İntrapartum Dönemde Kanıta Dayalı Uygulamalar: Doğum Yapan Kadınların Tercihleri

Giriş: Son yıllarda kanıta dayalı uygulama intrapartum bakım kalitesini arttırmak için etkili bir strateji olarak kabul edilmektedir. Dünya Sağlık Örgütü, etkisiz ve zararlı klinik uygulamaların kanıta dayalı uygulamalarla değiştirilmesi gerektiğini vurgulamaktadır. Amaç: Bu araştırmanın amacı intrapartum dönemde kanıta dayalı uygulamalar doğrultusunda uygulanan girişimler hakkında kadınların tercihlerini belirlemektir. Yöntem: Tanımlayıcı tipteki bu araştırmanın örneklemini Manisa’da bir devlet hastanesinde normal doğum yapan 325 kadın oluşturmuştur. Veriler tanımlayıcı analizler ile SPSS 21.0 programı kullanılarak değerlendirilmiştir. Bulgular: Kadınların yaş ortalaması 26.0±3.6’dır. İntrapartum dönemde kadınların %84.0’ı bir şeyler yemek istediğini, %96.6’sı yakınlarından birinin yanında kalmasını istediğini, %97.8’i nefes alma-gevşeme teknikleri yapmak istediğini, %48.9’u masaj yapılmasını istediğini, %97.8’i duygusal destek verilmesini istediğini ve %93.5’i odada hareket etmeyi istediğini belirtmiştir. Kadınların istemediği girişimler indüksiyon (%95.0), karnına basınç (%95.1), lavman (%92.6) ve epizyotomidir (%95.1). Kadınların %0.9’u ayakta, %2.2’si çömelme, oturma pozisyonunda ve %42.5’i suda doğum yapmak istediğini belirtmiştir. Sonuç: Bu çalışmada kadınların çoğunluğu intrapartum dönemde uygulanan etkisiz ba

Anahtar Kelimeler:

Kanıta Dayalı Uygulamalar, İntrapartum Dönem, Doğum, Kadınların Tercihleri.

Evidence-Based Practice During Intrapartum Period: Preferences of Women Giving Birth

Background: Evidence-based practice is an effective strategy to improve the quality of intrapartum care especially in recent years. The World Health Organization has emphasized that the ineffective and harmful clinical practices should be replaced with evidence-based ones. Objectives: The aim of the study is to determine women’s preferences about effective and ineffective interventions during intrapartum period in accordance with evidence-based practices. Methods: The descriptive study sample included 325 women who had vaginal delivery at a state hospital in Manisa. Descriptive analysis was performed for evaluating data by using SPSS 21.0. Results: The mean age of the women was 26.0 ±3.6. In intrapartum period, 84.0% of the women wanted to eat something, 96.6% wanted to stay with one of their relatives, 97.8% wanted to do breathing-relaxation techniques, 48.9% wanted massage, 97.8% wanted emotional support and 93.5% wanted to move in the room. Women did not want induction (95.0%), abdominal pressure (95.1%), enema (92.6%) and episiotomy (95.1%). Overall, 0.9% of the women wanted to deliver their baby by standing, 2.2% in squatting and sitting position, and 42.5% in water. Conclusion: Most of women stated that they did not want some ineffective interventions to be applied during intrapartum period. Women’s preferences should be considered providing evidence-based intrapartum care

Keywords:

Evidence-Based Practices, Intrapartum Period, Birth, Women’s Preference.,

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Aasheim, V., Nilsen, A.B., Lukasse, M., & Reinar, L.M. (2011, Dec 7). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Systematic Reviews, 12, Art. No: CD006672. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006672.pub2/pdf/
Alfirevic, Z., Devane, D., & Gyte, G.M. (2013, May 31). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Systematic Reviews, 5, Art. No: CD006066. Retrived November 9
2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006066.pub2/pdf Basevi, V., & Lavender, T. (2014, Nov 14). Routine perineal shaving on admission in labour. Cochrane Database Systematic Reviews, 11
Art. No: CD001236. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001236.pub2/pdf
Berghella, V., Baxter, J.K., & Chauhan, S.P. (2008). Evidence-based labor and delivery management. American Journal of Obstetrics & Gynecology, 199 (5), 445-454.
Bugg, G.J., Siddiqui, F., & Thornton, G.J. (2011, Jul 6). Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Systematic Reviews, 6, Art No: CD007123. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007123.pub2/full.
Carroli, G., & Mignini, L.. (2009, Jan 21). Episiotomy for vaginal birth. Cochrane Database Systematic Reviews, 1, Art No:CD000081. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000081.pub2/pdf/
Chen, C., Wang, S.Y., & Chang, M.Y. (2001). Women’s perceptions of helpful and unhelpful nursing behaviors during labor: A study in Taiwan. Birth, 28 (3), 180-185.
Chen, C.Y., & Wang, K.G. (2006). Are routine interventions necessary in normal birth? Taiwanese Journal of Obstetrics and Gynecology, 45 (4), 302-306.
Conde-Agudelo, A., Rosas-Bermudez, A., & Gulmezoglu, A.M. (2008). Evidence-based intrapartum care in Cali, Colombia: A quantitative and qualitative study. BJOG: An International Journal of Obstetrics and Gynaecology, 3, 1547-1549.
Creedon, D., Akkerman, D., Atwood, L., Bates, L., Harper, C., Levin, A., et al. (2013, March). Management of labor. Institute for Clinical Systems Improvement. Retrived November 9, 2016, from http://www.spog.org.pe/web/phocadownloadpap/GUIAMANEJODELPARTO.pdf
Dahlen, H.G., Homer, C.S.E., Cooke, M., Upton, A.M., Nunn, R., & Brodrick, B. (2007). Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial. Birth, 34, 282-290.
Downe, S., Gyte, G.M.L., Dahlen, H.G., & Singata, M. (2013, Jul 15). Routine vajinal examinations for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database Systematic Reviews, 7, Art No: CD010088. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010088.pub2/pdf
Gülmezoğlu, A.M., Langer, A., Piaggio, G., Lumbiganon, P., Villar, J., & Grimshaw, J. (2007). Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices. BJOG: An International Journal of Obstetrics and Gynaecology, 114 (1),16–23.
Hodnett, E.D, Gates, S., Hofmeyr, G.J, & Sakala, C. (2013, Jul 15). Continuous support for women during childbirth. Cochrane Database Systematic Reviews, 7, Art. No: CD003766. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003766.pub5/pdf
Hofmeyr, G.J. (2005). Evidence-based intrapartum care. Best Practice & Research Clinical Obstetrics & Gynaecology, 19 (1), 103–115. http://merkezefendidh.saglik.gov.tr/
Jones, L., Othman, M., Dowswell, T., Alfirevic, Z., Gates, S., Newburn, M., et al.(2012, May 5). Pain management for women in labour: an overview of systematic reviews. Cochrane Database Systematic Reviews, 3, Art. No: CD009234. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1111/j.1756-5391.2012.01182.x/full
Lawrence, A., Lewis, L., Hofmeyr, G.J., & Styles, C. (2013, Aug 20). Maternal positions and mobility during first stage labour. Cochrane Database Systematic Reviews, 10, Art No: CD003934. Retrived November 9, 2016, from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003934.pub3/pdf
Lothian, J.A., Amis, D., & Crenshaw, J. (2007). Care practice: no routine interventions. The Journal of Perinatal Education, 16 (3), 29-34.
Mclachlan, H., & Waldenström, U. (2005). Childbirth experiences in Australia of women born in Turkey, Vietnam, and Australia. Birth, 32 (4), 272-282.
Melo, I., Katz, L., Coutinho, I., & Amorim, M.M. (2014, Aug 14). Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial. Reproductive Health, 11:66. Retrived November 9, 2016, from http://www.reproductive-healthjournal.com/content/11/1/66