Okuqukethwe
Ubufakazi - bonke abangaziwa - buyingozi. « Phakathi nohlelo lwami lokuzalwa, ngangibonise ukuthi ngifuna ukulinda izinsuku ezi-2 noma ezi-3 ngemva kosuku olunqunyiwe ngaphambili ukuzala. Akunakwanga. Ngabizelwa esibhedlela ngosuku lwethemu futhi ngathunjwa, ngaphandle kokunginikeza enye indlela. Lesi senzo kanye nokubhoboza iphakethe lamanzi kwabekwa kimina. Ngakubona njengodlame olukhulu », Ikhombisa omunye wabahlanganyeli ocwaningweni olukhulu lwe-Collective interassociative ngesikhathi sokuzalwa (Ciane *) ukubhekana "Nezingane eziqalwa endaweni yasesibhedlela". Ezimpendulo ezingu-18 zeziguli ezabeletha phakathi kuka-648 no-2008, u-2014% wabesifazane ababuzwayo uthe bake babhekana “ne-trigger”. Isibalo esizinzile ezweni lakithi, njengoba besingama-23% kwabangama-23 (iNational Perinatal Survey) kanye no-2010% ngesikhathi socwaningo lokugcina lwama-22,6.
Ikhonjiswa nini i-trigger?
UDkt Charles Garabedian, udokotela wezifo zabesifazane kanye nenhloko yomtholampilo esibhedlela sabakhulelwe i-Jeanne de Flandres e-Lille, esinye sezikhulu kunazo zonke eFrance esibelethisa ka-5 ngonyaka, uyachaza: “ Ukungeniswa kuyindlela yokwenziwa yokuyenga ukubeletha lapho umongo wezokwelapha nokubelethisa ukudinga.. »Sinquma ukucupha izinkomba ezithile: lapho usuku lomnqamulajuqu seludlulile, kuya ngokubeletha phakathi kosuku D + 1 no-D + 6 izinsuku (futhi kufika emkhawulweni wamaviki angu-42 we-amenorrhea (SA) + izinsuku ezingu-6 esiphezulu **). Kodwa futhi uma umama wakusasa ene- ukuphuka kwesikhwama samanzi ngaphandle kokusikwa kungakapheli amahora angama-48 (ngenxa yengozi yokutheleleka nge-fetus), noma uma umbungu unokukhula okuvimbile, isigqi senhliziyo esingavamile, noma ukukhulelwa okungamawele (kulokhu, siqala ku-39 WA, kuye ngokuthi amawele abelana nge-placenta efanayo noma cha). Ngasohlangothini lukamama okhulelwe, kungaba lapho i-preeclampsia yenzeka, noma uma kukhona isifo sikashukela ngaphambi kokukhulelwa noma isifo sikashukela sokukhulelwa engalingani (iphathwa nge-insulin). Kuzo zonke lezi zinkomba zezokwelapha, odokotela bakhetha ukuzala. Ngoba, kulezi zimo, inzuzo / ibhalansi yengozi ihlehla kakhulu ivuna ukuqaliswa kokubeletha, kumama kanye nengane.
Ukucupha, isenzo sezokwelapha esingasho lutho
« EFrance, ukubeletha kuqaliswa njalo, wembula u-Bénédicte Coulm, umbelethisi kanye nomcwaningi kwa-Inserm. Ngo-1981, sasiku-10%, futhi lelo zinga liphindeke kabili laya ku-23% namuhla. Liyanda kuwo wonke amazwe aseNtshonalanga, futhi iFrance inamanani afanayo nomakhelwane bayo baseYurophu. Kodwa asisilona izwe elithinteke kakhulu. E-Spain, cishe umntwana oyedwa kwabathathu uyaqaliswa. »Noma, Inhlangano Yezempilo Yomhlaba (i-WHO) ikhuthaza “ukuthi asikho isifunda sendawo okufanele sibhalise izinga lokungeniswa kwabasebenzi elingaphezu kuka-10%”. Ngoba i-trigger ayisona isenzo esincane, noma esigulini, noma enganeni.
I-trigger: ubuhlungu kanye nengozi yokopha
Imithi enqunyiwe izovuselela ukufinyela kwesibeletho. Lezi zingaba buhlungu kakhulu (bambalwa abesifazane abakwazi lokhu). Ikakhulukazi uma isibeletho sibangelwa ngosizo lokufakwa kwe-synthetic oxytocin, kunengozi enkulu yokungasebenzi kahle kwesibeletho. Kulokhu, ukufinyela kunamandla kakhulu, kusondelene kakhulu noma akukhululekile ngokwanele (umuzwa wokufingqa okukodwa, okude). Enganeni, lokhu kungaholela ekucindezelekeni kwe-fetus. Kumama, ukuphuka kwesibeletho (okungavamile), kodwa ngaphezu kwakho konke, ingozi ukopha kwangemva kokubeletha iphindwe kabili. Kuleli phuzu, i-National College of Midwives, ngokubambisana nodokotela obulala izinzwa, odokotela bokubelethisa nodokotela bezingane, baye bahlongoza izincomo mayelana nokusetshenziswa kwe-oxytocin (noma i-oxytocin yokwenziwa) ngesikhathi sokubeletha. EFrance, abesifazane ababili kwabathathu bayithola lapho bebeletha, kungakhathaliseki ukuthi iqalisiwe noma cha. “ Siyizwe lase-Europe elisebenzisa kakhulu i-oxytocin futhi omakhelwane bethu bayamangala ngokwenza kwethu. Nokho, ngisho noma kungekho ukuvumelana ngezingozi ezihlobene nokungeniswa, ucwaningo luqokomisa ukuxhumana phakathi kokusetshenziswa kwe-oxytocin yokwenziwa kanye nengozi enkulu yokopha kumama. “
Ukucupha kubekiwe: ukungabi sobala
Omunye umphumela: umsebenzi omude, ikakhulukazi uma wenziwa kulokho okubizwa ngokuthi "intamo engathandeki". (umlomo wesibeletho osavaliwe noma omude ekupheleni kokukhulelwa). “ Abanye besifazane bayamangala ukuthi kufanele bahlale esibhedlela amahora ayi-XNUMX ngaphambi kokuthi kuqale ukubeletha kwangempela », Kuchaza u-Bénédicte Coulm. Ophenyweni lukaCiane, isiguli sathi: “ Bengingathanda ukwazi kakhudlwana iqiniso lokuthi umsebenzi ungase ungaqali isikhathi eside… amahora angama-24 kimi! Omunye umama uyaziveza: “ Ngibe nesipiliyoni esibi kakhulu ngalesi sicupha, esithathe isikhathi eside kakhulu. I-tamponade elandelwa ukumnika ithathe ingqikithi yamahora angu-48. Ngesikhathi ngixoshwa, ngangikhathele. “Eyesithathu iphetha ngokuthi: Ukufinyela okwakulandela inhlamvu kwakubuhlungu kakhulu. Ngakuthola kunodlame kakhulu, ngokomzimba nangokwengqondo. Kodwa-ke, ngaphambi kwanoma yikuphi ukuqubuka, abesifazane kufanele baziswe ngalesi senzo kanye nemiphumela yaso engase ibe khona. Kufanele sibaveze ngengozi/ibhalansi yenzuzo yesinqumo esinjalo, futhi ngaphezu kwakho konke sithole imvume yabo. Ngempela, Ikhodi Yomphakathi Yezempilo ibonisa ukuthi "asikho isenzo sezokwelapha noma ukwelashwa okungenziwa ngaphandle kwemvume yamahhala nenolwazi lomuntu, futhi le mvume ingahoxiswa nganoma yisiphi isikhathi".
Ukuzalwa kwengane okuyengelwayo: isinqumo esimisiwe
Ocwaningweni lwe-Ciane, nakuba izicelo zemvume zenyuka phakathi kwesikhathi sika-2008-2011 kanye nesikhathi sika-2012-2014 (izigaba ezimbili zocwaningo), ingxenye enkulu yabesifazane namanje, Amaphesenti angu-35,7 omama bokuqala (okuyingane yabo yokuqala) kanye nama-21,3% ama-multiparas (okungenani ingane yesibili) awazange abe nombono wawo wokunikela. Bangaphansi kwesi-6 kwabesifazane abangu-10 abathi bazisiwe futhi bacelwe imvume yabo. Kunjalo ngalomama ofakaza: “Lapho ngeqa isikhathi sami, ngosuku olwandulela ulwelwesi oluhleliwe, umbelethisi wenza ithimba lolwelwesi, ukuxhaphaza okubuhlungu kakhulu, ngaphandle kokungilungiselela noma ukungixwayisa! Omunye wathi: “ Ngangineziqhumane ezintathu ezinsukwini ezintathu zephakethe okusolwa ukuthi liqhekekile, lapho sasingenaso isiqiniseko. Angibuzwanga umbono wami, njengokungathi akukho ukukhetha. Ngatshelwa ngokuhlinzwa uma izimbangela zingaphumelelanga. Ekupheleni kwezinsuku ezintathu, ngangikhathele futhi ngididekile. Nganginezinsolo eziqinile zokuhlukaniswa kolwelwesi, ngoba ukuhlolwa kwesitho sangasese sangasese engangikutholile kwakubuhlungu kakhulu futhi kungihlukumeza kakhulu. Angikaze ngicelwe imvume yami. "
Abanye besifazane okwaxoxwa nabo kulolu cwaningo abazange bathole noma yiluphi ulwazi, kodwa babuzwa ukuthi baveze imibono yabo ... Ngaphandle kolwazi, lokho kukhawulela uhlobo "lokukhanyiselwa" lwalesi sinqumo. Ekugcineni, ezinye zeziguli okwaxoxwa nazo zaba nomuzwa wokuthi zazicelwa imvume yazo, zigcizelela izingozi zomntwana futhi zenza idrama ngokucacile isimo. Kungazelelwe, laba besifazane baba nomuzwa wokuthi isandla sabo siphoqelelwe, noma ngisho nokuthi baye baqanjelwa amanga. Inkinga: ngokusho kocwaningo lukaCiane, ukuntuleka kolwazi kanye neqiniso lokuthi omama besikhathi esizayo ababuzwa umbono wabo kubonakala kuyizici ezicindezelayo zenkumbulo enzima yokubeletha.
Ukungeniswa okubekiwe: ukubeletha okungaphili kahle
Kwabesifazane ababengenalo ulwazi, u-44% uba nesipiliyoni “esibi kakhulu noma esibi kakhulu” sokubeletha kwabo, uma kuqhathaniswa nama-21% kulabo abazisiwe.
KwaCiane, le mikhuba igxekwa kakhulu. UMadeleine Akrich, unobhala we-Ciane: “ Abanakekeli kumele bahlomise abesifazane futhi babanikeze ulwazi olusobala ngangokunokwenzeka, ngaphandle kokuzama ukubenza bazizwe benecala. "
E-National College of Midwives, u-Bénédicte Coulm uqinile: “ Isikhundla seKolishi sicace bha, sikholwa wukuthi abesifazane kumele baziswe. Ezimweni lapho singekho isimo esiphuthumayo, zinike isikhathi sokuchazela omama abakhulelwe ukuthi kwenzekani, izizathu zesinqumo, kanye nezingozi ezingase zibe khona, ngaphandle kokuzama ukubethusa. . Ukuze baqonde intshisekelo yezokwelapha. Akuvamile ukuthi kuphuthume ukuthi umuntu angakwazi ukuthatha isikhathi, ngisho imizuzu emibili, azinze futhi azise isiguli. “Indaba efanayo ohlangothini lukaDkt Garabedian:” Kungumthwalo wethu njengabanakekeli ukuchaza ukuthi buyini ubungozi, kodwa futhi izinzuzo zabo bobabili umama nengane. Nami ngincamela ukuthi ubaba abekhona futhi aziswe. Awukwazi ukunakekela umuntu ngaphandle kwemvume yakhe. Kungcono ukuza futhi ukhulume nesiguli nozakwethu onguchwepheshe kuye ngokuthi isifo sinjani, esimweni esiphuthumayo futhi uma isiguli singafisi ukuqalwa. Ulwazi luba yi-multidisciplinary futhi ukukhetha kwalo kunolwazi oluthe xaxa. Ngasohlangothini lwethu, siyamchazela lokho esingakwenza. Akuvamile ukungafiki ekuvumelaneni. UMadeleine Akrich ucela umthwalo wemfanelo womama bakusasa: “Ngifuna ukuthi kubazali, ‘Yibani abadlali! Buza! Kufanele ubuze imibuzo, ubuze, ungasho ukuthi yebo, ngoba nje uyesaba. Kumayelana nomzimba wakho kanye nokubeletha kwakho! “
* Ucwaningo olumayelana nezimpendulo eziyi-18 kuhlu lwemibuzo lwabesifazane ababeletha esibhedlela phakathi kuka-648 no-2008.
** Izincomo zoMkhandlu Kazwelonke Wodokotela Bezifo Zabesifazane Ababelethisayo (CNGOF) ka-2011
Ngokusebenza: i-trigger ihamba kanjani?
Kunezindlela eziningi zokuheha ukubekwa komsebenzi okwenziwe. Eyokuqala ingeyemanyuwali: “Ihlanganisa ukuhlukana kolwelwesi, ngokuvamile lapho kuhlolwa isitho sangasese sowesifazane.
Ngalesi senzo, singakwazi ukudala ukufinyela okuzosebenza emlonyeni wesibeletho, ”kuchaza uDkt Garabedian. Enye indlela eyaziwa ngokuthi i-mechanical: “ibhaluni eliphindwe kabili” noma i-catheter ye-Foley, ibhaluni elincane elivutheleke phezulu ezingeni lomlomo wesibeletho elizofaka ingcindezi kulo futhi libangele ukusikwa.
Ezinye izindlela zokwelapha i-hormonal. I-tampon esekelwe ku-prostaglandin noma ijeli ifakwa esithweni sangasese. Ekugcineni, ezinye izindlela ezimbili zingasetshenziswa, kuphela uma umlomo wesibeletho kuthiwa "uthandeka" (uma usuqalile ukufinyeza, uvule noma uthambe, ngokuvamile ngemva kwamasonto angu-39). Ikona ukuphuka okwenziwa isikhwama samanzi kanye ne-synthetic oxytocin infusion. Abanye abakhulelwe baphinde banikeze amasu athambile, njengokubeka izinaliti zokutshopa.
Ucwaningo lukaCiane luveze ukuthi iziguli ezibuzwayo bezingu-1,7% kuphela ezinikezwe ibhaluni kanye no-4,2% we-acupuncture. Ngokuphambene, ukumnika kwe-oxytocin kwanikezwa ku-57,3% yomama abakhulelwe, okulandelwa eduze nokufakwa kwe-tampon ye-prostaglandin esithweni sangasese (41,2%) noma i-gel (19,3, XNUMX%). Izifundo ezimbili zilungiselela ukuhlola ukuqubuka kweFrance. Olunye lwazo, ucwaningo lwe-MEDIP, luzoqala ekupheleni kuka-2015 ngokubeletha abangu-94 futhi luzothinta abesifazane abangu-3. Uma ubuzwa, ungangabazi ukuphendula!
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