DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL BAKIŞ; RİSKLER VE FAYDALARI

Öz

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

Anahtar Kelimeler

• 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

Kaynakça

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