Dünyada Planlı Ev Doğumlarına Güncel Bakış; Riskler ve Faydaları

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 ye nidoğan sonuçları açısından daha değişkendir. Daha önceki araştırmalarda, düşük riskli kadında planlı ev doğumlarında, oksitosin indüksiyonu, sezaryen/operatif doğum, doğum son rası kanama, perineal laserasyon, farmakolajik analjezik ih tiyacı ve epizyotomi gibi müdahale ve maternal morbiditeler azalmış olarak bildirilmiştir. Düşük riskli kadında intrapartum fetal ölümler, yenidoğan ölümleri, düşük Apgar skorları ve ye nidoğan 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 bildi - rilmiştir. Fakat makat prezentasyon, çoğul gebelik, ve geçirilmiş sezaryen öyküsü olan kadınlarda evde doğum önerilme mektedir. 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. Planlı ev doğumlarının sonuçlarını gebelik sırasında alı - nan 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 uy - gulama 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 göz- den geçirecek ve planlı ev doğumlarının riskleri ve faydaları tartışacaktır.

A Current Overview of Planned Home Deliveries in The World; Risks And Benefits

In developed countries, the planned home delivery rate varies between 0.1% and 20%. In the last 20 years, espe cially 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 hemorrha ge, 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 diffrences for low-risk women between hospital and home births; in terms of intrapartum fetal deaths, neona tal deaths, low Apgar scores, and admission to the neonatal intensive care unit rates, other studies report increased nega tive 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 signifi - cantly 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 conditi - ons, avoid undesired interventions, and increase their satisfac tion because they can play an active role in decision-making at birth. Planned home births were effcted 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 / obstetrici - an 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 plan ned home births and maternal and neonatal outcomes with re gard to current studies and discuss the risks and benefits of planned home births.

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