Original Article (Orijinal Araştırma)
Investigation of Adolescent Mothers’ Practices Related to Neonatal Care Adölesan Annelerin Yenidoğan Bakımına İlişkin Uygulamalarının Değerlendirilmesi Eylem TOKER1, Nazife AKAN2, Ali ÖZER3, Deniz C. ARIKAN4 Yrd. Doç. Dr. Kahramanmaraş Sütçü İmam Üniversitesi Sağlık Yüksek Okulu, Ebelik Bölümü, KAHRAMANMARAŞ Yrd. Doç. Dr. Toros Üniversitesi Sağlık Bilimleri Yüksek Okulu, Hemşirelik ve Sağlık Hizmetleri Bölümü, MERSİN 3 Doç. Dr. İnönü Üniversitesi Tıp Fakültesi, Halk Sağlığı AD, MALATYA 4 Doç. Dr. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD, KAHRAMANMARAŞ 1
2
Özet
Abstract
Amaç: Adölesan annelerin yenidoğan bakımına ilişkin uygulamalarının
Objective: To investigate adolescent mothers’ practices related to neo-
değerlendirilmesi amacı ile yapılmıştır.
natal care.
Gereç ve Yöntem: Tanımlayıcı bir çalışmadır, doğum sonu 2. haftada
Materials and Methods: Descriptive study, using questionnaire deliv-
adölesan annelerle yüz yüze görüşülerek doldurulan anket formu kul-
ered face to face to adolescent mothers 2 weeks after delivery. The cur-
lanılmıştır. Çalışma kriterlerine uygun 118 gebeden, katılmayı kabul
rent study included a sample of one hundred and eighteen adolescent
eden Kahramanmaraş ilindeki 100 gebe örneklemi oluşturmuştur.
mothers were eligible to participate, 100 agreed, living in the city of
Bulgular: Adölesan annelerin %17’sinin 15-16, %83’ünün 17-19 yaş
Kahramanmaras.
aralığında olduğu tespit edilmiştir. Annelerin %70’i vajinal doğum yap-
Results: Seventeen per cent were 15-16 years old and 83% were 17-19
mıştır. %71’i evlidir. Annelerin hiçbiri çalışmaz iken, sadece %34’ünün
years old. Seventy percent of the mothers had delivered vaginally. Sev-
sosyal güvencesi bulunduğu tespit edilmiştir. Adölesan annelerin
enty-one percent were registered as married. None of the mothers was
yenidoğan bakımında yaşadığı bazı sorunlar: %89 gaz problemi, %61
working for financial gain and only 34% had health insurance. Some of
gözlerde çapaklanma, %33 göbek enfeksiyonu, %16 diyare, %20 kabı-
the problems seen by the adolescent mothers in the babies were: disten-
zlık, %24 ateş, %63 sarılık ve %44 ağızda aft (monoliazis). Meme ucunu
tion in 89%, sticky eye 61%, umbilical infection 33%, diarrohoea 16%,
anne sütü ile temizleyen annelerde hiçbir şey yapmayan annelere oranla
constipation 20%, fever 24%, jaundices 63.0%, and moniliasis 44%. The
bebeklerinde monoliazis gelişme riski 36 kat daha yüksek bulunmuştur
risk of moniliasis in babies whose mothers cleaned the tip of the nip-
(B (regression coefficient)=36.000, p=0.020). Adölesan annelerin yüzde
ple with breast milk was 36 times higher than that of the babies whose
onu bebeklerinin ateşi çıktığında hiçbir şey yapmayıp kendi kendine
mothers did nothing (B (regression coefficient)=36.000, p=0.020). It
iyileşmesini beklerken, annelerin 40’ı bebeklerinde sarılık geliştiğinde
was seen that 10 of 100 adolescent mothers whose babies had fever had
tıbbi açıdan yanlış uygulamalar yapmışlardır. Annelerin 93’ü yeterli an-
done nothing and waited for it to resolve itself, and 40 of them had ap-
tenatal bakım alırken, %24’ü gebeliklerinde yenidoğan bakımı hakkında
plied medically incorrect practices when jaundice occurred in their ba-
eğitim almışlardır.
bies. Ninety three of the mothers had received an adequate number of
Sonuçlar: Bu adölesan annelerin yenidoğan bakımında problem
antenatal visits, and 24% had received education in pregnancy about
yaşadıkları, doğum öncesi ve doğum sonrası aldıkları eğitimlerin bu
neonatal care.
sorunları gidermede yeterli olamadığı saptanmıştır. Adölesan annelerin
Conclusions: These adolescent mothers experienced problems with
yenidoğan bakımı ile ilgili geleneksel uygulamalar yaptıkları belirlen-
neonatal care, and the education that they received during pregnancy
miştir.
and postnatal periods was inadequate on some subjects. These adolescent mothers had traditional attitudes about neonatal care.
Anahtar kelimeler: adölesan anne; doğum öncesi bakım; doğum sonu bakım; yenidoğan bakımı; ebelik bakımı
Key words: adolescent mothers; antenatal care; postnatal care; neonatal care; midwifery care
INTRODUCTION
(17 years age) (2). Adolescents do not receive adequate or suitable information about reproduction and sexual health (3). According to Turkey Demographic and Health Survey 2008 (TDHS, 2008), the proportion of the female population 15 to 19 years old is 9.2% (4). In Turkey, pregnancy in women younger than 18 years is seen frequently because of early marriages most-
The World Health Organization (WHO) describes the adolescent period as the 10 to 19 years interval that comprises the period of development of emotion, thought, and behaviour, and preparation of social maturation together with physiological and psychological alterations in an individual (1). The adolescent period has been categorised as early adolescence İletişim:
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[email protected] Kabul Tar: 26.05.2015
Eylem TOKER, KSÜ Sağlık Yüksekokulu, İsmetpaşa Mah. Bahçelievle Kampüsü, 46050 Kahramanmaraş
Tel
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KSU Tıp Fak Der 2016;11(1) :13- 19
Adolescent mothers
Toker ve ark
Table 1: Socio-demographic characteristics of the adolescent mothers and details of ly due to cultural reasons. So, according to antenatal and postnatal care visits. (N = 100) 2007 Turkey Youth Sexual and Reproductive Health Survey in Turkey (2007), 7.5% Characteristics of women N % of female children aged between 15 and Age (year) 19 years are married and 73.1% of these 17 17.0 15-16 have experienced pregnancy (5). In addi17-19 83 83.0 tion, according to Turkey Demographic Education and Health Survey 2008 the overall level of teenage childbearing was 9.3% in 1998, Uneducated 7 7.0 and 7.5% in 2003, 6% 2008 (4, 6, 7). AcPrimary school 90 90.0 cording to the same study, the adolescent High school 3 3.0 mothers rate of the 15-19 age group was Educational level of her husband totally 3.9%, 5% in urban areas and 9% in Uneducated rural areas (4). 68.0 Primary school 68 In adolescent pregnancy, medical com28.0 High school 28 plications such as toxaemia, anaemia, 4.0 University 4 difficult and delayed labour, and bleedMarriage age ing that increase maternal death develop (8). 2014 World Health Statistics indicate 14 4 4.0 15-16 37 37.0 that 3 million girls aged 15 to 19 under17-19 59 59.0 go unsafe abortions every year. Moreover babies born to adolescent mothers face Marital status a substantially higher risk of dying than Married (religious) 29 29.0 those born to women aged 20 to 24 (9). Officially married 71 71.0 For this reason, WHO (2002) advises that Health insurance pregnant women should receive at least 4 Yes 34 34.0 antenatal examinations during their pregNo 66 66.0 nancy (10). In addition, the Ministry of Health of Turkey advises that antenatal Occupation care should start in the first trimester of Employed 0 0.0 pregnancy, and at least six examinations Housewife 100 100.0 be performed during pregnancy, with a Parity higher number for women with high risk Primiparous 89 89.0 pregnancies (11). Multiparous 11 11.0 According to TDHS (2008), the proportion of pregnant women receiving anDelivery type of last labor tenatal care was 92.0% (4). In addition, Vaginal delivery 70 70.0 the data for 2005 show that number of Cesarean section 30 30.0 examinations per pregnant woman and Characteristics of the care per woman in the puerperium increased to 2.41 and 0.91, respectively (12). In Kahramanmaras there were Antenatal care (N=100) 2.69 care examinations for pregnant women and 0.86 for womYes 99 99.0 en at puerperium (13). According to TDHS-2008 data, 84.8% of No 1 1.0 mothers received postnatal care and 89.7% of infants (4). Adequacy of antenatal care* The neonatal period comprises the period until 28 days after de(N = 99)** livery. The midwife and nurse, while meeting the neonate’s care Yes 93 93.9 needs, also evaluate his/her physical adaptation (14, 15). For this No 6 6.1 adaptation to be healthy, it is important to meet the care needs Neonatal care education of the neonate. It is also necessary to meet the parent education (N=100) needs of adolescent mothers. To meet these needs, support from Yes 24 24.0 family members and medical staff is required (16, 17). No 76 76.0 Due to the recommendations made by the Ministry of Health of Turkey, puerperal women must be visited three times; once in Postnatal care (N=100) the first 24 hours after labour (if delivered at home), and later on, Yes 54 54.0 once at two weeks and once at four weeks (11, 17, 18). During No 46 46.0 the home visits the midwife assesses the mother and baby and Place of postnatal care informs the mother about baby care, hygiene, and neonatal care. (N=54)*** It has been noted that in Turkey adolescent mothers experience Home 26 48.1 difficulties with baby care (7). Thus the role of the midwife is of Hospital 42 76.4 even greater importance. *Inadequacy was defined as 1-3 antenatal care visits, adequacy was deThis study was performed to assess adolescent mothers’ neonatal fined as 4 or more antenatal care visits. care practices. **Number of mothers who received antenatal care. ***As 14 of the mothers indicated that they had received postnatal care both at home and at the hospital n is increased
MATERIALS AND METHODS
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KSU Tıp Fak Der 2016;11(1) :13- 19
Toker ve ark
Adolescent mothers
Table 2. Distribution of frequency of breast feeding due to receiving education about neonatal care during pregnancy and receiving care at the hospital during the postnatal period.
Frequency of breast feeding At 3-4 hour intervals
At 1-2 hour Every time intervals the baby cried
Total
N
%
N
%
N
%
N
%
X2
P
Yes
0
0.0
4
16.7
20
83.3
24
100.0
2.272
0.321
No
4
5.3
13
17.1
59
77.6
76
100.0
Total
4
4.0
17
17.0
79
79.0
100
100.0
Yes
2
4.8
10
23.8
30
71.4
42
100.0
6.080
0.048
No
1
7.7
0
0.0
12
92.3
13
100.0
Total
3
5.5
10
18.2
42
76.4
55
100.0
Variables Was training received?
Was care received?
at their address, 1 due to the death of her baby, and 1 due to her baby being in hospital. Therefore, 100 (84.8%) adolescent mothers were included in the study. A questionnaire was developed and consisted of 52 questions; 8 were related to the mother’s socio-demographic characteristics, 8 to pregnancy, laTable 3. Distribution of mothers’ hand washing before breast feeding due to receiving training about neonatal bour history, and care during pregnancy and receiving care during the postnatal period at home (N=100). characteristics of the postnatal Hand washing before breast feeding periods, and 36 Yes Total were related to No the investigation N % N % N % X2 P on the mother’s Was training educaneonatal care tion received during practices. The pregnancy? q u e s t i o n n a i re was performed Yes 16 66.7 8 33.3 24 100.0 5.990 0.014 at the adolescent No 29 38.2 47 61.8 76 100.0 mothers’ home Total 45 45.0 55 55.0 100 100.0 in a face to face manner by the Was care received at first author and home during postthe midwife natal period? working at the Yes 17 65.4 9 34.6 26 100.0 5.967 0.015 PHC. No 9 32.1 19 67.9 28 100.0 Data were reTotal 26 48.1 28 51.9 54 100.0 corded and analysed using the Kahramanmaras. The study was planned to involve all adoles- Statistical Package for the Social Sciences software (SPSS Inc., cent mothers (15-19 years old) in the regions covered by these USA, version 11.5) and MINITAB 13.0 were used for the statis15 PHCs two weeks after the baby’s birth (19). Sampling was not tical analysis. Chi-square, logistic regression, and two ratio tests performed. were performed to analyze the data. Statistical significance was Every midwife at the PHC was responsible for the population defined as p
