Doğum hizmetlerinde paradigma değişimi: Holistik ebelik yaklaşımı üzerine kuramsal bir derleme

Year 2025, Volume: 6 Issue: 3, 196 - 208, 30.12.2025

Filiz Okumuş , Ali Timucin Atayoglu

https://doi.org/10.53445/batd.1758563

Abstract

Bu makale, doğum hizmetlerinde yaşanan dönüşümün bilim felsefesi perspektifinden kuramsal olarak ele alınmasını amaçlamaktadır. Thomas S. Kuhn’un paradigma kuramı çerçevesinde geliştirilen çalışmada, doğumda hâkim olan biyomedikal yaklaşımın tarihsel gelişimi incelenmiş ve günümüzde bu paradigmada yaşanan sınırlılıklara dikkat çekilmiştir. Geleneksel teknokratik paradigma, doğumu tıbbi bir olay ve kadın bedenini kontrol edilmesi gereken bir nesne olarak konumlandırırken normal doğumdan uzaklaşma ve artan sezaryen oranları doğum hizmetlerinde bir kriz dönemine işaret etmekte ve yeni bir paradigma ihtiyacını ortaya koymaktadır. Bu derleme çalışmasında, doğum yardımına dair üç temel paradigma tanımlanarak karşılaştırılmıştır: teknokratik (biyomedikal), hümanistik (biyopsikososyal) ve natüralistik (biyopsikososyal-spiritüel) paradigma. Özellikle natüralistik paradigma içerisinde yer alan holistik ebelik yaklaşımı; doğumu yalnızca fizyolojik değil, aynı zamanda psikolojik, sosyal ve spiritüel bir deneyim olarak değerlendiren bütüncül bir bakış açısı sunmaktadır. Çalışma, doğum hizmetlerinde paradigmatik bir değişimin gerekliliğini vurgulamakta; sürekli ebe desteği, endikasyon temelli müdahale protokolleri, saygılı annelik bakımı ile geleneksel ve tamamlayıcı tıp (GETAT) yaklaşımlarının doğum hizmetlerine entegrasyonu gibi öneriler sunmaktadır. Bu önerilerin tümü, doğumu yalnızca fizyolojik bir süreç olarak değil; aynı zamanda kadının duygusal, sosyal ve spiritüel gereksinimlerini de gözeten bir bakım deneyimi olarak ele alan holistik ebelik yaklaşımının temel ilkeleriyle örtüşmektedir. Bu doğrultuda, ebelik eğitiminin ve sağlık politikalarının holistik yaklaşım doğrultusunda yeniden yapılandırılması, doğum hizmetlerinde paradigma değişimini destekleyecek stratejik bir adım niteliğindedir. Bununla birlikte, çalışmanın kuramsal bir derleme niteliğinde olması nedeniyle bazı yöntemsel sınırlılıkları bulunmaktadır. Bu nedenle, gelecekte holistik ebelik uygulamalarının etkililiğini değerlendirmek amacıyla çok merkezli, nitel ve karma yöntemli araştırmaların yürütülmesi önem arz etmektedir.

Keywords

Ebelik , holistik sağlık , maneviyat , hasta merkezli bakım , tamamlayıcı terapiler

Paradigm shift in maternity care: A theoretical review of the holistic midwifery approach

Abstract

This article aims to provide a theoretical analysis of the transformation in childbirth services from the perspective of the philosophy of science. Developed within the framework of Thomas S. Kuhn’s paradigm theory, the study examines the historical development of the dominant biomedical approach in childbirth and draws attention to its current limitations. While the traditional technocratic paradigm conceptualizes childbirth as a medical event and the female body as an object to be controlled, the increasing rates of cesarean sections and the decline in physiological birth indicate a period of crisis in childbirth services, highlighting the need for a new paradigm. In this review, three core paradigms related to childbirth assistance are identified and compared: the technocratic (biomedical), the humanistic (biopsychosocial), and the naturalistic (biopsychosocial-spiritual) paradigms. The holistic midwifery model, situated within the naturalistic paradigm, offers a comprehensive perspective that considers childbirth not only as a physiological event but also as a psychological, social, and spiritual experience. The study emphasizes the necessity of a paradigmatic shift in childbirth services and proposes recommendations such as continuous midwifery support, indication-based intervention protocols, respectful maternity care, and the integration of traditional and complementary medicine (TCM) approaches into birth services. All of these recommendations align with the fundamental principles of holistic midwifery, which frames childbirth as a care experience that attends not only to physiological but also to emotional, social, and spiritual needs of women. In this context, restructuring midwifery education and healthcare policies in line with the holistic approach constitutes a strategic step toward supporting a paradigm shift in childbirth services. However, due to the theoretical and narrative nature of this review, it is subject to certain methodological limitations. Therefore, future research should include multi-center, qualitative, and mixed-method studies to evaluate the effectiveness of holistic midwifery practices.

Keywords

Midwifery , holistic health , spirituality , patient-centered care , complementary therapies

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