HOLISTIC MIDWIFERY CARE PRACTICES BASED ON THE NEUMAN SYSTEMS MODEL DURING PREGNANCY

Öz

Holistic care is an approach that considers individuals as a whole, addressing their physical, psychological, social, and spiritual dimensions while evaluating health services based on the interaction of all these aspects. Rooted in Jan Christian Smuts’ concept of “holism,” this approach advocates for addressing an individual’s health comprehensively, beyond just the physical aspect. Holistic care is founded on principles of person-centeredness, personalized care, empathy, and holistic evaluation. The Neuman Systems Model (NSM) views individuals as systems interacting with their environment and focuses on stress management and well-being. During pregnancy, this approach supports maternal and fetal health and alleviates emotional states such as stress and anxiety through methods like breathing exercises, meditation, mindfulness, yoga, haptonomy, music therapy, art therapy, and expressive writing. Holistic care practices in midwifery play a vital role in protecting and enhancing maternal and fetal health during pregnancy. These practices help meet pregnant women’s physiological and psychological needs, enabling them to experience pregnancy more healthily and consciously. They also enhance the awareness of pregnant women, aiding them in learning stress management techniques, effectively handling birth fear, strengthening maternal attachment, reinforcing social support systems, and improving communication between midwives and pregnant women. The holistic care approach emphasizes the necessity of considering individuals in all their dimensions, fostering both physical and emotional recovery during pregnancy and childbirth, and serving as a foundation for midwifery care. This review aims to examine holistic midwifery care approaches and practices based on the Neuman Systems Model for pregnant women, providing a guiding perspective for healthcare professionals within the birth team.

Anahtar Kelimeler

• Holistic Care
• Midwifery
• Midwifery Care
• Pregnancy

Gebelik Sürecinde Neuman Sistemler Modeline Dayılı Bütüncül Ebelik Bakım Uygulamaları

Öz

Bütüncül bakım, bireyi fiziksel, psikolojik, sosyal ve ruhsal boyutlarıyla bir bütün olarak ele alarak sağlık hizmetlerini tüm yönlerin etkileşimiyle değerlendiren bir yaklaşımdır. Bu yaklaşımın temeli, Jan Christian Smuts’un “holizm” kavramına dayanmakta ve bireyin sağlığını sadece fiziksel değil, tüm yönleriyle ele almayı savunmaktadır. Bütüncül bakım, birey merkezlilik, kişiselleştirilmiş bakım, empati ve bütüncül değerlendirme ilkeleri üzerine kuruludur. Neuman’ın Sistemler Modeli ise, bireyi çevresiyle etkileşim içinde bir sistem olarak ele alırken, stres yönetimi ve iyilik hali üzerine odaklanmaktadır. Gebelikte bu yaklaşım, nefes egzersizleri, meditasyon, mindfulness, yoga, haptonomi, müzik terapisi, sanat terapisi ve ifade edici yazma gibi yöntemlerle maternal ve fetal sağlığı destekleyip stres, kaygı gibi duygusal durumları azaltmaya yardımcı olmaktadır. Ebelik bakımında bütüncül bakım uygulamaları, gebelik sürecinde maternal ve fetal sağlığı korumak ve geliştirmek için önemli bir rol oynamaktadır. Bu uygulamalar, gebelerin fizyolojik ve psikolojik ihtiyaçlarını destekleyerek gebelik sürecini daha sağlıklı ve bilinçli bir şekilde deneyimlemelerine olanak tanır. Aynı zamanda gebenin bilinçlenmesini sağlayarak stresle baş etme yöntemlerini öğrenmesine, doğum korkusunu daha etkili bir şekilde yönetmesine, maternal bağlanmanın artmasına, sosyal destek mekanizmalarını güçlendirmesine ve ebe-gebe iletişimini pekiştirmesine yardımcı olur. Bütüncül bakım anlayışı, gebelik ve doğum süreçlerinde hem fizyolojik hem de duygusal iyileşmeyi sağlarken, ebelik bakımının temelinde bireyin tüm boyutlarıyla ele alınmasının gerekliliğini vurgulamaktadır. Bu derlemede, gebelere yönelik Neuman sistemler modeline dayılı bütüncül ebelik bakım yaklaşım ve uygulamaları incelenerek, doğum ekibi içerisinde yer alan sağlık profesyonellerine rehberlik edecek bir perspektif sunulması amaçlanmıştır.

Anahtar Kelimeler

• Holistic Care
• Midwifery
• Midwifery Care
• Pregnancy

Kaynakça

1. Acar, N. (2016). Breath, its use, and vocal training. Ulakbilge Journal of Social Sciences, 4(8), 231-246.
2. Aksoy, A., & Vefikuluçay Yılmaz, D. (2019). Nursing care plan for an individual diagnosed with threatened preterm labor based on the Neuman Systems Model: A case study. Balıkesir Journal of Health Sciences, 8(3), 177-186.
3. Alivand, Z., Nourizadeh, R., Hakimi, S., Esmaeilpour, K., & Mehrabi, E. (2023). The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial. BMC psychiatry, 23(1), 929.
4. Allen, S. F., Wetherell, M. A., & Smith, M. A. (2020). Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals. Psychiatry Research, 284, 112697.
5. Anolak, M. H. (2022). Creative arts intervention in support of women experiencing a high-risk pregnancy. Women and Birth, 35, 7.
6. Atabek Aştı, T., & Karadağ, A. (2013). Fundamentals of Nursing: The science and art of nursing. Istanbul: Akademi.
7. Bhartia, N., Jain, S., Shankar, N., Rajaram, S., & Gupta, M. (2019). Effects of antenatal yoga on maternal stress and clinical outcomes in north indian women: A randomised controlled trial. J. Indian Acad. Clin. Med, 20(11).
8. Bruce, D., & Hackett, S. S. (2021). Developing art therapy practice within perinatal parent-infant mental health. International Journal of Art Therapy, 26(3), 111-122.

9. Chaharrahifard, L., Motlagh, A. J., Akbari-Kamrani, M., Ataee, M., & Esmaelzadeh–Saeieh, S. (2021). The effect of midwife-led psycho-education on parental stress, postpartum depression and parental competency in high risk pregnancy women: a randomized controlled trial. Journal of Caring Sciences, 10(2), 70.
10. Chen, P. J., Yang, L., Chou, C. C., Li, C. C., Chang, Y. C., & Liaw, J. J. (2017). Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial. Complementary therapies in medicine, 31, 109-117.
11. Chitracheti, S. N. (2024). Holistic Care for Women During Pregnancy to Improve Outcomes: A Heartfulness Approach. Vidhyayana-An International Multidisciplinary Peer-Reviewed E-Journal-ISSN 2454-8596, 10(s1), 875-882.
12. Crepinsek, M., Bell, R., Graham, I., & Coutts, R. (2022). Towards a conceptualisation of woman centred care—a global review of professional standards. Women and birth, 35(1), 31-37.
13. Çatalgöl, Ş., & Ceber Turfan, E. (2022). The effects of music therapy applied to pregnant women on maternal, fetal, and neonatal results: A randomized controlled study. Health Care for Women International, 43(5), 448-464.
14. Estrella‐Juarez, F., Requena‐Mullor, M., Garcia‐Gonzalez, J., Lopez‐Villen, A., & Alarcon‐Rodriguez, R. (2023). Effect of virtual reality and music therapy on the physiologic parameters of pregnant women and fetuses and on anxiety levels: A randomized controlled trial. Journal of Midwifery & Women's Health, 68(1), 35-43.
15. Fancourt, D., & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe.
16. Fancourt, D., & Perkins, R. (2018). Could listening to music during pregnancy be protective against postnatal depression and poor wellbeing post birth? Longitudinal associations from a preliminary prospective cohort study. BMJ open, 8(7), e021251.
17. Garcia-Gonzalez, J., Ventura-Miranda, M. I., Requena-Mullor, M., Parron-Carreño, T., & Alarcon-Rodriguez, R. (2018). State-trait anxiety levels during pregnancy and foetal parameters following intervention with music therapy. Journal of Affective Disorders, 232, 17-22.
18. Guennec, S., & Wendland, J. (2023). Evaluation of Haptonomy's Effects on Maternal Depressive and Anxious Symptoms during Pregnancy. Périnatalité, 15(1), 10-18.
19. Hannoodee, S., & Dhamoon, A. S. (2020). Nursing neuman systems model.
20. Horden, P. (Ed.). (2017). Music as medicine: The history of music therapy since antiquity. Routledge.
21. Horsch, A., Tolsa, J. F., Gilbert, L., Du Chêne, L. J., Müller-Nix, C., & Graz, M. B. (2016). Improving maternal mental health following preterm birth using an expressive writing intervention: a randomized controlled trial. Child Psychiatry & Human Development, 47, 780-791.
22. Jahdi, F., Sheikhan, F., Haghani, H., Sharifi, B., Ghaseminejad, A., Khodarahmian, M., & Rouhana, N. (2017). Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial). Complementary therapies in clinical practice, 27, 1-4.
23. Klabbers, G. A., & Vingerhoets, A. J. J. M. (2021). What is the effect of haptotherapy on patients with chronic pain. International Journal of Haptonomy and Haptotherapy, 1(1), 1–9. https://doi.org/10.61370/xzug1370
24. Leutenegger, V., Grylka-Baeschlin, S., Wieber, F., Daly, D., & Pehlke-Milde, J. (2022). The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review. BMC Pregnancy and Childbirth, 22(1), 856.
25. Lönnberg, G., Jonas, W., Unternaehrer, E., Bränström, R., Nissen, E., & Niemi, M. (2020). Effects of a mindfulness based childbirth and parenting program on pregnant women's perceived stress and risk of perinatal depression–Results from a randomized controlled trial. Journal of affective disorders, 262, 133-142.
26. Nan, J. K. M. (2020). From clay to ceramic: An alchemical process of self-transformation. In Craft in Art Therapy (pp. 55-71). Routledge.
27. Ozbek, H., & Pinar, S. E. (2023). The effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment: A randomized controlled experimental study. Current Psychology, 42(27), 23313-23322. https://doi.org/10.1007/s12144-022-03388-1
28. Örün, D., Karaca, S., & Arıkan, Ş. (2022). The effect of breathing exercises on stress hormones. Cyprus Journal of Medical Sciences, 7(1), 54-59. https://doi.org/10.4274/cjms.2021.2020.2390
29. Öztürk, G. (2020). Developing and evaluating the effectiveness of a guide to coping with fear of childbirth. [Unpublished doctoral dissertation], Aydın Adnan Menderes University.
30. Pan, W. L., Chang, C. W., Chen, S. M., & Gau, M. L. (2019). Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood-a randomized control trial. BMC pregnancy and childbirth, 19, 1-8.
31. Papathanasiou, I., Sklavou, M., & Kourkouta, L. (2013). Holistic nursing care: Theories and perspectives. American Journal of Nursing Science, 2(1), 1-5.
32. Pennebaker, J. W., & Chung, C. K. (2013). 18 Expressive Writing: Connections Physical and Mental Health to. The Oxford handbook of health psychology, 417.
33. Qian, J., Zhou, X., Sun, X., Wu, M., Sun, S., & Yu, X. (2020). Effects of expressive writing intervention for women's PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry research, 288, 112933.
34. Rakhshani, A., Nagarathna, R., Mhaskar, R., Mhaskar, A., Thomas, A., & Gunasheela, S. (2012). The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: a randomized controlled trial. Preventive medicine, 55(4), 333-340.
35. Renzi, A., Solano, L., Di Trani, M., Ginobbi, F., Minutolo, E., & Tambelli, R. (2020). The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment. Psychology & Health, 35(6), 718-733.
36. Rizki, F. (2022). Application of antenatal care with a holistic approach in reducing anxiety. Jurnal Kesehatan Ibu dan Anak, 16(1), 33-40.
37. Sabancı Baransel, E., & Barut, S. (2024). The effect of diaphragmatic breathing exercises on coping with fetal health anxiety and prenatal stress. Journal of Exercise Therapy & Rehabilitation, 11(2).
38. Sedlmeier, P., Eberth, J., Schwarz, M., Zimmermann, D., Haarig, F., Jaeger, S., & Kunze, S. (2012). The psychological effects of meditation: A meta-analysis. Psychological Bulletin, 138(6), 1139.
39. Sezen, C., & Ünsalver, B. Ö. (2019). Group art therapy for the management of fear of childbirth. The Arts in Psychotherapy, 64, 9-19.
40. Shafqat, N., Agrawal, A., Pushpalatha, K., Singh, B., Verma, R., Podder, L., ... & Sutar, R. F. (2024). Effect of Music Therapy on Anxiety in Pregnancy: A Systematic Review of Randomized Controlled Trials. Cureus, 16(9), e69066
41. Sharifpour, L., Askarizadeh, G., & Bagheri, M. (2023). Investigating the effectiveness of art therapy based on painting on sleep quality of pregnant women. Journal of Research and Health, 13(2), 123-132.
42. Sherfield, E. (2021). The experience of women on a high-risk pregnancy unit engaged in art therapy.
43. Shorey, S., Loh, D. N. L., Chan, V., Chua, C., & Choolani, M. A. (2022). Parents’ perceptions of antenatal educational programs: a meta-synthesis. Midwifery, 113, 103432.
44. Smuts, J. C. (1926). Holism and Evolution. 3rd Edition. Reprinted by Kessinger Publisher. New York: The Macmillan Company; 84-100.
45. Sun, Y., Li, Y., Wang, J., Chen, Q., Bazzano, A. N., & Cao, F. (2024). Effectiveness of smartphone-based mindfulness training on maternal perinatal depression: randomized controlled trial. Journal of Medical Internet Research, 23(1), e23410.
46. Telles, S., Gupta, R. K., Bhardwaj, A. K., Singh, N., Mishra, P., Pal, D. K., & Balkrishna, A. (2018). Increased mental well-being and reduced state anxiety in teachers after participation in a residential yoga program. Medical science monitor basic research, 24, 105.
47. Traylor, C. S., Johnson, J. D., Kimmel, M. C., & Manuck, T. A. (2020). Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. American Journal of Obstetrics & Gynecology MFM, 2(4), 100229.
48. Wilson, H. (2024). Holistic Education to Empower and Enhance Women's Health Throughout Pregnancy, Birth, and the Postpartum Period.
49. Wulff, V., Hepp, P., Wolf, O. T., Balan, P., Hagenbeck, C., Fehm, T., & Schaal, N. K. (2021). The effects of a music and singing intervention during pregnancy on maternal well-being and mother–infant bonding: a randomised, controlled study. Archives of gynecology and obstetrics, 303, 69-83.
50. Yaqoob, A., Jan, R., Rattani, S., & Kumar, S. (2023). Betty Neuman System Model: A Concept Analysis. Anxiety, 7, 011-015.