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

Yıl 2023, Cilt: 6 Sayı: 1, 205 - 216, 17.04.2023

İlkay Güngör Satılmış Selinay Aktaş

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

Öz

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.

Anahtar Kelimeler

doğum, hemşirelik bakımı, uygulama

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

Öz

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.

Anahtar Kelimeler

delivery, nursing care, practice

Kaynakça

• ACOG. (2016). Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics & Gynecology. 128,1, e1-e15. http://doi.org/10.1097/AOG.0000000000001523
• Alfirevic Z, Gyte GM, Cuthbert A, Devane D. (2017). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, 3, 2, CD006066. https://doi.org/10.1002/ 14651858.CD006066
• American College of Obstetricians and Gynecologists. Approaches to limit intervention during labor and birth. ACOG Committee Bulletin, 2017. Erişim Tarihi: 09.01.2020, https://www.acog.org/-/media /project/acog/acogorg/clinical/files/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth.pdf.
• Aygar H, Metintaş S. (2018). Bir kalkınma göstergesi olarak anne ölümleri. Eskişehir Türk Dünyası Uygulama ve Araştırma Merkezi Halk Sağlığı Dergisi, 3(3), 63-70.
• Başgöl Ş, Beji NK. (2015). Doğum eyleminin birinci evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşım. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 5(2), 32-39.
• Beji NK, (2015). Hemşire ve ebelere yönelik kadın sağlığı ve hastalıkları. İstanbul, Nobel Tıp Kitabevleri. s.400.
• Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM. (2016). WHO Working Group on Caesarean Section. WHO statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology, 123(5), 667-670. https://doi.org/10.1111/1471-0528 .13526.
• Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 6, 7, CD003766. https://doi.org/10.1002/ 14651858.CD003766.pub6
• Budak MŞ, Kaya C, Akgöl S, Şentürk MB, Pektaş MK, Görük NY ve ark. (2016). Prostaglandin E2 ile doğum indüksiyonu: Kadın doğum ve çocuk hastalıkları hastanesi deneyimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 13(2), 61-64.
• Bugg, GJ, Siddiqui F, Thornton JG. (2013). Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labor. Cochrane Database of Systematic Reviews, 6, (7), CD007123. https://doi.org/10.1002/14651858.CD00 7123
• Cahill AG, Spain J. (2015). Intrapartum fetal monitoring. Clinical Obstetrics and Gynecology, 58(2), 263-268. https://doi.org/10.1097/grf.0000000000000109
• Chen W, Xue J, Peprah MK, Wen SW, Walker M, Gao Y ve ark. (2016). A systematic review and network meta‐ analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour. BJOG: An International Journal of Obstetrics & Gynaecology, 123(3), 346-354. https://doi.org/10.1111/1471-0528.13456
• Chuma C, Kihunrwa A, Matovelo D, Mahendeka M. (2014). Labour management and Obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania. BMC pregnancy and childbirth, 14(1), 68. https://doi.org/10.1186/1471-2393-14-68
• Chwo MJ, Anderson GC, Good M, Dowling DA, Shiau SH, Chu DM. (2007). “A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity”. Journal of Nursing Research, 10(2), 129-142. https://doi. org/10.4103/2249-4847.151163
• Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. (2018). The evolution of birth medicalisation: A systematic review. Midwifery, 66, 161-167. https://doi.org/10.1016/j.midw.2018.08.003
• Coşkun A. (2000). Doğum ve kadın hastalıkları hemşireliği el kitabı. 2. Baskı, İstanbul, Vehbi Koç Vakfı Yayınları., s. 205.
• Çağlayan EK, Kara M, Gürel Y. (2010). Kliniğimizde üç yıllık sezaryen oranı ve endikasyonları. Journal of Experimental and Clinical Medicine, 27(2), 50-53.
• Doğum ve sezaryen eylemi yönetim rehberi 2010. Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü. Erişim Tarihi: 10.01.2020, https://kalite.saglik.gov.tr/ Eklenti/6407/0/dogum-ve-sezaryen-eylemi-yonetim-rehberipdf.pdf.
• Güvenli Annelik Katılımcı Kitabı (2009). T.C. Sağlık Bakanlığı. Ankara; 90-95. Erişim Tarihi: 06.01.2020, https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/G%C3%BCvenli%20Annelik%20kat%C4%B1l%C4%B1mc%C4%B1%20kitab%C4%B11.pdf.
• Ismail KM, Webb SS. (2016). Episiotomy and Second‐degree Tear. Gynecologic and Obstetric Surgery: Challenges and Management Options, 488-489. https://doi.org/10.1002/9781118298565.ch163
• Jiang H, Qian X, Carroli G, Garner P. (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 8(2), CD000081.https://doi.org/10.1002/14651858.CD00 0081.pub3
• Kenyon S, Tokumasu H, Dowswell T, Pledge D, Mori R. (2013). High‐dose versus low‐dose oxytocin for augmentation of delayed labour. Cochrane Database of Systematic Reviews, 13, 7, CD007201. https://doi. org/10.1002/14651858.CD007201.pub3
• King TL, Pinger W. (2014). Evidence‐based practice for intrapartum care: the pearls of midwifery. Journal of midwifery & women's health, 59(6), 572-585. https://doi.org/10.1111/jmwh.12261
• Knight HE, Self A, Kennedy SH. (2013). Why are women dying when they reach hospital on time? A systematic review of the ‘third delay’. PloS One, 8(5), e63846. https://doi.org/10.1371/journal.pone.0063846
• Lauzon L, Hodnett ED. (2001). Labour assessment programs to delay admission to labour wards. Cochrane Database of Systematic Reviews, 3, CD000936. https://doi.org/10.1002/14651858.CD00 0 936
• Miller S, Abalos E, Chamillard M, Ciapponi, A, Colaci, D, Comandé D ve ark. (2016). Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The
• Lancet, 388(10056), 2176-2192. https://doi.org/ 10.1016/S0140-6736(16)31472-6
• Moore ER, Bergman N, Anderson GC, Medley N. (2016). Early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane database of systematic Reviews, 25, 11, CD003519. https://doi.org/ 10.1002/14651858.CD003519.pub4
• Pazandeh F, Huss R, Hirst J, House A, Baghban AA. (2015). An evaluation of the quality of care for women with low risk pregnancy: The use of evidence-based practice during labour and childbirth in four public hospitals in Tehran. Midwifery, 31(11), 1045-1053. https://doi.org/10.1016/j.midw.2015.07. 003
• Recommendations for augmentation of labour: highlights and key messages from World Health Organization’s 2014 global recommendations. Geneva: World Health Organization; 2015. Erişim Tarihi: 09.01.2020, https://apps.who.int/iris/bitstream/handle/10665/174001/WHO_RHR_15.05_eng.pdf?sequence=1.
• Sayın NC, Erzincan SG, Çilingir IU. (2018). Sezaryen: kanıta dayalı bilgiler. Turkiye Klinikleri Gynecology Obstetrics-Special Topics, 11(1), 76-81.
• Smyth RMD, Markham C, Dowswell T. (2013). Amniotomy for shortening spontaneous labour.Cochrane Database of Systematic Reviews, 18, 6, CD006167. https://doi.org/10.1002/14651858. CD006167.pub4
• Sultan AH, Thakar R, Ismail KM, Kalis V, Laine K, Räisänen SH ve ark. (2019). The role of mediolateral episiotomy during operative vaginal delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology. 192-196. https://doi.org/ 10.1016/ j.ejogrb.2019.07.005
• Şahin AB, Eyi EGY. (2017). Amniyotominin eylem süresi, sezaryen oranları, maternal ve fetal sonuçlar üzerine etkisi. Perinatal Journal/Perinatoloji Dergisi, 25(1), 19-25.
• Şahin M, Erbil N. (2019). Doğum ve medikalizasyon. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 2(2), 120-130.
• Takahashi K, Ganchimeg T, Ota E, Vogel JP, Souza JP, Laopaiboon M ve ark. (2017). Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO global survey. Scientific reports, 7:44868. https://doi.org/10.1038/srep44868
• Timur S, Şahin NH. (2010). Kadınların Doğumda Sosyal Destek Tercihleri ve Deneyimleri. Turkish Journal of Research & Development in Nursing, 12(1). 29-40.
• Toprak FÜ, Turan Z, Erenel AŞ. (2017). Doğum Sonu Erken Dönem Hemşirelik Uygulamalarında Güncel Yaklaşımlar. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 6(2), 96-103.
• Türkiye Nüfus ve Sağlık Araştırması 2018 (TNSA). Erişim Tarihi: 12.12.2019, http://www.hips.hacettepe .edu.tr/tnsa2018/rapor/2018_TNSA_SR.pdf.
• United Nations: Millennium Development Goals Report; 2014. Erişim Tarihi: 10.12.2019, https://www.un.org /en/development/desa/publications/mdg-report-2014.html.
• WHO recommendations for induction of labour. World Health Organization; 2018. Erişim Tarihi: 19.01.2020,https://apps.who.int/iris/bitstream/ handle/10665/277233/9789241550413-eng.pdf?ua=1.
• WHO Recommendations on Newborn Health Guidelines Approved by the WHO Guidelines Review Committee Updated May 2017. Geneva: World Health Organization. Erişim Tarihi: 07.01.2020, https://apps.who.int/iris/bitstream/handle/10665/259269/WHO-MCA-17.07 eng.pdf?sequence=1&is Allowed=y.
• WHO recommendations: induction of labour at or beyond term. World Health Organization; 2018. Erişim Tarihi: 29.01.2019, https://apps.who.int/iris/ bitstream/handle/10665/277233/9789241550413-eng.pdf.