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Uvod: Ženske so v preteklosti in danes pogosto rojevale v vodnem viru ali ob njem, in vodo uporabljale na različne načine. Hidroterapija (porod v vodi) je način poroda, primeren za porodnice z nizkim tveganjem, pri katerem porodnica v kateri koli porodni dobi vsaj nekaj časa preživi v vodi. Hidroterapija je predstavljena kot varna in učinkovita možnost lajšanja bolečin, še posebej za porodnice, ki si želijo manj medporodnih intervencij. Vendar je pomanjkanje randomiziranih kontrolnih študij, ki bi preučevale tak način poroda, pri nekaterih rodilo dvome in skepticizem. Namen: Predstaviti pomen uporabe vode med porodom in njene učinke ter ugotoviti prednosti in slabosti za porodnico in novorojenčka. Metode dela: Uporabljena je bila deskriptivna metoda s sistematičnim pregledom literature. Pri iskanju literature v časovnem okvirju od leta 2010 do 2017 so bile uporabljene ključne besede v angleškem ter v slovenskem jeziku. Iskanje je bilo opravljeno s pomočjo različnih domačih in tujih podatkovnih baz. Kriteriji za izbor so bili objava v določenem časovnem obdobju, dostopnost celotnih besedil v slovenščini, angleščini ali španščini, navajanje prednosti, slabosti, pozitivnih, negativnih posledic, indikacij, kontraindikacij, odnos babic do hidroterapije, izobraženost in izobraževanja ter potek poroda v vodi. Izključene so bile raziskave, ki so metodološko sporne, so si tekom članka kontradiktorne ali ne izpolnjujejo vključitvenih kriterijev. Rezultati: Hidroterapija je blagodejen ukrep med porodom, ki ima mnogo psihofizičnih in emocionalnih prednosti, podprtih s strokovno literaturo in ključnimi načeli babiške filozofije. Potencialne slabosti hidroterapije za porodnico in novorojenčka lahko večinoma prepoznamo pravočasno. Strokovno utemeljenih kontraindikacij za vse tri porodne dobe pod vodo je malo, a obstajajo (npr. fetalni distres). Razprava in sklep: Porod v vodi prinaša mnoge z znanstvenimi raziskavami dokazane prednosti, kot so analgetični in diuretični učinek, mišični relaksant, hipotenzivno sredstvo, manj intervencij in poškodb porodne poti, svoboda gibanja in intima. Toda ni še znano vse, kar bi bilo dobro vedeti o hidroterapiji. Pereča vprašanja so na primer: Ali obstaja vzročna povezava med uporabo vode in perinatalno mortaliteto/morbiditeto? Kdaj naj bi porodnica med porodom začela uporabljati medij vode? Potrebne so nove kvalitetne,obsežnejše in kakovostne raziskave, ki bodo vnašale nova spoznanja in vidike na odgovore, ki jih še ne poznamo. Introduction: Throughout history water has been used during labour and giving birth women often delivered their babies either near or in water. One option for labour and delivery is a waterbirth or hydrotherapy, usually appropriate for low-risk parturients, and involves immersion in water sometime during the first, second or third stage of labour. It has been presented as a safe and effective option of managing the pain associated with labour contractions, especially for those women who prefer less labour interventions. However it has provoked scepticism due to a lack of randomised control trials. Purpose: This study presents the use of water and its effects on labouring women and neonates during birth and assesses its advantages and disadvantages. Methods: A descriptive method using a systematic literature review has been employed here, covering the years 2010–2017. Various databases were searched using English and Slovene keywords. The inclusion criteria comprised the publication of a study in a certain year range, accessibility of its whole text in Slovenian, English or Spanish, and its relevance to the purpose of this study. Studies with methodological problems, contradictions or not meeting the inclusion criteria were excluded. Results: The literature suggests that hydrotherapy is beneficial during childbirth and that any potential risks can be identified either prior to birth or at an early stage before serious problems arise. There are only a few contraindications when waterbirth should not be used or should be terminated immediately (e.g. foetal distress) according to the scientific evidence. However it is a labour method congruent with the philosophy of midwifery, although it should be noted that not all midwives support this method of giving birth. Discussion and conclusion: Waterbirth brings abundant evidence-based benefits (e.g. analgesic and diuretic effects of water, muscular relaxant, hypotensive lower intervention rates and reduced trauma to the birth canal freedom of movement and intimacy for parturients). However, there are still some questions regarding waterbirth which need to be answered. Of particular interest at present is the causal relationship between waterbirth in the first and second stages of birth and an increase in perinatal mortality or serious perinatal morbidity and at what dilation should a parturient begin with water use. Hence, new qualitative research and large scale studies need to be performed to assess this ancient practice in order to develop a new understanding of its effects. |
