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Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler

Year 2023, Volume: 16 Issue: 3, 339 - 348, 18.12.2023

Abstract

Amaç: Bu araştırma, doğum salonunda çalışan ebelerin yaptırdıkları doğumla ilişkili ikincil travma sonrası stres bozukluğu ve ilişkili faktörleri değerlendirmek amacıyla yapılmıştır. Yöntem: Bu çalışma nicel araştırma metodolojisine uygun olarak kesitsel bir araştırma olarak yapılmıştır. Araştırmaya doğum salonunda en az bir yıldır çalışan, Web 2 teknolojilerini kullanabilen, araştırmaya katılmaya gönüllü olan 307 ebe dahil olmuştur. Veriler “Tanıtıcı Bilgi Formu” ve “Olayların Etkisi Ölçeği” kullanılarak toplanmıştır. Araştırmanın duyurusu sosyal medya platformlarında kartopu yöntemi kullanılarak yapılmıştır. Bulgular: Ebelerin %53.1’inin 23-30 yaş aralığında, %85.7’sinin eğitim düzeyinin lisans olduğu, %57.7’sinin doğum salonunda çalışma süresinin 1-4 yıl olduğu, %36.2’sinin sıklıkla ebelik uygulamalarında bağımsız karar aldığı bulunmuştur. Ebelerin %98.3’ünün travmatik doğuma tanıklık ettikleri ve bu ebelerin %94.9’unun travma sonrası stres bozukluğu yaşadığı belirlenmiştir. Travmatik doğum deneyimleyen ebelerin travma sonrası stres bozukluğu puan ortalamalarının 51.88±14.32 olduğu belirlenmiştir. Bireysel ve mesleki özellikler ile doğumla ilişkili ikincil travma sonrası stres bozukluğu arasında ilişki bulunmamıştır. Sonuç: Ebelerin tamamına yakını doğum salonunda travmatik doğuma tanıklık etmekte, büyük çoğunluğu ise doğumla ilişkili travma sonrası stres bozukluğu yaşamaktadır. Organizasyonların ebeleri koruyucu uygulamalara yönelik strateji geliştirmeleri önerilmektedir.

Ethical Statement

Araştırmanın etik kurul izni araştırmacıların çalıştığı üniversitesinin Sosyal ve Beşeri Bilimler Etik Kurulu’ndan alınmıştır (05.12.2022/401). Katılımcılardan bilgilendirme metni okunduktan sonra onlıne ortamda onam sekmesini onaylaması istenmiştir. Onaylamayan ebeler araştırma anket formlarına ulaşamamıştır. Anket formlarında kişisel veriler yoktur.

Supporting Institution

Araştırmanın maliyeti araştırmacılar tarafından karşılanmıştır.

References

  • Beck CT, Gable RK. A mixed methods study of secondary traumatic stress in labor and delivery nurses. J Obstet Gynecol Neonatal Nurs. 2012; 41(6): 747–760. doi: 10.1111/j.1552-6909.2012.01386.x.
  • Uddin N, Ayers S, Khine R, Webb R. The perceived impact of birth trauma witnessed by maternity health professionals: A systematic review. Midwifery. 2022; 114: 103460. https://doi.org/10.1016/j.midw.2022.103460.
  • Rice H, Warland J. Bearing witness: midwives experiences of witnessing traumatic birth. Midwifery. 2013; 29 (9): 1056-1063.
  • Cross H, Krahé C, Spiby H, Slade P. Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health?. BMC Pregnancy and Childbirth. 2023; 23(1): 543.
  • Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
  • Kinman, Gail and Teoh, Kevin and Harriss, Anne (2020) The mental health and wellbeing of nurses and midwives in the United Kingdom. Technical Report. Society of Occupational Medicine. [updated 2020; cited 10 Agust 2023]. Available from: https://eprints.bbk.ac.uk /id/eprint/40551/1/2020%20%20The%20Mental%20
  • Aydın R, Aktaş S. Midwives' experiences of traumatic births: A systematic review and meta-synthesis. Eur J Midwifery. 2021 Jul 26; 5: 31. doi: 10.18332/ejm/138197.
  • Leinweber J, Rowe HJ. The costs of ‘being with the woman’: secondary traumatic stress in midwifery. Midwifery. 2010; 26(1): 76-87. https://doi.org/10.1016 /j.midw.2008.04.003.
  • Hunter B, Warren L. Midwives experiences of workplace resilience. Midwifery. 2014; 30: 926–34.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.), American Psychiatric Association, Washington, DC
  • Beck C, LoGiudice J, Gable RK. A mixed-methods study of secondary traumatic stress in certified nurse-midwives: shaken belief in the birth process. J Midwifery Womens Health. 2015; 60 (1): 16-23
  • Sheen K, Spiby H, Slade P. Exposure to traumatic perinatal experiences and posttraumatic stress symptoms in midwives: prevalence and association with burnout. Int J Nurs Stud. 2015; 52 (2): 578-587.
  • Creedy DK, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth. 2017;17(1):13. doi: 10.1186/s12884-016-1212-5.
  • Leinweber J, Creedy DK, Rowe H, Gamble J. A socioecological model of posttraumatic stress among Australian midwives. Midwifery. 2017; 45: 7-13. https://doi.org/10.1016/j.midw.2016.12.001.
  • Dixon L, Guilliland K, Pallant JF, Sidebotham M, Fenwick J, McAra-Couper J, Gilkison A. The emotional wellbeing of New Zealand midwives: Comparing responses for midwives in caseloading and shift work settings. New Zealand College of Midwives Journal. 2017; 53:5-14
  • Minooee S, Cummins A, Sims D J, Foureur M, Travaglia J. Scoping review of the impact of birth trauma on clinical decisions of midwives. Journal of Evaluation in Clinical Practice. 2020; 26(4): 1270–1279. https://doi.org/10 .1111/jep.1333
  • Harvie K, Sidebotham M, Fenwick J. Australian midwives' intentions to leave the profession and the reasons why. Women Birth. 2019; 32(6): e584-e593. doi: 10.1016/j.wombi.2019.01.001.
  • Stoll K, Gallagher J. A survey of burnout and intentions to leave the profession among Western Canadian midwives. Women Birth. 2019; 32(4): e441-e449. doi: 10.1016/j.wombi.2018.10.002.
  • Türkiye Sağlık Enstitüleri Başkanlığı (TUSEB) (2017). Doğum Şekli Tercihinin Multidisipliner İrdelenmesi Çalıştayı Sonuç Raporu. Ankara.
  • Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41: 209-218.
  • Weiss D, Marmar C The impact of Event Scale-Revised. Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 1997: 399–411
  • Creamer M, Bell R, Failla S Psychometric properties of the Impact of Event Scale-Revised. Behav Res Ther. 2003; 41: 1489- 1496
  • Çorapçıoğlu A, Yargıç İ, Geyran P, Koçabaşoğlu N. Olayların Etkisi Ölçeği (IES-R) Türkçe versiyonunun geçerlilik ve güvenilirliği. New/Yeni Symposium: Psikiyatri, Nöroloji ve Davranış Bilimleri Dergisi. 2006; 44(1): 14-22.
  • Leinweber J, Fontein-Kuipers Y, Thomson G, Karlsdottir SI, Nilsson C, Ekström-Bergström A, Olza I, Hadjigeorgiou E, Stramrood C. Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth (Berkeley, Calif.). 2022; 10.1111/birt.12634. https:// doi.org/10.1111/birt.12634
  • Cohen R, Leykin D, Golan-Hadari D, Lahad M. Exposure to traumatic events at work, posttraumatic symptoms and professional quality of life among midwives, Midwifery. 2017; 50: 1-8. https://doi.org/10.1016/j.midw.2017.03.009.
  • Patterson, J. (2019). Traumatised midwives; traumatised women. AIMS J., 30 (4). [updated 2019; cited 10 Agust 2023]. Available from: https://www.aims.org.uk/journal/item/traumatised-midwives-traumatised-women.
  • Cankaya S, Erkal Aksoy Y, Dereli Yılmaz S. Midwives' experiences of witnessing traumatic hospital birth events: A qualitative study. J Eval Clin Pract. 2021; 27: 847–857. https://doi.org/10.1111/jep.13487
  • Kendall-Tackett K, Beck CT. Secondary Traumatic Stress and Moral Injury in Maternity Care Providers: A Narrative and Exploratory Review. Front Glob Womens Health. 2022; 4(3) :835811. doi: 10.3389/fgwh.2022.835811.
  • Shorey S, Wong PZE. Vicarious trauma experienced by health care providers ınvolved in traumatic childbirths: A meta-synthesis. Trauma Violence Abuse. 2022; 23(5): 1585-1598. doi: 10.1177/15248380211013135.
  • Calvert I, Benn C. Trauma and the Effects on the Midwife. International Journal of Childbirth. 2015; 5(2): 100-112. doı: 10.1891/2156-5287.5.2.100.
  • Zondag DC, van Haaren-Ten Haken TM, Offerhaus P M, Maas VYF, Nieuwenhuijze MJ Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives. Netherlands. European Journal of Midwifery. 2022; 6(September): 1-9. https://doi.org/10.18332/ejm/151653
  • Peterwerth NH, Halek M, Schäfers R. Intrapartum risk perception–A qualitative exploration of factors affecting the risk perception of midwives and obstetricians in the clinical setting. Midwifery. 2022; 106: 103234. https://doi.org/10.1016/j.midw.2021.103234.
  • Edqvist M, Lindgren H. Lundgren I. Midwives’ lived experience of a birth where the woman suffers an obstetric anal sphincter injury- a phenomenological study. BMC Pregnancy Childbirth. 2014; 14: 258. https://doi.org/10.1186/1471-2393-14-258.
  • Toohill J, Fenwick J, Sidebotham M, Gamble J, Creedy DK. Trauma and fear in Australian midwives. Women Birth. 2019; 32(1): 64-71. doi: 10.1016/j.wombi.2018.04.003.
  • Wiklund I, Wallin J, Vikström M, Ransjö-Arvidson AB. Swedish midwives' rating of risks during labour progress and their attitudes toward performing intrapartum interventions: a web-based survey, Midwifery. 2012; 28(4): e516-e520.
  • Styles M, Cheyne H, O’Carroll R, Greig F, Dagge-Bell F, Niven C. The Scottish Trial of Refer or Keep (the STORK study): midwives’ intrapartum decision making. Midwifery. 2011; 27(1): 104-111, https://doi.org/10.1016/j.midw.2009.12.003.
  • Hajiesmaello M, Hajian S, Riazi H, Majd HA, Yavarian R. Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management. BMC Psychiatry. 2022; 22(1): 56. doi: 10.1186/s12888-022-03707-7.
Year 2023, Volume: 16 Issue: 3, 339 - 348, 18.12.2023

Abstract

Aim: The aim of this study was to evaluate the secondary posttraumatic stress disorder associated with childbirth in midwives working in the delivery room and related factors. Method: This study was conducted as a cross-sectional study in accordance with the quantitative research methodology. The study included 307 midwives who had been working in the delivery room for at least one year, were able to use Web 2 technologies, and volunteered to participate in the research. Data were collected using the "Introductory Information Form" and "Impact of Events Scale". The announcement of the research was made using the snowball method on social media platforms. Results: It was found that 53.1% of the midwives were between the ages of 23-30, 85.7% had a bachelor's degree, 57.7% worked in the delivery room for 1-4 years, and 36.2% frequently made independent decisions in midwifery practices. It was determined that 98.3% of midwives witnessed a traumatic birth and 94.9% of these midwives experienced post-traumatic stress disorder. It was determined that the average post-traumatic stress disorder score of midwives who experienced traumatic birth was 51.88±14.32. No relationship was found between individual and professional characteristics and birth-related secondary post-traumatic stress disorder. Conclusion: Almost all midwives witness a traumatic birth in the delivery room, and the majority of them experience birth-related post-traumatic stress disorder. It is recommended that organizations develop strategies for protective practices for midwives.

References

  • Beck CT, Gable RK. A mixed methods study of secondary traumatic stress in labor and delivery nurses. J Obstet Gynecol Neonatal Nurs. 2012; 41(6): 747–760. doi: 10.1111/j.1552-6909.2012.01386.x.
  • Uddin N, Ayers S, Khine R, Webb R. The perceived impact of birth trauma witnessed by maternity health professionals: A systematic review. Midwifery. 2022; 114: 103460. https://doi.org/10.1016/j.midw.2022.103460.
  • Rice H, Warland J. Bearing witness: midwives experiences of witnessing traumatic birth. Midwifery. 2013; 29 (9): 1056-1063.
  • Cross H, Krahé C, Spiby H, Slade P. Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health?. BMC Pregnancy and Childbirth. 2023; 23(1): 543.
  • Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
  • Kinman, Gail and Teoh, Kevin and Harriss, Anne (2020) The mental health and wellbeing of nurses and midwives in the United Kingdom. Technical Report. Society of Occupational Medicine. [updated 2020; cited 10 Agust 2023]. Available from: https://eprints.bbk.ac.uk /id/eprint/40551/1/2020%20%20The%20Mental%20
  • Aydın R, Aktaş S. Midwives' experiences of traumatic births: A systematic review and meta-synthesis. Eur J Midwifery. 2021 Jul 26; 5: 31. doi: 10.18332/ejm/138197.
  • Leinweber J, Rowe HJ. The costs of ‘being with the woman’: secondary traumatic stress in midwifery. Midwifery. 2010; 26(1): 76-87. https://doi.org/10.1016 /j.midw.2008.04.003.
  • Hunter B, Warren L. Midwives experiences of workplace resilience. Midwifery. 2014; 30: 926–34.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.), American Psychiatric Association, Washington, DC
  • Beck C, LoGiudice J, Gable RK. A mixed-methods study of secondary traumatic stress in certified nurse-midwives: shaken belief in the birth process. J Midwifery Womens Health. 2015; 60 (1): 16-23
  • Sheen K, Spiby H, Slade P. Exposure to traumatic perinatal experiences and posttraumatic stress symptoms in midwives: prevalence and association with burnout. Int J Nurs Stud. 2015; 52 (2): 578-587.
  • Creedy DK, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth. 2017;17(1):13. doi: 10.1186/s12884-016-1212-5.
  • Leinweber J, Creedy DK, Rowe H, Gamble J. A socioecological model of posttraumatic stress among Australian midwives. Midwifery. 2017; 45: 7-13. https://doi.org/10.1016/j.midw.2016.12.001.
  • Dixon L, Guilliland K, Pallant JF, Sidebotham M, Fenwick J, McAra-Couper J, Gilkison A. The emotional wellbeing of New Zealand midwives: Comparing responses for midwives in caseloading and shift work settings. New Zealand College of Midwives Journal. 2017; 53:5-14
  • Minooee S, Cummins A, Sims D J, Foureur M, Travaglia J. Scoping review of the impact of birth trauma on clinical decisions of midwives. Journal of Evaluation in Clinical Practice. 2020; 26(4): 1270–1279. https://doi.org/10 .1111/jep.1333
  • Harvie K, Sidebotham M, Fenwick J. Australian midwives' intentions to leave the profession and the reasons why. Women Birth. 2019; 32(6): e584-e593. doi: 10.1016/j.wombi.2019.01.001.
  • Stoll K, Gallagher J. A survey of burnout and intentions to leave the profession among Western Canadian midwives. Women Birth. 2019; 32(4): e441-e449. doi: 10.1016/j.wombi.2018.10.002.
  • Türkiye Sağlık Enstitüleri Başkanlığı (TUSEB) (2017). Doğum Şekli Tercihinin Multidisipliner İrdelenmesi Çalıştayı Sonuç Raporu. Ankara.
  • Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41: 209-218.
  • Weiss D, Marmar C The impact of Event Scale-Revised. Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 1997: 399–411
  • Creamer M, Bell R, Failla S Psychometric properties of the Impact of Event Scale-Revised. Behav Res Ther. 2003; 41: 1489- 1496
  • Çorapçıoğlu A, Yargıç İ, Geyran P, Koçabaşoğlu N. Olayların Etkisi Ölçeği (IES-R) Türkçe versiyonunun geçerlilik ve güvenilirliği. New/Yeni Symposium: Psikiyatri, Nöroloji ve Davranış Bilimleri Dergisi. 2006; 44(1): 14-22.
  • Leinweber J, Fontein-Kuipers Y, Thomson G, Karlsdottir SI, Nilsson C, Ekström-Bergström A, Olza I, Hadjigeorgiou E, Stramrood C. Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth (Berkeley, Calif.). 2022; 10.1111/birt.12634. https:// doi.org/10.1111/birt.12634
  • Cohen R, Leykin D, Golan-Hadari D, Lahad M. Exposure to traumatic events at work, posttraumatic symptoms and professional quality of life among midwives, Midwifery. 2017; 50: 1-8. https://doi.org/10.1016/j.midw.2017.03.009.
  • Patterson, J. (2019). Traumatised midwives; traumatised women. AIMS J., 30 (4). [updated 2019; cited 10 Agust 2023]. Available from: https://www.aims.org.uk/journal/item/traumatised-midwives-traumatised-women.
  • Cankaya S, Erkal Aksoy Y, Dereli Yılmaz S. Midwives' experiences of witnessing traumatic hospital birth events: A qualitative study. J Eval Clin Pract. 2021; 27: 847–857. https://doi.org/10.1111/jep.13487
  • Kendall-Tackett K, Beck CT. Secondary Traumatic Stress and Moral Injury in Maternity Care Providers: A Narrative and Exploratory Review. Front Glob Womens Health. 2022; 4(3) :835811. doi: 10.3389/fgwh.2022.835811.
  • Shorey S, Wong PZE. Vicarious trauma experienced by health care providers ınvolved in traumatic childbirths: A meta-synthesis. Trauma Violence Abuse. 2022; 23(5): 1585-1598. doi: 10.1177/15248380211013135.
  • Calvert I, Benn C. Trauma and the Effects on the Midwife. International Journal of Childbirth. 2015; 5(2): 100-112. doı: 10.1891/2156-5287.5.2.100.
  • Zondag DC, van Haaren-Ten Haken TM, Offerhaus P M, Maas VYF, Nieuwenhuijze MJ Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives. Netherlands. European Journal of Midwifery. 2022; 6(September): 1-9. https://doi.org/10.18332/ejm/151653
  • Peterwerth NH, Halek M, Schäfers R. Intrapartum risk perception–A qualitative exploration of factors affecting the risk perception of midwives and obstetricians in the clinical setting. Midwifery. 2022; 106: 103234. https://doi.org/10.1016/j.midw.2021.103234.
  • Edqvist M, Lindgren H. Lundgren I. Midwives’ lived experience of a birth where the woman suffers an obstetric anal sphincter injury- a phenomenological study. BMC Pregnancy Childbirth. 2014; 14: 258. https://doi.org/10.1186/1471-2393-14-258.
  • Toohill J, Fenwick J, Sidebotham M, Gamble J, Creedy DK. Trauma and fear in Australian midwives. Women Birth. 2019; 32(1): 64-71. doi: 10.1016/j.wombi.2018.04.003.
  • Wiklund I, Wallin J, Vikström M, Ransjö-Arvidson AB. Swedish midwives' rating of risks during labour progress and their attitudes toward performing intrapartum interventions: a web-based survey, Midwifery. 2012; 28(4): e516-e520.
  • Styles M, Cheyne H, O’Carroll R, Greig F, Dagge-Bell F, Niven C. The Scottish Trial of Refer or Keep (the STORK study): midwives’ intrapartum decision making. Midwifery. 2011; 27(1): 104-111, https://doi.org/10.1016/j.midw.2009.12.003.
  • Hajiesmaello M, Hajian S, Riazi H, Majd HA, Yavarian R. Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management. BMC Psychiatry. 2022; 22(1): 56. doi: 10.1186/s12888-022-03707-7.
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Midwifery (Other)
Journal Section Articles
Authors

Meltem Aydın Beşen 0000-0003-3012-7531

Gözde Gökçe İşbir 0000-0003-0101-0641

Early Pub Date December 5, 2023
Publication Date December 18, 2023
Submission Date September 12, 2023
Acceptance Date October 2, 2023
Published in Issue Year 2023 Volume: 16 Issue: 3

Cite

APA Aydın Beşen, M., & Gökçe İşbir, G. (2023). Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 16(3), 339-348.
AMA Aydın Beşen M, Gökçe İşbir G. Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler. Mersin Univ Saglık Bilim derg. December 2023;16(3):339-348.
Chicago Aydın Beşen, Meltem, and Gözde Gökçe İşbir. “Ebelerde doğumla ilişkili Ikincil Travma Sonrası Stress bozukluğu Ve ilişkili faktörler”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16, no. 3 (December 2023): 339-48.
EndNote Aydın Beşen M, Gökçe İşbir G (December 1, 2023) Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16 3 339–348.
IEEE M. Aydın Beşen and G. Gökçe İşbir, “Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler”, Mersin Univ Saglık Bilim derg, vol. 16, no. 3, pp. 339–348, 2023.
ISNAD Aydın Beşen, Meltem - Gökçe İşbir, Gözde. “Ebelerde doğumla ilişkili Ikincil Travma Sonrası Stress bozukluğu Ve ilişkili faktörler”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16/3 (December 2023), 339-348.
JAMA Aydın Beşen M, Gökçe İşbir G. Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler. Mersin Univ Saglık Bilim derg. 2023;16:339–348.
MLA Aydın Beşen, Meltem and Gözde Gökçe İşbir. “Ebelerde doğumla ilişkili Ikincil Travma Sonrası Stress bozukluğu Ve ilişkili faktörler”. Mersin Üniversitesi Sağlık Bilimleri Dergisi, vol. 16, no. 3, 2023, pp. 339-48.
Vancouver Aydın Beşen M, Gökçe İşbir G. Ebelerde doğumla ilişkili ikincil travma sonrası stress bozukluğu ve ilişkili faktörler. Mersin Univ Saglık Bilim derg. 2023;16(3):339-48.

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