Doğumda Zararın Önlenmesi ve Güvenli Bakım Prensipleri
Özet
Doğum süreci, fizyolojik bir olay olmakla birlikte anne ve yenidoğan açısından çeşitli riskler barındıran kritik bir dönemdir. Bu süreçte ortaya çıkan önlenebilir zararlar, anne ve yenidoğanın güvenliğini tehdit ederek morbidite ve mortalite yaşanmasına neden olabilir. Güncel literatür, doğumla ilişkili zararların önemli bir bölümünün kanıta dayalı, kadın merkezli ve saygılı bakım uygulamaları ile önlenebileceğini göstermektedir. Hasta güvenliği kavramı, doğumda zararın önlenmesine yönelik sistematik yaklaşımları, klinik uygulamaları ve sağlık hizmeti sunum süreçlerini kapsamaktadır. Bu kitap bölümünde, doğumda zarar kavramı ve hasta güvenliği ilişkisi ele alınmış; anneye ve yenidoğana yönelik fiziksel ve psikolojik zararlar ile bu zararları artıran risk faktörleri ayrıntılı olarak incelenmiştir. Ayrıca, doğumda zararın önlenmesi ve hasta güvenliğinin sağlanmasında kadın merkezli ebelik bakımı, kanıta dayalı uygulamalar, risk değerlendirmesi, sürekli izlem, etkili iletişim, olumlu hasta güvenliği kültürün oluşturulması ve ekip çalışmasının önemi vurgulanmıştır. Ebelerin doğum sürecinde hasta güvenliğinin sağlanmasındaki rolü, güncel literatür ışığında tartışılarak ebe liderliğinde sunulan bakım modellerinin anne ve yenidoğan güvenliği üzerindeki olumlu etkileri ortaya konmuştur.
Childbirth, while a physiological event, is a critical period involving various risks for both mother and newborn. Preventable harm during this process can threaten the safety of both mother and newborn, leading to morbidity and mortality. Current literature indicates that a significant portion of childbirth-related harms can be prevented through evidence-based, woman-centered, and respectful care practices. The concept of patient safety encompasses systematic approaches, clinical practices, and healthcare delivery processes aimed at preventing harm during childbirth. This book chapter addresses the relationship between the concept of harm during childbirth and patient safety; physical and psychological harms to the mother and newborn, and the risk factors that exacerbate these harms, are examined in detail. Furthermore, the importance of woman-centered midwifery care, evidence-based practices, risk assessment, continuous monitoring, effective communication, establishing a positive patient safety culture, and teamwork in preventing harm during childbirth and ensuring patient safety is emphasized. The role of midwives in ensuring patient safety during childbirth is discussed in light of current literature, and the positive effects of midwife-led care models on maternal and newborn safety are highlighted.
Referanslar
World Health Organization. Patient safety. World Health Organization. 2019. Erişim adresi: https://www.who.int/health-topics/patient-safety
Macleod H, Greenfield D. Navigating the complex terrain of patient safety: challenges, strategies, and the importance of ongoing evaluation and knowledge sharing. International Journal for Quality in Health Care. 2024;36(3): mzae074. doi:10.1093/intqhc/mzae074
World Health Organization. Maternal mortality (Fact sheet). World Health Organization. 2025. Erişim adresi: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Klemann D, Rijkx M, Mertens H, et al. Causes for medical errors in obstetrics and gynaecology: A systematic review. Healthcare. 2023;11(11): 1636. doi:10.3390/healthcare11111636
Rodziewicz TL, Houseman B, Vaqar S, et al. Medical error reduction and prevention. In: StatPearls [Internet]. StatPearls Publishing; 2024. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK499956
Renfrew MJ, McFadden A, Bastos MH, et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet. 2014;384(9948): 1129–1145. doi:10.1016/S0140-6736(14)60789-3
Bohren MA, Vogel JP, Hunter EC, et al. The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Medicine. 2015;12(6): e1001847. doi:10.1371/journal.pmed.1001847
Gregory S, Caffrey L, Daly D, et al. How woman-centred care is experienced and understood in maternity services by women and professionals: A rapid review. Scandinavian Journal of Caring Sciences. 2025;39(3): e70086. doi:10.1111/scs.70086
World Health Organization. Patient safety: Global action on patient safety. World Health Organization. 2019. Erişim adresi: https://iris.who.int/handle/10665/328696
International Federation of Gynecology and Obstetrics. Ethical framework for respectful maternity care during pregnancy and childbirth (FIGO Statement). International Federation of Gynecology and Obstetrics. 2021. Erişim adresi: https://www.figo.org/sites/default/files/2021-09/FIGO_Statement_Ethical-Framework-Respectful-Maternity-Care-During-Pregnancy-Childbirth_0.pdf
World Health Organization. WHO urges expansion of lifesaving midwifery care for women and babies. World Health Organization. 2024. Erişim adresi: https://www.who.int/news/item/16-10-2024-who-urges-expansion-of-lifesaving-midwifery-care-for-women-and-babies
International Confederation of Midwives. International definition and scope of practice of the midwife. International Confederation of Midwives. 2024. Erişim adresi: https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html
Fikre R, Gubbels J, Teklesilasie W, et al. Effectiveness of midwifery-led care on pregnancy outcomes in low- and middle-income countries: A systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2023;23: 386. doi:10.1186/s12884-023-05664-9
Sriram S, Almutairi FM, Albadrani M. Midwife-led versus obstetrician-led perinatal care for low-risk pregnancy: A systematic review and meta-analysis of 1.4 million pregnancies. Journal of Clinical Medicine. 2024;13(22): 6629. doi:10.3390/jcm13226629
World Health Organization. WHO urges expansion of lifesaving midwifery care for women and babies. World Health Organization. 2024. Erişim adresi: https://www.who.int/news/item/16-10-2024-who-urges-expansion-of-lifesaving-midwifery-care-for-women-and-babies
World Health Organization. Patient safety (Fact sheet). World Health Organization. 2023. Erişim adresi: https://www.who.int/news-room/fact-sheets/detail/patient-safety
World Health Organization. Global patient safety action plan 2021–2030: Towards eliminating avoidable harm in health care. World Health Organization. 2021. Erişim adresi: https://www.who.int/publications/i/item/9789240032705
Hüner B, Derksen C, Schmiedhofer M, et al. Preventable adverse events in obstetrics: Systemic assessment of their incidence and linked risk factors. Healthcare. 2022;10(1): 97. doi:10.3390/healthcare10010097
World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization. 2018. Erişim adresi: https://apps.who.int/iris/handle/10665/260178
Sobat H. Razlika između pogreške i komplikacije u naknadi štete. Liječnički vjesnik. 2008;130(11–12):302–304.
World Health Organization. Second global call for data on postpartum haemorrhage. World Health Organization. 2024. Erişim adresi: https://www.who.int/news-room/articles-detail/second-global-call-for-data-on-postpartum-haemorrhage
Volkert A, Bach L, Hagenbeck C, et al. Obstetric interventions’ effects on the birthing experience. BMC Pregnancy and Childbirth. 2024;24(1): 508. doi:10.1186/s12884-024-06626-5
Alrida NA, Ababneh A, Al-Sharif K, et al. A systematic review of the use of routine versus selective episiotomy for vaginal birth. Cureus. 2024;16(7): e65865. doi:10.7759/cureus.65865
Brady S, Gibbons KS, Bogossian F. Defining woman-centred care: A concept analysis. Midwifery. 2024;131: 103954. doi:10.1016/j.midw.2024.103954
Willan K, Moss RH, Santorelli G, et al. Effectiveness of a midwife-led continuity of care model on birth outcomes and maternal mental health in vulnerable women. BMJ Open. 2023;13(11): e072415. doi:10.1136/bmjopen-2023-072415
Bradford BF, Wilson AN, Portela A, et al. Midwifery continuity of care: A scoping review. PLOS Global Public Health. 2022;2(10): e0000935. doi:10.1371/journal.pgph.0000935
Ayers S, Bond R, Bertullies S, et al. The aetiology of post-traumatic stress following childbirth. Psychological Medicine. 2016;46(6): 1121–1134. doi:10.1017/S0033291715002706
Tomita Y, Kiriya J, Silwal RC, et al. Association between the person-centered maternity care experience and mental health after delivery. BMC Pregnancy and Childbirth. 2023;23: 398. doi:10.1186/s12884-023-05709-z
Jeong G, Kim HK, Bang U. Effect of a continuity of midwifery care model in Korea. Frontiers in Public Health. 2025;13: 1578158. doi:10.3389/fpubh.2025.1578158
World Health Organization Regional Office for Europe. Newborn health. World Health Organization. 2021. Erişim adresi: https://www.who.int/europe/news-room/fact-sheets/item/newborn-health
Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring. International Journal of Gynecology and Obstetrics. 2015;131(1): 5–8. doi:10.1016/j.ijgo.2015.06.018
World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization. 2018. Erişim adresi: https://www.who.int/publications/i/item/9789241550215
Al Wattar BH, Honess E, Bunnewell S, et al. Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes. Canadian Medical Association Journal. 2021;193(14): E468–E477. doi:10.1503/cmaj.202538
Shorey S, Wong PZE. Traumatic childbirth experiences of new parents: A meta-synthesis. Trauma, Violence, and Abuse. 2020. doi:10.1177/1524838020977161
Vincent C, Amalberti R. Safer healthcare: Strategies for the real world. Cham: Springer; 2016. doi:10.1007/978-3-319-25559-0
Waring J, Allen D, Braithwaite J, et al. Healthcare quality and safety. Sociology of Health and Illness. 2016;38(2): 198–215. doi:10.1111/1467-9566.12391
Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care. Cochrane Database of Systematic Reviews. 2016;4: CD004667. doi:10.1002/14651858.CD004667.pub5
Ramu B, Kanniyappan D, Rajendran SS, et al. Effect of midwife-led care models on maternal and fetal outcomes. Bioinformation. 2025;21(5): 957–961. doi:10.6026/973206300210957
Grigoletto V. Evidence-based practice in midwifery. Journal of Nursing and Care. 2025;14(1): 694. doi:10.37421/2167-1168.2025.14.694
Downe S, Finlayson K, Oladapo OT, et al. What matters to women during childbirth. PLoS One. 2018;13(4): e0194906. doi:10.1371/journal.pone.0194906
Kennedy HP, Cheyney M, Dahlen HG, et al. Asking different questions. Women and Birth. 2018;31(4): 242–243. doi:10.1016/j.wombi.2018.06.011
Sevransky JE, Agarwal A, Jabaley CS, et al. Standardized care is better than individualized care. Critical Care Medicine. 2021;49(1): 151–155. doi:10.1097/CCM.0000000000004676
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. 2016. Erişim adresi: https://www.who.int/publications/i/item/9789241549912
Souza JP, Tunçalp Ö, Vogel JP, et al. Obstetric transition. BJOG: An International Journal of Obstetrics and Gynaecology. 2014;121(Suppl. 1): 1–4. doi:10.1111/1471-0528.12735
International Confederation of Midwives. ICM global standards for midwifery education. International Confederation of Midwives. 2021. Erişim adresi: https://www.internationalmidwives.org/a-moment-for-midwives-2021/pdf/global-standards-for-midwifery-education_2021_en-1.pdf
Beauchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. Oxford: Oxford University Press; 2019.
The Joint Commission. National patient safety goals. The Joint Commission. 2021. Erişim adresi: https://www.jointcommission.org/en-us/standards/national-patient-safety-goals
Wu M, Tang J, Etherington C, et al. Interventions for improving teamwork in intrapartum care. BMJ Quality and Safety. 2020;29(1): 77–85. doi:10.1136/bmjqs-2019-009689
Vikan M, Haugen AS, Bjørnnes AK, et al. Patient safety culture and adverse events. BMC Health Services Research. 2023;23: 300. doi:10.1186/s12913-023-09332-8
Finn M, Walsh A, Rafter N, et al. Effect of interventions to improve safety culture. BMJ Open Quality. 2024;13(2): e002506. doi:10.1136/bmjoq-2023-002506
International Confederation of Midwives. International definition and scope of practice of the midwife. International Confederation of Midwives. 2021. Erişim adresi: https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html
Dent M. The essential role of midwifery care in modern healthcare. Journal of Labor and Childbirth. 2024;7(4). Erişim adresi: https://www.openaccessjournals.com/articles/the-essential-role-of-midwifery-care-in-modern-healthcare-17913.html
Sandall J, Fernandez Turienzo C, Devane D, et al. Midwife continuity of care models versus other models of care. Cochrane Database of Systematic Reviews. 2024;4(4): CD004667. doi:10.1002/14651858.CD004667.pub6
