Yüksek riski gebelerin emzirme durumunun incelenmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Bu çalışma yüksek riskli gebelerin emzirme durumunun incelenmesi adına yapılan kesitsel tipte bir araştırmadır. Araştırma, Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi'nde yüksek riskli gebeliği olan doğum yapmış kadınlarla yürütülmüştür. Araştırmanın evrenini, Ocak 2020 ve Kasım 2021- Ocak 2022 tarihleri aralığında Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi'nde yüksek riskli gebeliği olan doğum yapmış kadınlar oluşturmakta olup, hastanenin perinatoloji servisinde yatan yıllık yüksek riskli gebelik sayısı 2778'dir( N= 2778). Örneklem değeri N=2778 üzerinden hesaplanmış olup, örneklem hacminin belirlenmesinde Epiınfo Version 6 kullanılmıştır. Araştırmanın örneklemini Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi'nin perinatoloji servisinde, Ocak 2020 ve Kasım 2021- Ocak 2022 tarihleri arasında dahil etme kriterlerine uyan 340 yüksek riskli gebeden oluşmaktadır. Araştırma verileri sırasıyla, Sağlık Bakanlığı Risk Değerlendirme Formu, Anne Tanıtıcı Bilgi Formu, Dünya Sağlık Örgütü (DSÖ) Emzirme İndikatörü, Emzirme Sorunları Değerlendirme Ölçeği(ESDÖ) kullanılarak toplanmıştır. Veri toplama yöntemi için Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi'nde gebelerin riskli olup olmadığını öğrenmek ve risk kategorisini belirlemek adına Sağlık Bakanlığı'nın oluşturduğu Risk Değerlendirme Formu'na evet cevabı veren ve yüksek riskli gebeliği olan doğum yapmış kadınlarla yüz yüze görüşülerek aydınlatılmış onam formu kullanılarak çalışmaya katılacaklarına dair onayları alınmıştır. Çalışmaya alınan kadınlar, doğumhaneden çıkıp odasına alındıktan sonra ilk 24 saat içinde 'Anne Tanıtım Bilgi Formu', Dünya Sağlık Örgütü'nün oluşturduğu 'Emzirme Sınıflandırma İndikatörü', 'Emzirme Sorunları Değerlendirme Ölçeği'(1. Uygulama) kullanılmıştır. Doğumdan sonra 15.günde araştırmacı tarafından telefonla ulaşılarak; 'Emzirme Sorunları Değerlendirme Ölçeği' ikinci kez kullanılmıştır. Kadınlarla görüşme ve veri araçlarının doldurulması yaklaşık 20- 30 dk arası sürmüştür. Taburculuktan 15 gün sonra ESDÖ'nin tekrar doldurulması ise 10 dk sürmüştür. Verilerin analizinde SPSS (Statistical Package for Social Sciences) for Windows 25.0 ve AMOS (Analysis of Moment Structures) 23.0 programı kullanılarak analiz edilmiştir. Elde edilen verileri değerlendirilirken tanımlayıcı istatistiksel metotları (sayı, yüzde, ortalama, standart sapma) kullanılmıştır. Normal dağılım uygunluk normallik testleri ve basıklık çarpıklık değerleri ile kontrol edilmiştir. Ölçek puanlarının normal dağılım varsayımını sağlanmadığı tespit edilmiştir. Bu durumda niceliksel verilerin karşılaştırılması, iki grup karşılaştırılması için Mann Whitney U testi, ikiden fazla grup karşılaştırılmasında Kruskal Wallis H testi, farklılık bulunan grupların tespiti için düzeltişmiş Bonferroni testi ve bağımlı örneklem karşılaştırmaları Wilcoxon testi kullanılmıştır. Uygulanan testlerin ve sonuçların güvenilir olabilmesi için ölçümlerin güvenilir olması gerekmektedir. Bu amaçla ölçeğe ilişkin güvenirlikler Cronbach Alpha ile incelenmiştir Araştırmaya katılan kadınların %2,8'inin 19 yaş ve altı, %26,5'inin 20-24 yaş, %35,9'unun 25-29 yaş, %17,4'ünün 30-34 yaş, %17,4'ünün 35 ve üzeri olduğu, kadınların çalışma durumuna bakıldığında, %85,6'sının çalışmıyor olduğu görülmüştür. Kadınların gebelik sayıları incelendiğinde, %25'inin bir, %22,6'sının iki, %52,4'ünün üç ve üzeri olduğu, kadınların doğum sayıları incelendiğinde, %33,8'inin bir, %27,1'inin iki, %39,1'inin üç ve üzeri olduğu görülmektedir. Kadınların risk sayısı incelendiğinde ortalama 3,69±1,69 olarak bulunmuştur. Çalışmamıza katılan kadınlar, Sağlık Bakanlığı Risk Değerlendirme Formu'na birden fazla soruya evet cevabı vermiştir. Bu cevaplar doğrultusunda, kadınların, %85,3'ünün obstetrik risk, %74,4'ünün mevcut gebelikte risk, %51,5'inin genel tıbbi öykü riskine sahip olduğu görülmektedir. Emzirme Sorunları Değerlendirme Ölçeği birinci ve ikinci uygulama puanları karşılaştırıldığında, kadınların Mekanik Endişeler, Sürece Ait Endişeler, Süt Yetersizliğine Ait Endişeler, Memeye Ait Endişeler ve Emzirme Sorunları Değerlendirme Ölçeği birinci uygulama ve ikinci uygulama puanları arasında istatistiksel olarak anlamlı bir fark bulunmaktadır (p<0,05). Kadınların Mekanik Endişeler, Süt Yetersizliğine Ait Endişeler, Memeye Ait Endişeler ve Emzirme Sorunları Değerlendirme Ölçeği birinci uygulama puanlarının ikinci uygulama puanlarına göre daha yüksek olduğu; Sürece Ait Endişeler ikinci uygulama puanlarının ise birinci uygulama puanlarına göre daha yüksek olduğu görülmektedir. Primipar gebelik ve riskli bir gebelik yaşayan annelerin emzirme sürecinde sorunlarla karşılaştığı görülmüştür. Kadınların gebelikte hastaneye yatma durumlarına göre ESDÖ 1. uygulama puanları arasında istatistiksel olarak anlamlı bir fark bulunmaktadır. Gebelikte hastaneye yatan kadınların ESDÖ 1. uygulama puanlarının hastanede yatmayan kadınlara göre daha yüksek olduğu görülmektedir. Bu sonuca bağlı olarak gebelikte hastaneye yatmanın emzirme sürecini olumsuz yönde etkilediğini görmekteyiz. Kadınların postpartum ruhsal durumlarına göre ESDÖ 1. uygulama puanları arasında istatistiksel olarak anlamlı bir fark bulunmaktadır. Postpartum ruhsal durumu iyi hissetmiyorum cevabını veren kadınların ESDÖ 1.uygulama puanlarının postpartum ruhsal durumu iyi olan kadınlara göre daha yüksek olduğu görülmektedir. Çalışmamıza katılan yüksek riskli gebelik yaşayan kadınların, doğumdan sonra emzirme sürecinde karşılaştığı sorunlara bakıldığında, kadınların mevcut gebelikte riskli olma durumları ile ESDÖ 1.ve 2.uygulama puanları arasında istatiksel olarak anlamlı bir fark bulunmaktadır. Mevcut gebelik riski olan kadınların ESDÖ 1.uygulama için memeye ait endişelerin yüksek olduğu görülmüştür. Ayrıca mevcut gebelik riski olan kadınların ESDÖ 1. Uygulama için mekanik endişelerin yüksek olduğu görülmüştür. Kadınların obstetrik açıdan riskli olma durumları ile ESDÖ 2.uygulama puanları arasında istatiksel olarak olarak anlamlı bir fark bulunmaktadır. Obstetrik risk olmayan kadınların memeye ait endişeler ESDÖ 1. uygulama puanlarının daha yüksek olduğu görülmektedir. Bu sebeple obstetrik riskin emzirme üzerinde doğrudan bir etkiye sahip olmadığını görmekteyiz. Genel tıbbi öykü risk olan kadınların sosyal endişeler ESDÖ 1.uygulama puanlarının daha yüksek olduğu görülmektedir. Sonuç olarak; yüksek riskli gebelik anne ve yenidoğan sağlığını tehdit eden ciddi bir durumdur. Ayrıca yüksek riskli gebelik doğum sonrası, emzirme sürecini etkileyebilmektedir. Bu sorunu çözmek adına yüksek riskli gebelerin emzirme süreci, profesyonel sağlık personeli olan ebeler tarafından anneyle birlikte desteklenmeli ve güçlendirilmelidir. Anahtar kelime: Yüksek risk; gebe, emzirme
Investigation of Breastfeeding Status of High-Risk Pregnants The aim of this study is a cross-sectional study conducted to examine the breastfeeding status of high-risk pregnant women. The research was carried out in Konya Necmettin Erbakan University Medical Faculty Hospital perinatology service. The population of the study consists of women who gave birth in Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022 with high-risk pregnancy. The annual number of high-risk pregnancies hospitalized in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital is 2778 (N= 2778). The sample value was calculated over N=2778, and EpiInfo Version 6 was used to determine the sample size. The population of the study consists of women who gave birth in Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022 with high-risk pregnancy. The annual number of high-risk pregnancies hospitalized in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital is 2778 (N= 2778). The sample value was calculated over N=2778, and EpiInfo Version 6 was used to determine the sample size. The sample of the study consisted of 340 high-risk pregnant women who met the inclusion criteria in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022. Research data were collected by using Ministry of Health Risk Assessment Form, Maternal Descriptive Information Form, World Health Organization (WHO) Breastfeeding Indicator, Breastfeeding Problems Evaluation Scale, respectively. As a data collection method, high-risk pregnant women who answered yes to the Risk Evaluation Form prepared by the Ministry of Health in Konya Necmettin Erbakan University Meram Medical Faculty Hospital to determine the risk category of pregnant women were interviewed face to face and their consent was obtained.The 'Ministry of Health Risk Assessment Form' was used. The consent of the risky pregnant women who answered yes to this form to participate in the study was obtained. "Mother Information Form", "Breastfeeding Classification Indicator" created by the World Health Organization, "Breastfeeding Problems Evaluation Scale" (1st Application) were used for the women included in the study, within the first 24 hours after delivery. The researcher was reached by phone on the 15th day after birth. Interviewing with women and filling out the data tools took approximately 20-30 minutes. The Breastfeeding Problems Rating Scale was refilled 15 days after discharge and took 10 minutes. The 'Breastfeeding Problems Assessment Scale' was used for the second time. The SPSS (Statistical PackageforSocialSciences) 23.0 program was analyzed in the analysis of the data for Windows 25.0 and AMOS (Moment Structures Analysis). While evaluating the obtained data, descriptive statistical methods (number, percentage, mean, standard deviation) were used. The normal distribution was checked with conformity tests of normality and kurtosis skewness values. It was determined that the scale scores did not satisfy the assumption of normal distribution. In this case, the Mann Whitney U test was used to compare quantitative data, to compare two groups, and the Kruskal Wallis H test to compare more than two groups. In order for the tests and results to be reliable, the measurements must be reliable. For this purpose, the reliability of the scale was examined with Cronbach Alpha. Of the women participating in the study, 2.8% were aged 19 and under, 26.5% aged 20-24, 35.9% aged 25-29, 17.4% aged 30-34, 17% .4 of them were 35 and above. Looking at the working status of women, it was seen that 85.6% of them were not working. When the number of pregnancies of women was examined, it was seen that 25% of them had one, 22.6% had two, 52.4% had three or more. the number of births of women was seen as one in 33.8%, two in 27.1%, three or more in 39.1%. The mean risk number of women was found to be 3.69±1.69. Women who participated in our study answered yes to more than one question in the Risk Assessment Form of the Ministry of Health. In line with these answers; ıt was observed that 85.3% of women had an obstetric risk, 74.4% had a risk in current pregnancy, and 51.5% had a general medical history risk. The first and second application scores of the Breastfeeding Problems Rating Scale were compared. As a result of the comparison; There is a statistically significant difference between the scores of the first application and the second application of the Mechanic Worries, Concerns Related to Process, Concerns Regarding Milk Insufficiency, Breast Concerns and Breastfeeding Problems Assessment Scale (p<0.05). It was found that the first application scores of the Women's Mechanic Worries, Concerns About Milk Insufficiency, Breast Worries and Breastfeeding Problems Evaluation Scale were higher than the second application scores; It is seen that the second application scores of Concerns about the Process are higher than the first application scores. It has been observed that mothers who have a primiparous pregnancy and a risky pregnancy face problems during the breastfeeding process. There is a statistically significant difference between the Breastfeeding Problems Rating Scale 1st admission scores according to the hospitalization status of women during pregnancy. It is seen that the Breastfeeding Problems Rating Scale 1st application scores of women hospitalized during pregnancy are higher than those of women who were not hospitalized. Based on this result, we see that hospitalization during pregnancy affects the breastfeeding process negatively. There is a statistically significant difference between the Breastfeeding Problems Rating Scale 1st application scores according to the postpartum mental status of the women. It is seen that the Breastfeeding Problems Rating Scale 1st application scores of the women who answered that their postpartum mental state does not feel good were higher than the women whose postpartum mental state was good. Considering the problems experienced by high-risk pregnant women participating in our study during the postpartum breastfeeding period, there is a statistically significant difference between the risk status of women in their current pregnancy and the 1st and 2nd application scores of the Breastfeeding Problems Assessment Scale. İt was observed that women with current pregnancy risk had high concerns about the breast for the 1st application of the Breastfeeding Problems Rating Scale. According to the risk status of women in their current pregnancy, there is a statistically significant difference between mechanical concerns and the first application scores of the Breastfeeding Problems Assessment Scale. It is seen that the first application scores of the Mechanical Anxiety and Breastfeeding Problems Evaluation Scale are higher in women who are at risk in the current pregnancy. There is a statistically significant difference between the obstetric risk status of women and the second application of the Breastfeeding Problems Assessment Scale scores. It was observed that women without obstetric risk had higher scores for breast-related concerns on the Breastfeeding Problems Rating Scale 1. application. For this reason, we see that obstetric risk does not have a direct effect on breastfeeding. There is a statistically significant difference between the social anxiety first admission scores of women according to their general medical history risk. It was observed that women with a general medical history risk had higher social anxiety scores at first admission. As a result; High-risk pregnancy is a serious condition that threatens maternal and newborn health. In addition, high-risk pregnancy may affect the postpartum and breastfeeding process. In order to solve this problem, the breastfeeding process of high-risk pregnant women should be supported and strengthened by midwives, who are professional health personnel, together with the mother. Keyword: Hight risk; pregnant; breast-feeding
Investigation of Breastfeeding Status of High-Risk Pregnants The aim of this study is a cross-sectional study conducted to examine the breastfeeding status of high-risk pregnant women. The research was carried out in Konya Necmettin Erbakan University Medical Faculty Hospital perinatology service. The population of the study consists of women who gave birth in Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022 with high-risk pregnancy. The annual number of high-risk pregnancies hospitalized in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital is 2778 (N= 2778). The sample value was calculated over N=2778, and EpiInfo Version 6 was used to determine the sample size. The population of the study consists of women who gave birth in Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022 with high-risk pregnancy. The annual number of high-risk pregnancies hospitalized in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital is 2778 (N= 2778). The sample value was calculated over N=2778, and EpiInfo Version 6 was used to determine the sample size. The sample of the study consisted of 340 high-risk pregnant women who met the inclusion criteria in the perinatology service of Konya Necmettin Erbakan University Meram Medical Faculty Hospital between January 2020 and November 2021- January 2022. Research data were collected by using Ministry of Health Risk Assessment Form, Maternal Descriptive Information Form, World Health Organization (WHO) Breastfeeding Indicator, Breastfeeding Problems Evaluation Scale, respectively. As a data collection method, high-risk pregnant women who answered yes to the Risk Evaluation Form prepared by the Ministry of Health in Konya Necmettin Erbakan University Meram Medical Faculty Hospital to determine the risk category of pregnant women were interviewed face to face and their consent was obtained.The 'Ministry of Health Risk Assessment Form' was used. The consent of the risky pregnant women who answered yes to this form to participate in the study was obtained. "Mother Information Form", "Breastfeeding Classification Indicator" created by the World Health Organization, "Breastfeeding Problems Evaluation Scale" (1st Application) were used for the women included in the study, within the first 24 hours after delivery. The researcher was reached by phone on the 15th day after birth. Interviewing with women and filling out the data tools took approximately 20-30 minutes. The Breastfeeding Problems Rating Scale was refilled 15 days after discharge and took 10 minutes. The 'Breastfeeding Problems Assessment Scale' was used for the second time. The SPSS (Statistical PackageforSocialSciences) 23.0 program was analyzed in the analysis of the data for Windows 25.0 and AMOS (Moment Structures Analysis). While evaluating the obtained data, descriptive statistical methods (number, percentage, mean, standard deviation) were used. The normal distribution was checked with conformity tests of normality and kurtosis skewness values. It was determined that the scale scores did not satisfy the assumption of normal distribution. In this case, the Mann Whitney U test was used to compare quantitative data, to compare two groups, and the Kruskal Wallis H test to compare more than two groups. In order for the tests and results to be reliable, the measurements must be reliable. For this purpose, the reliability of the scale was examined with Cronbach Alpha. Of the women participating in the study, 2.8% were aged 19 and under, 26.5% aged 20-24, 35.9% aged 25-29, 17.4% aged 30-34, 17% .4 of them were 35 and above. Looking at the working status of women, it was seen that 85.6% of them were not working. When the number of pregnancies of women was examined, it was seen that 25% of them had one, 22.6% had two, 52.4% had three or more. the number of births of women was seen as one in 33.8%, two in 27.1%, three or more in 39.1%. The mean risk number of women was found to be 3.69±1.69. Women who participated in our study answered yes to more than one question in the Risk Assessment Form of the Ministry of Health. In line with these answers; ıt was observed that 85.3% of women had an obstetric risk, 74.4% had a risk in current pregnancy, and 51.5% had a general medical history risk. The first and second application scores of the Breastfeeding Problems Rating Scale were compared. As a result of the comparison; There is a statistically significant difference between the scores of the first application and the second application of the Mechanic Worries, Concerns Related to Process, Concerns Regarding Milk Insufficiency, Breast Concerns and Breastfeeding Problems Assessment Scale (p<0.05). It was found that the first application scores of the Women's Mechanic Worries, Concerns About Milk Insufficiency, Breast Worries and Breastfeeding Problems Evaluation Scale were higher than the second application scores; It is seen that the second application scores of Concerns about the Process are higher than the first application scores. It has been observed that mothers who have a primiparous pregnancy and a risky pregnancy face problems during the breastfeeding process. There is a statistically significant difference between the Breastfeeding Problems Rating Scale 1st admission scores according to the hospitalization status of women during pregnancy. It is seen that the Breastfeeding Problems Rating Scale 1st application scores of women hospitalized during pregnancy are higher than those of women who were not hospitalized. Based on this result, we see that hospitalization during pregnancy affects the breastfeeding process negatively. There is a statistically significant difference between the Breastfeeding Problems Rating Scale 1st application scores according to the postpartum mental status of the women. It is seen that the Breastfeeding Problems Rating Scale 1st application scores of the women who answered that their postpartum mental state does not feel good were higher than the women whose postpartum mental state was good. Considering the problems experienced by high-risk pregnant women participating in our study during the postpartum breastfeeding period, there is a statistically significant difference between the risk status of women in their current pregnancy and the 1st and 2nd application scores of the Breastfeeding Problems Assessment Scale. İt was observed that women with current pregnancy risk had high concerns about the breast for the 1st application of the Breastfeeding Problems Rating Scale. According to the risk status of women in their current pregnancy, there is a statistically significant difference between mechanical concerns and the first application scores of the Breastfeeding Problems Assessment Scale. It is seen that the first application scores of the Mechanical Anxiety and Breastfeeding Problems Evaluation Scale are higher in women who are at risk in the current pregnancy. There is a statistically significant difference between the obstetric risk status of women and the second application of the Breastfeeding Problems Assessment Scale scores. It was observed that women without obstetric risk had higher scores for breast-related concerns on the Breastfeeding Problems Rating Scale 1. application. For this reason, we see that obstetric risk does not have a direct effect on breastfeeding. There is a statistically significant difference between the social anxiety first admission scores of women according to their general medical history risk. It was observed that women with a general medical history risk had higher social anxiety scores at first admission. As a result; High-risk pregnancy is a serious condition that threatens maternal and newborn health. In addition, high-risk pregnancy may affect the postpartum and breastfeeding process. In order to solve this problem, the breastfeeding process of high-risk pregnant women should be supported and strengthened by midwives, who are professional health personnel, together with the mother. Keyword: Hight risk; pregnant; breast-feeding
Açıklama
28.02.2023 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır
Anahtar Kelimeler
Ebelik, Midwifery, Emzirme, Breast feeding, Gebelik-yüksek riskli, Pregnancy-high-risk
