İntrapartum Dönemde Sürekli Bakım ve Ebelerin Rolü

İntrapartum dönemde sürekli bakım, gebe kadınlara doğum sürecinde ebe veya bu konuda eğitim almış bir sağlık profesyoneli tarafından birebir bakım sağlanması ve uygulanması olarak tanımlanmaktadır. Sürekli bakım kavramı; Ulusal Sağlık ve Bakım Mükemmelliği Enstitüsü (National Institute for Health and Care Excellence), Kraliyet Kadın Hastalıkları ve Doğum Uzmanları Koleji (Royal College of Obstetricians and Gynaecologists), Ulusal Sağlık Sistemi (National Health Service), Dünya Sağlık Örgütü (World Health Organization) gibi uluslararası kuruluşların raporlarında yer verilen ve doğum hizmetlerinin niteliğini artırmak için önerilen bakımdır. Doğum sırasında sürekli ebelik bakımının; doğum sürecine, doğum sonuçlarına olumlu katkı sağladığı, doğum eylemine gereksiz müdahaleleri azalttığı pek çok çalışma ile kanıtlanmıştır. Travay ve doğum sürecinde sağlanan sürekli bakım, olumlu sağlık çıktılarının yanı sıra doğum yapan kadının ve doğum hizmeti veren sağlık çalışanlarının doğum memnuniyetini de arttırmaktadır. Sürekli bakımın merkezinde ebelik hizmetleri yer almaktadır. Ancak sürekli bakımın sağlanmasının önünde sağlık kurum ve politikalarının yetersiz desteği, ebelikte örgütlenme yetersizliği ve doğum hizmetlerinin planlanmasından kaynaklı çok yönlü engeller mevcuttur. Doğumda sürekli ebelik bakımı ile ilgili kanıta dayalı politikaların ulusal programlara ve sağlık hizmetlerine dâhil edilmesi, iyi planlanmış, katılımcı fikir birliğine dayalı uyum ve uygulama süreçlerine bağlıdır. Bu derlemede intrapartum dönemde sürekli bakımın önemi, bakımda ebelerin rolü ve sürekli ebelik bakımının önündeki engeller incelenmiştir.

Anahtar Kelimeler:

Gebelik, ebelik, intrapartum bakım, doğum

Continuous Care in the Intrapartum Period and the Role of Midwives

Continuous care in the intrapartum period is defined as providing and applying oneto- one care to pregnant women during the birth process by a midwife or a health professional trained in this subject. The concept of continuous care; such as the National Institute for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists, the National Health Service, and the World Health Organization. It is the care that is included in the reports of international organizations and that is recommended to increase the quality of maternity services. Continuous midwifery care during birth; It has been proven by many studies that it contributes positively to the birth process, birth results and reduces unnecessary interventions in labor. Continuous care provided during labor and delivery increases the satisfaction of the woman giving birth and the healthcare professionals providing birth services, as well as positive health outcomes. Midwifery services are at the center of continuous care. However, there are multiple obstacles in the way of providing continuous care due to insufficient support of health institutions and policies, insufficient organization in midwifery and planning of maternity services. The inclusion of evidence-based policies on continuing midwifery care in birth into national programs and health services depends on well-planned, participatory consensus-based compliance and implementation processes. In this review, the importance of continuous care in the intrapartum period, the role of midwives in care and the obstacles to continuous midwifery care are examined.

Keywords:

Pregnancy, midwifery, intrapartum care, childbirth,

PDF

___

Kerber KJ, Graft-Johnson JE, Zulfiqar AB, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. J Lancet. 2007 Oct 13;(370), p.1358–1369.
Dahlberg U, Aune I. The woman's birth experience-the effect of interpersonal relationships and continuity of care. Midwifery. 2013 Apr;29(4):407-15.
Royal College Of Obstetricians And Gynaecologists. Providing Quality Care for Women: Obstetrics and Gynaecology Workforce; 2016. Available from:https://www.rcog.org.uk/en/guidelines-research-services/guidelines/providing-quality-care-for-women-obstetrics-and-gynaecology-workforce/
National İnstitute For Health And Care Excellence. Making sure there are enough midwives to safely care for women and babies. 2015. Available from:https://www.nice.org.uk/guidance/ng4/resources/ making-sure-there-are-enough-midwives-to-safely-care-for-women-and-babies-pdf-6837671365
The National Health Service. National Maternity Review,Better Births. 2016. Available from:https://www.england.nhs.uk/wp-content/ uploads/2016/02/national-maternity-review-report.pdf
World Health Organization. World Health Statistics. 2015. Available from:https://www.who.int/docs/default-source/gho-documents/ world-health-statistic-reports/world-health-statistics-2015.pdf
Hodnett ED, Gates S, Hoffmeyer GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2013 Jul 15;7:CD003766.
Yanti Y, Claramita M, Emilia O, Hâkimi M. Students understanding of “Women-Centred Care Philosophy” in midwifery care through Continuity of Care (CoC) learning model: Aquasi-experimental study. BMC Nurs. 2015 Apr 22;14-22.
Guilliland K. Tracy S. Australia and New Zealand midwifery and Maternity Services. Midwifery: Preparation for Practice, 3rd ed;2015. Pp:3-38.
Pairman S. McAra- Couper J. Theoretical frameworks for midwifery practice. 2015. Midwifery: Preparation for Practice, 3rd ed;2015. Pp:383- 411.
Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG. 2018 Jul;125(8):932-942.
Dove S, Muir-Cochrane E. Being safe practitioners and safe mothers: A critical ethnography of continuity of care midwifery in Australia. Midwifery. 2014 Oct; 30 (10):1063-72.
Homer CS, Leap N, Edwards N, Sandall J. Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997-2009). Midwifery. 2017 May; 48:1-10.
Skinner J. Maude R. The tensions of uncertainty: Midwives managing risk in and of their practice. Midwifery. 2016 Jul; 38:35-41.
Wang M, Song Q, Xu J, Hu Z, Gong Y, Arier CL, et al. Continuous support during labour inchildbirth: a Cross-Sectional study in a university teaching hospital in Shanghai, China. BMC Pregnancy Childbirth. 2018 Dec 6;18(1):480.
Dekker R. Evidence Based Birth. Evidence on:Doulas. 2018. Available from: https://evidencebasedbirth.com/wp-content/uploads/2018/01/ Doula-Handout.pdf.
Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766.
Hunter LP. A descri ptive study of "being with woman" during labor and birth. J Midwifery Womens Health. Mar-Apr 2009;54(2):111-8.
Sehhatie F, Najjarzadeh M, Zamanzadeh V, Seyyedrasooli A. The effect of midwifery continuing care on childbirth outcomes. Iran J Nurs Midwifery Res. 2014 May;19(3): 233–7.
McLachlan HL, Forster DA, Davey MA, Farrell T, Flood M, Shafiei T, et al. The effect of primary midwife-led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial. BJOG. 2015,123(3):465-74.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD003766.
Bryanton J, Gagnon A, Johnston C, Hatem M. Predictors of women's perception of their childbirth experience. J Obstet Gynecol Neonatal Nurs. Jan-Feb 2008;37(1):24-34.
Hildingsson IM, Johansson M, Karlström A, Fenwick J. Factors associated with a positive birth experience. An exploration of Swedish women's experiences. Int J Childbirth. 2013, 3(3):153-164.
Uludağ E, Mete S. Doğum eyleminde destekleyici bakım. Cumhuriyet Hemşirelik Dergisi. 2014, 3(2): 22-9. Childbirth Connection. Giving Birth: Labor Support, Research and Evidence. 2018. Available from: http://www.childbirthconnection.org/ giving-birth/labor-support/resources/
Sosa G, Crozier K, Robinson J. What is meant by one to-one support in labour: analysing the concept. Midwifery. 2012, 28,451-457.
Ronald S. Gibbs, Beth Y. Karlan, Haney, Nygaard I. Normal doğum eylemi. Danforth’s Obstetrik ve Jinekoloji, Güneş Tıp Kitabevi. 2010, 21- 43.
Çiçek N, Akyürek C, Çelik Ç, Haberal A. Kadın Hastalıkları ve Doğum Bilgisi. Güneş Kitabevi. 2006, 217-238.
Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: A systematic review. Am J Obstet Gynecol. 2002; 186(5): 160- 72.
Teeffelen AS, Nieuwenhuijze M, Korstjens I. Women want proactive psychosocial support from midwives during transition to motherhood: A qualitative study. Midwifery. 2011; 27(1): 122-7.
Powell Kennedy H. The essence of nurse-midwifery care. The woman's story. J Nurse Midwifery. Sep-Oct 1995;40(5):410-7.
World Health Organization. Safe childbirth checklist implementation guide. 2015. Available from: https://apps.who. int/iris/bitstream/handle/10665/199177/9789241549455_eng. pdf;jsessionid=306983531A39DA985AF3222AB2049E22?sequence=1
World Health Organization. Intrapartum care for a positive childbirth experience 2018. Available from:https://apps.who.int/iris/bitstream/han dle/10665/260178/9789241550215-eng.pdf
Filby A, McConville F, Portela A. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective. PLoS One. 2016 May 2;11(5): e0153391.
Spencer NS, Preez A, Minnie CS. Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa. Health SA. 2018, 23: 1068.
Gu C, Zhang Z, Ding Y. Chinese midwives’ experience of providing continuity of care to labouring women. Midwifery. 2009, 27(2):243-9.
Walker DS, Worrell R. Promoting healthy pregnancies through Perinatal groups: a comparison of Centering Pregnancys group prenatal care and child- birth education classes. J. Perinat. Educ. 2008, 17, 27–34.
Gökçek A. İ., Yazıcı S. Doğum Desteği ve Ebelik Bakımı. Avrasya Sağlık Bilimleri Dergisi. 2022; 5(1): 93-99.