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Doğum Ortamının Düzenlenmesi ve Doğumun Fizyolojisini Desteklemede Ebe Önderliğinde Bakım

Year 2025, Volume: 8 Issue: 2, 105 - 115, 18.07.2025

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.

References

  • 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.

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

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

  • 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.
There are 36 citations in total.

Details

Primary Language Turkish
Subjects Health Sciences Education and Development of Programs: Medicine, Nursing and Health Sciences
Journal Section Review
Authors

Rukiye Sülü Dursun 0000-0003-1093-4635

Ebru Gözüyeşil 0000-0002-9193-2182

Publication Date July 18, 2025
Submission Date October 4, 2024
Acceptance Date December 27, 2024
Published in Issue Year 2025 Volume: 8 Issue: 2

Cite

APA Sülü Dursun, R., & Gözüyeşil, E. (2025). Doğum Ortamının Düzenlenmesi ve Doğumun Fizyolojisini Desteklemede Ebe Önderliğinde Bakım. Tıp Fakültesi Klinikleri Dergisi, 8(2), 105-115.