characterizing the temporal dynamics
of melatonin and cortisol changes in
response to nocturnal light exposure. Scie
Reports. 2019;(1):19720. doi:10.1038/
s41598-019-54806-7
-
Karaman ÖE, Yıldız H. The effect on
birth pain and process of the freedom of
movement in the first stage of labor: A randomized
controlled study. Clin Exp Hea
Scie. 2022;12(3):730-738. doi:10.33808/
clinexphealthsci.1016033
-
Nicoletta S, Eletta N, Cardinali P, Migliorini
L. A broad study to develop maternity
units design knowledge combining
spatial analysis and mothers’ and midwives’
perception of the Birth Environment.
Hea Envi Res Desi J. 2022;15(4):204-232.
doi:10.1177/19375867221098987
-
Poškienė I Vanagas G, Kirkilytė A, Nadišauskienė
RJ. Comparison of vaginal birth
outcomes in midwifery-led versus physician-
led setting: A propensity score-matched
analysis. Open Med. 2021;16(1):1537-
1543. doi:10.1515/med-2021-0373.
Midwife-Led Care in Arranging the Birth Environment and Supporting the Physiology of Birth
Year 2025,
Volume: 8 Issue: 2, 105 - 115, 18.07.2025
Rukiye Sülü Dursun
,
Ebru Gözüyeşil
Abstract
Labor is a highly sensitive physiological process during which women can easily be affected by many factors, including environmental and psychosocial factors. The physiology of labor can be supported or hindered by birth environments. Places where birth takes place include homes, birth centers, and hospitals. A calming and stress-reducing birth environment supports physiological birth. An environment restricting movements and ignoring privacy causes the woman to feel insecure about herself and her baby. In such situation, there is an increase in the woman’s level of stress and anxiety. When a woman's level of stress increases, there is an increase in cortisol and adrenaline levels and a decrease in oxytocin and beta-endorphin levels. This hormonal cycle ceases the progression of labor and increases rates of medicalized birth or cesarean section. The training and counseling provided to women by midwives should be able to help them decide what kind of environment they want to give birth in. Midwives are competent to provide the necessary support and arrangements to create birth environments where women can feel safe and peaceful and also support natural childbirth. Midwives can use practices that support the physiology of labor in birth environments for women with low-risk pregnancies. This review was prepared in light of current knowledge to indicate the importance of birth environments and midwife-led care in supporting the physiology of birth.
References
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Hammond A, Foureur M, Homer CS.
(2014). The hardware and software
implications of hospital birth room design:
A midwifery perspective. Midwifery.
2014;30(7):825-830. doi:10.1016/j.
midw.2013.07.013
-
Aşci Ö, Bal MD. The prevalence of obstetric
violence experienced by women during
childbirth care and its associated factors in
Türkiye: A cross-sectional study. Midwifery.
2023;124(12):103766. doi:10.1016/j.
midw.2023.103766.
-
Harte JD, Sheehan A, Stewart SC, Foureur
M. Childbirth supporters’ experiences
in a built hospital birth environment:
exploring inhibiting and facilitating factors
in negotiating the supporter role.
Hea Envi Res Des J. 2016;9(3):135-161.
doi:10.1177/1937586715622006.
-
Mena-Tudela D, Iglesias-Casás S, González-
Chordá VM, et al. Obstetric violence
in Spain (part II): interventionism and medicalization
during birth. Inter J Envi Res
Pub Healt. 2021;18(1):199. doi:10.3390/
ijerph18010199.
-
World Health Organization. (2018). WHO
recommendations on intrapartum care for
a positive childbirth experience. World
Health Organization. http://www.who.int/
reproductivehealth/publications/inrapartum-
care-guidelines/en/.
-
American College of Nurse-Midwives
(ACNM), Midwives Alliance of North
America; National Association of Certified
Professional Midwives. Supporting
healthy and normal physiologic childbirth:
a consensus statement by the American
College of Nurse-Midwives, Midwives
Alliance of North America, and the National
Association of Certified Professional
Midwives. Midwifery Womens Heal J.
2012;57(5):529-532. doi:10.1111/j.1542-
2011.2012.00218.x
-
World Health Organisation (WHO).
Standards for improving quality of maternal
and newborn care in health facilities.
https://iris.who.int/bitstream/handle/
10665/249155/9789241511216eng.
pdf?sequence=1. 2016.
-
Cheung NF, Mander R, Wang X, et al.
Clinical outcomes of the first midwife-led
normal birth unit in China: a retrospective
cohort study. Midwifery. 2011; 27(5), 582-
587. doi:10.1016/j.midw.2010.05.012.
-
Adams ED. Birth environments: a woman's
choice in the 21st century. J Perin
Neonatal Nurs. 2016;30(3):2224-227.
doi:10.1097/JPN.0000000000000186.
-
Howard ED. Optimizing the birth environment
with evidence-based design. J Perin
Neonatal Nurs. 2017;31(4):290-293.
doi:10.1097/JPN.0000000000000287.
-
Stark MA, Remynse M, Zwelling E. Importance
of the birth environment to support
physiologic birth. J Obst Gyne Neo
Nurs. 2016;45(2):285-294. doi:10.1016/j.
jogn.2015.12.008.
-
Erbaydar PN. Mother-friendly hospital
programme of Turkey: national intervention
to improve the quality of maternity services.
East Medi Heal J. 2021;27(2):202-
210. doi:10.26719/emhj.20.138.
-
Stenglin M, Foureur M. Designing out the
Fear Cascade to increase the likelihood of
normal birth. Midwifery, 2013;29(8):819-
825. doi:10.1016/j.midw.2013.04.005
-
Folmer MB, Jangaard K, Buhl H. Design
of genuine birth environment: Midwives
intuitively think in terms of
evidence-based design thinking. Hea
Envi Res Design J. 2019;12(2):71-86.
doi:10.1177/1937586718796654
-
Kumru P, Topuzoğlu A. Dünyada Planlı
Ev Doğumlarına Güncel Bakış; Riskler
ve Faydaları. Zeynep Kamil Tıp
Bült. 2019;50(2):82-90. doi:10.16948/zktipb.
531769
-
Royal College of Obstetricians and Gynaecologists/
Royal College of Midwives.
Home births (RCOG/RCM)Joint
Statement. No 2. London: RCOG; April
2007. p.1-6. https://www.rcog.org.uk/careers-
and-training/training/courses-and-events)?
gclid=EAIaIQ
-
National Institute for Health and Care Excellence
(NICE). Intrapartum
care for healthy
women and babies. Clinical Guideline
190. London. https://www.nice.org.uk/
guidance/cg190. 2014.
-
Galera-Barbero TM, Aguilera-Manrique
G. (2022). Women's reasons and motivations
around planning a home birth with
a qualified midwife in Spain. J Advan
Nurs. 2022;78(8):2608-2621. https://doi.
org/10.1111/jan.15225
-
Sakuntari MDV, Sanjaya INH, Pemayun
CIM et al. (2022). Planned home birth in
low-risk pregnancies. Indonesian Journal
of Perinatology, 2022;3(1): 8-11.
doi:10.51559/inajperinatol.v3i1.19
-
American Association of Birth Centers
(2013). AABC Perinatal Data Registry
(PDR), https://www.birthcenters.org/pdr.
-
Nethery, E., Schummers, L., Levine, A.,
Caughey, A. B., Souter, V., & Gordon, W.
(2021). Birth outcomes for planned home
and licensed freestanding birth center births
in Washington state. Obstetrics & Gynecology,
138(5), 693-702. https://doi.
org/10.1097%2FAOG.0000000000004578
-
Türkiye Nüfus ve Sağlık Araştırması
(2018) TNSA. Erişim: http://www.hips.hacettepe.
edu.tr/tnsa2018/index.htm.
-
MacDorman, M. F., Mathews, T. J., & Declercq,
E. (2014). Trends in out-of-hospital
births in the United States, 1990-2012 (No.
2014). US Department of Health and Human
Services, Centers for Disease Control
and Prevention, National Center for Health
Statistics.144, ss:1-8.
-
Forster DA, McLachlan HL, Davey M, et
al. Continuity of care by a primary midwife
(caseload midwifery) increases women’s
satisfaction with antenatal, intrapartum and
postpartum care: Results from the COSMOS
randomised controlled trial. BMC
Pregnancy and Childbirth, 2016;16(28).
doi:10.1186/s12884-016-0798-y
-
Şahin M, Erbil N. Doğum ve medikalizasyon.
Ordu Üniv Hemş Çalış
Derg. 2019;2(2):20-130.
-
T.C. Sağlık Bakanlığı Halk Sağlığı Genel
Müdürlüğü Kadın ve Üreme Sağlığı Dairesi
Başkanlığı 2018a (2018). “Anne Dostu
Hastane Eğitimci Rehberi” Ankara Https://
khgmsaglikhizmetleridb.saglik.gov.tr/
Eklenti/33203/0/annedostu.hasyaneek0a-
6335e-c-4d6f-4c05-a29f-1f0e9bb03241.
-
T.C. Kamu Hastaneleri Genel Müdürlüğü
Sağlık Hizmetleri Dairesi Başkanlığı (https://
khgmsaglikhizmetleridb.saglik.gov.tr/
TR,42835/anne-dostu-hastane-listesi.html.
2024.
-
Diniz CSG, Bussadori JCDC, Lemes LB, et
al. A change laboratory for maternity care
in Brazil: Pilot implementation of Mother
Baby Friendly Birthing Initiative. Medical
Teacher. 2021;43(1):19-26. doi:10.1080/01
42159X.2020.1791319.
-
Ghahramani A, Azh N, Ranjbaran M,
Ranjkesh F. Evaluating the implementation
of Mother-Friendly Hospital
Steps in Qazvin, Iran. J Midw Repr Hea.
2019;7(4):1956-1963.doi:10.22038/
jmrh.2019.36306.1394.
-
Odent M. Journal of Prenatal and Perinatal
Psychology and Health 1 th (Ed.) Childbirth
and the Future of Homo Sapiensiçinde.
London, England: Pinter & Martin.
2013.
-
Zahrah F, Pratama AF, Hartanti, G. Interior
design of mother and child hospital in Jakarta.
In IOP Conference Series: Earth and Environmental
Science, 2021;729(1):012081.
doi:0.1088/1755-1315/729/1/012081.Jenkinson
B, Josey N, Kruske S. (2014). BirthSpace:
An evidence-based guide to birth
environment design. Queensland Centre
for Mothers & Babies, The University of
Queensland. c2014. ss:3-24.
-
Taşkın A, Ergin A. Effect of hot shower
application on pain anxiety and comfort in
the first stage of labor: A randomized controlled
study. Health Care for Women International,
2022;43(5):431-447. doi:10.1080
/07399332.2021.1925282.
-
Rahman SA, Wright KP, Lockley SW, et
al. Characterizing the temporal dynamics
of melatonin and cortisol changes in
response to nocturnal light exposure. Scie
Reports. 2019;(1):19720. doi:10.1038/
s41598-019-54806-7
-
Karaman ÖE, Yıldız H. The effect on
birth pain and process of the freedom of
movement in the first stage of labor: A randomized
controlled study. Clin Exp Hea
Scie. 2022;12(3):730-738. doi:10.33808/
clinexphealthsci.1016033
-
Nicoletta S, Eletta N, Cardinali P, Migliorini
L. A broad study to develop maternity
units design knowledge combining
spatial analysis and mothers’ and midwives’
perception of the Birth Environment.
Hea Envi Res Desi J. 2022;15(4):204-232.
doi:10.1177/19375867221098987
-
Poškienė I Vanagas G, Kirkilytė A, Nadišauskienė
RJ. Comparison of vaginal birth
outcomes in midwifery-led versus physician-
led setting: A propensity score-matched
analysis. Open Med. 2021;16(1):1537-
1543. doi:10.1515/med-2021-0373.