Dünyada Doğumda Uygulanan Girişimlerde İki Uç Durum: “Çok Az-Çok Geç” ve “Çok Fazla-Çok Erken” Yapılan Uygulamalar

Year 2023, , 205 - 216, 17.04.2023

İlkay Güngör Satılmış , Selinay Aktaş

https://doi.org/10.38108/ouhcd.1081787

Abstract

Dünyada doğumda uygulanan müdahalelerde zamanla iki uç durum meydana gelmiştir: “Çok Az-Çok Geç” ve “Çok Fazla-Çok Erken” uygulamalar. Geçmişte doğumda acil müdahalelere ulaşımın yetersiz ve geç olduğu “çok az-çok geç” uygulamaların üzerinde durulup komplikasyonlar önlenmeye çalışılmaktaydı. Günümüzde bu müdahalelerin kanıta dayalı olmayan bir şekilde gereksiz ve aşırı kullanımının olduğu çok fazla ve çok erken uygulamalar dikkat çekmektedir. İki uç uygulamanın kullanımı da maternal ve fetal sağlığı tehlikeye atmakta ve sağlıkta eşitsizliği arttırmaktadır. Bu amaçla derlemede, bu uygulamalara örnek veriler içeren uygulamaları: sezaryen, doğumun indüklenmesi, epizyotomi, oksitosinle doğumu hızlandırma, doğumhaneye erken/geç kabul, elektronik fetal monitorizasyon, amniyotomi, emzirmeye erken başlanması, ten tene temas ve doğumda doğum destekçisi bulunması uygulamalarını dünyadan ve Türkiye’den verilerle tartışılmıştır. Doğumda herkes için kanıta dayalı bakımın uygulanmasını destekleyen standardize edilmiş yaklaşımlara acilen ihtiyaç duyulmaktadır.

Keywords

doğum, hemşirelik bakımı, uygulama

Two Extreme Situations in Interventions Applied During Birth Worldwide: "Too Little-Too Late" and "Too Much-Too Soon" Practices

Abstract

Over time, two extreme situations have emerged in the interventions applied during birth worldwide: the "Too Little-Too Late" and "Too Much-Too Soon" practices. In the past, there was a focus on the "too little, too late" practices, where access to emergency interventions during birth was insufficient and delayed, in an attempt to prevent complications. Nowadays, there is a growing concern about the "too much, too soon" practices, characterized by the unnecessary and excessive use of interventions that are not evidence-based. The utilization of both extreme practices endangers maternal and fetal health and exacerbates health inequalities. In this review, practices exemplifying these situations, such as cesarean section, labor induction, episiotomy, labor acceleration with oxytocin, early/late admission to the delivery room, electronic fetal monitoring, amniotomy, early initiation of breastfeeding, skin-to-skin contact, and presence of a birth supporter during birth, are discussed with data from around the world and Turkey. There is an urgent need for standardized approaches that support evidence-based care for everyone during birth.

Keywords

delivery, nursing care, practice

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