Doğumun anatomisi ve fizyolojisi ve ilişkili davranışsal ipuçları
Özet
Doğum eyleminin anatomisi, fizyolojisi ve ilişkili davranışsal ipuçları, geleneksel olarak katı sınırlarla sınıflandırılsa da karmaşık ve doğrusal olmayan süreçler içerir. Araştırmalar, doğumun başlangıcını kadınların ve profesyonellerin farklı algıladığını, latent ve aktif evre tanımlarında geniş belirsizlikler bulunduğunu göstermektedir. Doğum eylemi fetüs tarafından tetiklenen hormonal mekanizmalarla, özellikle oksitosin ve prostaglandin seviyelerindeki artışla başlar; bu süreç anneyi sakinleştirirken ağrıyı ve stresi azaltır. Son çalışmalar, doğumun Friedman'ın geleneksel normlarından çok daha uzun sürebileceğini ve kişiye özel bakım gerektirdiğini kanıtlamıştır. Vajinal muayene gibi geleneksel yöntemlerin güvenilirliği sorgulanırken, mor çizgi gibi invaziv olmayan göstergeler ve ritmik hareketler gibi davranışsal ipuçları ilerlemeyi takip etmede önem kazanmaktadır. Ayrıca, doğum ortamının psikososyal etkisi büyüktür; ev veya merkez gibi alanlarda kadınlar daha aktif davranırken, dik pozisyonlar ve mobilizasyon yerçekimi etkisiyle pelvik boyutları genişleterek süreci kolaylaştırır. Doğum öncesi eğitim, su kullanımı, hipnoz, masaj ve ebelerin sağladığı sürekli destek ise ağrıyı ve müdahale oranlarını azaltarak vajinal doğumu teşvik eder.
The anatomy, physiology of labor, and associated behavioral cues involve complex and non-linear processes, although traditionally categorized by rigid boundaries. Research shows that women and professionals perceive the onset of labor differently, and wide uncertainties exist in the definitions of latent and active phases. Labor begins with hormonal mechanisms triggered by the fetus, particularly an increase in oxytocin and prostaglandin levels, which calms the mother while reducing pain and stress. Recent studies have proven that labor can take much longer than Friedman's traditional norms and requires personalized care. While the reliability of traditional methods like vaginal examinations is questioned, non-invasive indicators such as the purple line and behavioral cues like rhythmic movements are gaining importance in tracking progress. Furthermore, the psychosocial impact of the birth environment is significant; women behave more actively in spaces like home or birth centers, while upright positions and mobilization facilitate the process by expanding pelvic dimensions through the effect of gravity. Antenatal education, water immersion, hypnosis, massage, and continuous support provided by midwives promote vaginal delivery by reducing pain and intervention rates.
Referanslar
Abalos E, Oladapo OT, Chamillard M, Díaz V, Pasquale J, Bonet M, Souza JP, Gülmezoglu AM. 2018 Duration of spontaneous labour in ‘low-risk’ women with ‘normal’ perinatal outcomes: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:123-132. doi: 10.1016/j.ejogrb.2018.02.026. Epub 2018 Feb 27.
Albers, L., Schiff, M. & Gorwoda, J. 1996. The length of active labor in normal pregnancies. Obstetrics and Gynecology, 87, 355-9.
Beebe, K. R. & Humphreys, J. 2006. Expectations, perceptions, and management of labor in nulliparas prior to hospitalization. J Midwifery Womens Health, 51, 347-53.
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K. & Cuthbert, A. 2017. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews.
Borrelli, S. E., Locatelli, A. & Nespoli, A. 2013. Early pushing urge in labour and midwifery practice: A prospective observational study at an Italian maternity hospital. Midwifery, 29, 871-875.
Buckley, S. J. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care.
Washington, D.C.: Childbirth Connection Programs, National Partnership for Women & Families. Burvill, S. 2002. Midwifery diagnosis of labour-onset. British Journal of Midwifery, 10, 600-605.
Byrne, D. & Edmonds, D. K. 1990. Clinical method for evaluating progress in first stage of labour. The Lancet, 335, 122. Carbonne, B., Benachi, A., Leveque, M., Cabrol, D. & Papiernik, E. 1996. Maternal position during labor: effects on fetal oxygen saturation measured by pulse oximetry. Obstet Gynecol 88, 797-800. Cheyne, H.,
Dowling, D. W. & Hundley, V. 2006. Making the diagnosis of labour: midwives’ diagnostic judgement and management decisions. J Adv Nurs, 53. Davis, E. 1992. Heart and hands, Berkeley, Celestial Arts.
Dixon, L., Skinner, J. & Foureur, M. 2013. Women’s perspectives of the stages and phases of labour. Midwifery, 29, 10-17.
Dixon, L., Skinner, J. & Foureur, M. 2014. The emotional journey of labour—Women’s perspectives of the experienceof labour moving towards birth. Midwifery, 30, 371-377.
Downe, S., Finlayson, K., Melvin, C., Spiby, H., Ali, S., Diggle, P., Gyte, G., Hinder, S., Miller, V., Slade, P., Trepel, D., Weeks, A., Whorwell, P. & Williamson, M. 2015. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG: An International Journal of Obstetrics & Gynaecology, 122, 1226-1234.
Downe, S., Gyte, G. M. L., Dahlen, H. G. & Singata, M. 2013. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database of Systematic Reviews.
Downe, S., Young, C. & Moran, V. H. 2008. The early pushing urge: practice and discourse. In: DOWNE, S. (ed.) Normal Childbirth: Evidence and Debate. 2nd ed.
Duff, M. 2005. A study of labour. PhD, University of Technology.
E., A., Oladapo O.T, Chamillard M, Díaz V, Pasquale J, Bonet M, Souza J.P & A.M., G. 2018. Duration of spontaneous labour in ‘low-risk’ women with ‘normal’ perinatal outcomes: A systematic review. European Journal of Obstetrics and Gynecology and Reproductive Biology, 1, 123-32.
Eri, T. S., Bondas, T., Gross, M. M., Janssen, P. & Green, J. M. 2015. A balancing act in an unknown territory: A metasynthesis of first-time mothers’ experiences in early labour. Midwifery, 31, e58-e67. Finlayson, K., Downe, S., Hinder, S., Carr, H., Spiby, H. & Whorwell, P. 2015. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour. BMC Pregnancy and Childbirth, 15, 229.
Friedman, E. A. 1954. The graphic analysis of labor. The American Journal of Obstetrics and Gynecology, 68, 1568-1575. Friedman, E. A. 1955. Primigravid labor: A graphicostaticial analysis. American Journal of Obstetrics and Gynecology, 6, 567-589.
Goodenough, D. A. & Paul, D. L. 2009. Gap Junctions. Cold Spring Harbor Perspectives in Biology, 1, a002576. Gross, M. M., Burian, R. A., Fromke, C., Hecker, H., Schippert, C. & Hillemanns, P. 2009. Onset of labour: women’s experiences and midwives’ assessments in relation to first stage duration. Arch Gynecol Obstet, 280.
Gross, M. M., Haunschild, T., Stoexen, T., Methner, V. & Guenter, H. H. 2003. Women’s recognition of the spontaneous onset of labor. Birth, 30.
Gupta, J., Hofmeyr, G. & Shehmar, M. 2012. Position in the second stage of labour for women without epidural anaesthesia. . Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD002006. DOI: 10.1002/14651858. CD002006.pub3.
Gupta, J. K., Sood, A., Hofmeyr, G. J. & Vogel, J. P. 2017. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews.
Hanley, G. E., Munro, S., Greyson, D., Gross, M. M., Hundley, V., Spiby, H. & Janssen, P. A. 2016. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Pregnancy and Childbirth, 16, 71.
Haslinger, C., Burkhardt, T., Stoiber, B., Zimmermann, R. & Schäffer, L. 2015. Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study. Journal of Perinatal Medicine. , 43, 715- 20.
Hildingsson, I., Blix, E., Hegaard, H., Huitfeldt, A., Ingversen, K., Ólafsdóttír, Ó. Á. & Lindgren, H. 2015. How Long Is a Normal Labor? Contemporary Patterns of Labor and Birth in a Low-Risk Sample of 1,612 Women from Four Nordic Countries. . Birth: Issues In Perinatal Care, 42, 346-353.
Hollins Martin, C. J. & Martin, C. R. 2013. A narrative review of maternal physical activity during labour and its effects upon length of first stage. Complementary Therapies in Clinical Practice, 19, 44-49.
Johnstone, M. 1974. Facial vasomotor behaviour. Br J Anaesth, 46, 765-9.
Jones, L., Othman, M., Dowswell, T., Alfirevic, Z., Gates, S., Newburn, M., Jordan, S., Lavender, T. & Neilson, J. P. 2012.
Pain management for women in labour: An overview of systematic reviews. The Cochrane Library.
Levett, K. M., Smith, C. A., Bensoussan, A. & Dahlen, H. G. 2016. Complementary therapies for labour and birth study:a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open, 6.
Madden, K., Middleton, P., Cyna, A. M., Matthewson, M. & Jones, L. 2016. Hypnosis for pain management during labour and childbirth. Cochrane Database of Systematic Reviews.
Maharana, S., Nagarathna, R., Padmalatha, V., Nagendra, H. R. & Hankey, A. 2013. The effect of integrated yoga on labor outcome: A randomized controlled study. International Journal of Childbirth, 3, 165-177.
Mccourt, C. 2010. Cosmologies, concepts and theories: Time and childbirth in cross-cultural perspectives. In:
MCCOURT, C. (ed.) Childbirth, Midwifery and Concepts of Time. Oxford: Berghahn Books.
Mccourt, C. & Dykes, F. 2010. From tradition to Modernity: Time and childbirth in historical perspective. In: MCCOURT, C.(ed.) Childbirth, Midwifery and Concepts of Time. New York: Berghahn Books. Mcintosh, T. 2013. The concept of early labour in the experience of maternity in twentieth century Britain. Midwifery, 29, 3-9.
Michel, S., Rake, A. T., K., Seifert, B., Chaoui, R., Huch, R., Marincek, B. & Kubik-Huch, R. 2002. MR obstetric pelvimetry: Effect of birthing position on pelvic bony dimensions. American Journal of Roentgenology, 179, 1063-7.
Mondy, T., Fenwick, J., Leap, N. & Foureur, M. 2016. How domesticity dictates behaviour in the birth space: Lessons for designing birth environments in institutions wanting to promote a positive experience of birth. Midwifery, 43, 37-47.
Moraloglu, O., Kansu-Celik, H., Tasci, Y., Karakaya, B., Yilmaz, Y., Cakir, E. & Yakut, H. 2017. The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. The Journal of Maternal-Fetal & Neonatal Medicine. , 30, 245-9.
National Institute for Health and Care Excellence 2017. Intrapartum care for healthy women and babies (CG190). London: NICE.
Nolan, M., Smith, J. & Catling, J. 2009. Experiences of early labour (1) Contact with health professionals. The Practising Midwife, 12, 21-24.
Oladapo OT, Souza JP, Fawole B, Mugerwa K, Perdoná G, Alves D, Souza H, Reis R, Oliveira-Ciabati L, Maiorano A, Akintan A, Alu FE, Oyeneyin L, Adebayo A, Byamugisha J, Nakalembe M, Idris HA, Okike O, Althabe F, Hundley V, Donnay F, Pattinson R, Sanghvi HC, Jardine JE, Tunçalp Ö, Vogel JP, Stanton ME, Bohren M, Zhang J, Lavender T, Liljestrand J, Ten Hoope-Bender P, Mathai M, Bahl R, Gülmezoglu AM. 2018 Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries. PLoS Med. 2018 Jan 16;15(1):e1002492. doi: 10.1371/journal.pmed.1002492. eCollection 2018 Jan.
Olza, I., Leahy-Warren, P., Benyamini, Y., Kazmierczak, M., Karlsdottir, S. I., Spyridou, A., Crespo- Mirasol, E., Takács, L., Hall, P. J., Murphy, M., Jonsdottir, S. S., Downe, S. & Nieuwenhuijze, M. J. 2018. Women’s psychological experiences of physiological childbirth: a meta-synthesis. BMJ Open, 8, e020347.
Phelps, J. Y., Higby, K., Smyth, M. H., Ward, J. A., Arredondo, F. & Mayer, A. R. 1995. Accuracy and intraobserver variability of simulated cervical dilatation measurements. American Journal of Obstetrics and Gynecology, 173, 942-945.
Poder, T. & Larivière, M. 2014. Advantages and disadvantages of water birth. A systematic review of the literature. Gynecol Obstet Fertil. , 42, 706-13.
Priddis, H., Dahlen, H. & Schmied, V. 2012. What are the facilitators, inhibitors, and implications of birth positioning? A review of the literature. Women and Birth, 25, 100-106.
Reed, R., Barnes, M. & Rowe, J. 2015. Women’s experience of birth: Childbirth as a rite of passage. International Journal of Childbirth, 5, 46-56.
Shepherd, A., Cheyne, H., Kennedy, S., Mcintosh, C., Styles, M. & Niven, C. 2010. The purple line as a measure of labourprogress: a longitudinal study. BMC Pregnancy and Childbirth, 10, 54.
Smith, C. A., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H. G. & Suganuma, M. 2018a. Relaxation techniques for pain management in labour. Cochrane Database of Systematic Reviews.
Smith, C. A., Levett, K. M., Collins, C. T., Dahlen, H. G., Ee, C. C. & Suganuma, M. 2018b. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews.
Stark, M. 2013. Therapeutic showering in labor. Clinical Nursing Research, 22, 359-374.
Stark, M. 2017. Testing the effectiveness of therapeutic showering in labor. J Perinat Neonatal Nurs, 31, 109-117. The American College of Obstetricians and Gynecologists 2017. Approaches to Limit Intervention During Labor and Birth - Committee Opinion 687. Obstet Gynecol, 1-9.
Tuffnell, D. J., Johnson, N., Bryce, F. & Lilford, R. J. 1989. Simulation of cervical changes in labour: Reproducibility of expert assessment. The Lancet, 334, 1089-1090.
Uvnäs Moberg, K., Handlin, L. & Petersson, M. 2014. Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Frontiers in Psychology, 5, 1529.
Walmsley, K. 2003. Caring for women during the latent phase of labour. In: WICKHAM, S. (ed.)
Midwifery: Best practice. London: Elsevier.
Winter, C. & Duff, M. 2009. The progress of labour: orderly chaos? . In: MCCOURT, C. (ed.) Childbirth, Midwifery and Concepts of Time. London: Berghaun Books.
World Health Organization 2018. WHO recommendations: intrapartum care for a positive childbirth experience.
Geneva: World Health Organization. Zhang, H.-Y., Shu, R., Zhao, N.-N., Lu, Y.-J., Chen, M., Li, Y.-X., Wu, J.-Q., Huang, L.-H., Guo, X.-L., Yang, Y.-H., Zhang,
X.-L., Zhou, X.-Y., Guo, R.-F., Li, J. & Cai, W.-Z. 2016. Comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position. International Journal of Nursing Sciences, 3, 178- 184.
Zhang, J., Landy, H. J., Branch, D. W., Burkman, R., Haberman, S., Gregory, K. D., Hatjis, C. G., Ramirez, M. M., Bailit, J. L., Gonzalez-Quintero, V. H., Hibbard, J. U., Hoffman, M. K., Kominiarek, M., Learman, L. A., Van Veldhuisen, P., Troendle, J. & Reddy, U. M. 2010a. Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes. Obstetrics and gynecology, 116, 1281-1287. Zhang, J., Troendle, J., Mikolajczyk, R., Sundaram, R., Beaver, J. & Fraser, W. 2010b. The natural history of the normal first stage of labor. Obstet Gynecol, 115
