DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL BAKIŞ; RİSKLER VE FAYDALARI

Year 2019, , 82 - 90, 15.06.2019

Doç. Dr. Pınar Kumru , Prof. Dr. Ahmet Topuzoğlu

https://doi.org/10.16948/zktipb.531769

Abstract

DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL
BAKIŞ; RİSKLER VE FAYDALARI

ÖZET:

Gelişmiş ülkelerde planlı
evde doğum oranı %0,1-%20 arasında değişmektedir. Son 20 yıldır özellikle
gelişmiş ülkelerde evde doğum planlayan kadın sayısında artış dikkat
çekicidir.  

Planlı ev doğumlarında
çoğu literatürde birbiri ile uyumlu şekilde maternal sonuçları olumlu olarak
bildirilmişse de yenidoğan sonuçları açısından daha değişkendir.

Daha önceki
araştırmalarda, düşük riskli kadında planlı ev doğumlarında, oksitosin
indüksiyonu, sezaryen/operatif doğum, doğum sonrası kanama, perineal
laserasyon, farmakolajik analjezik ihtiyacı ve epizyotomi gibi müdahale ve
maternal morbiditeler azalmış olarak bildirilmiştir. 

Düşük riskli kadında
intrapartum fetal ölümler, yenidoğan ölümleri, düşük Apgar skorları ve
yenidoğan yoğun bakım ünitesine kabul açısından hastane ve ev doğumları
arasında fark bulunmadığını bildiren araştırmalar yanında artmış olumsuz
yenidoğan sonuçları gösteren araştırmalarda mevcuttur.

Planlı ev doğumları
özellikle nulliparlar gebeler için küçük de olsa artmış yenidoğan riskleri ile
ilişkili bulunmuşken multipar gebeler için daha güvenli olduğu bildirilmiştir.
Fakat makat prezentasyon, çoğul gebelik, ve geçirilmiş sezaryen öyküsü olan
kadınlarda evde doğum önerilmemektedir.

Kadınların ev
doğumlarında çevrelerini daha iyi kontrol edebildikleri, kendi şartlarını
belirleyebildikleri, istemedikleri müdahalelerden kaçınabilecekleri ve doğum
sırasında karar almada etkin rol alabildikleri için memnuniyetlerinin arttığı  bildirilmiştir.   

Evde doğumda bildirilen
diğer avantaj ise maliyet etkinliğidir.

Evde doğum konusunda,
radomize kontrollü çalışmalar yapmak mümkün değildir ayrıca araştırma
tasarımları ile ilgili bir çok zorluk vardır.

Planlı ev doğumlarının sonuçlarını gebelik sırasında
alınan annelik bakımı, gebelik ve doğum sırasında destek veren obstetrisyen ve
ebelerin eğitim düzeyi, hastaneye uzaklık ve transfer koşulları gibi bir çok
faktör etkilemektedir.  

Uluslararası kabul görmüş
standartlara dayanan uygulama ve kılavuzların kullanımı evde doğum güvenliği
için önemlidir.

Evde doğum, klavuzlar rehberliğinde,
eğitimli ebe/obstetrisyen eşliğinde veya
sağlık sistemine entegre transfer sistemlerinin varlığında, düşük riskli
kadınlar için özellikle yenidoğan sonuçları açısından risklerin çok az veya
hastane doğumlarına benzer olduğu tespit edilmiştir. 

Bu derleme, planlı ev
doğumlarını maternal ve neonatal sonuçlar ile olan ilişkisinini güncel
araştırmalar ışığında  gözden geçirecek
ve planlı ev doğumlarının riskleri ve faydaları tartışacaktır.

Anahtar Kelimeler: Ev doğumu, hastane doğumu, Düşük riskli gebelik,
riskler, faydalar, maternal sonuçlar, yenidoğan sonuçları

Keywords

Ev doğumu, hastane doğumu, Düşük riskli gebelik, riskler, faydalar, maternal sonuçlar

A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THE WORLD; RISKS AND BENEFITS

Abstract

A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THE
WORLD; RISKS AND BENEFITS

SUMMARY:

In developed countries, the planned
home delivery rate varies between 0.1% and 20%. In
the last 20 years, especially in developed countries, the number of women
planning birth at home increased noteworthy.

For planned home births, most
maternal outcomes were reported positive, and are compatible with each other
according to the results in the previous literature. However, the results for
the neonatal outcomes are more variable.

Planned home births in low-risk women
results with lower levels of oxytocin induction, cesarean/operative delivery,
postpartum hemorrhage, perineal laceration, need
for pharmacologic analgesic and episiotomy intervention and maternal morbidity, according to the previous reports.

In addition to the studies
indicating that there are no differences for low-risk women between hospital
and home births; in terms of intrapartum fetal deaths, neonatal deaths, low
Apgar scores, and admission to the neonatal intensive care unit rates, other studies report increased negative neonatal outcomes.

Planned home births are reported to
be safer for multiparous pregnancies, especially when they are compared with
nulliparous women who have small but significantly increased neonatal risks.
However, home delivery is not recommended for women with breech presentation,
multiple pregnancies and previous cesarean section.

It has been reported that women are
better able to control their environment in home births, determine their own
conditions, avoid undesired interventions, and increase their satisfaction
because they can play an active role in decision-making at birth.

Another advantage for home deliveries
is cost effectiveness.

On the subject of birth at home,
there is an obstacle on research designs because it is not feasible to conduct
randomized controlled studies.

Planned home births were effected by
maternal care during pregnancy, the level of education of obstetricians and
midwives who support during pregnancy and delivery, and the distance to
hospital and transfer conditions for the mothers.

The practices and guidelines based on
the internationally accepted standards are important for the home birth safety.

It was found that in the presence of
trained midwives / obstetrician guided guidance and integrated transfer
systems, the risks of home birth for low-risk women were very few or similar to
hospital deliveries, especially in the terms of newborn results.

This review will evaluate the
relationship between planned home births and maternal and neonatal outcomes
with regard to current studies and discuss the risks and benefits of planned
home births.

Keywords: Home birth, hospital
birth, low risk pregnancy,
without risk, benefit maternal outcomes, neonatal outcomes

Keywords

Home birth, hospital birth, low risk pregnancy, without risk, benefit maternal outcomes

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