Violência obstétrica: influência da Exposição Sentidos do Nascer na vivência das gestantes

"Normal in all the rush": A phenomenological study analyzing midwifery students' views on obstetric violence

INTRODUCTION

In recent years, obstetric violence, which undermines women's dignity and autonomy, has received increased attention worldwide. Considering the importance of midwives in combating violence in the obstetric field and the significance of the discussed issue, the following question arises: How do future midwives view obstetric violence?

OBJECTIVE

This study aimed to investigate midwifery students' thoughts about obstetric violence.

DESIGN AND METHOD

This study was conducted using a phenomenological qualitative research design. This study, which adopted a descriptive approach and used typical case sampling, was conducted in the midwifery department of the Kutahya Health Sciences University. Sixteen midwifery students studying fourth-year in the 2018-2019 academic year, who had participated in childbirth during their studies, and who agreed to participate in the study were included. All students had the experience of repeated monitoring and presence in labor. They had witnessed births in different institutions. Focus group interviews were conducted using an unstructured interview guide to obtain data for the study. Data were collected through four focus group interviews with groups of four students in the classroom environment. The data were evaluated separately by two researchers using the content analysis method in MAXQDA Analytics Pro 2020. The Consolidated Criteria for Reporting Qualitative Studies guidelines were used as a guide in reporting.

RESULTS

As a result of the analysis, four main themes emerged: defining violence, causes of violence, effects of witnessing violence, and whether can violence be prevented?

CONCLUSIONS

Midwifery students have an awareness of all visible forms of obstetric violence. However, they were less aware of the invisible structural and policy drivers of obstetric violence. It is invaluable to raise awareness of obstetric violence among midwifery students, who will be the most important defenders of women in childbirth. Studies focused on education and policy will contribute to women receiving quality care at birth.

Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada

BACKGROUND

The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period.

PURPOSE

To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada.

METHODS

This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design.

RESULTS

The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period.

CONCLUSIONS

Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

A qualitative study of women's experiences with obstetric violence during childbirth in Turkey

OBJECTIVES

to examine and explain the feelings, thoughts and experiences of women who reported that they had experienced obstetric violence at any stage of the childbirth process (i.e. pregnancy, delivery and postpartum) in Turkey.

DESIGN

a phenomenological qualitative study using the theoretical thematic analysis approach in data analysis.

SETTING

data were collected in individual in-depth interviews via video conferencing between 24 February 2021 and 16 November 2021.

PARTICIPANTS

27 women who reported that they had experienced obstetric violence during the childbirth process and who met the study inclusion criteria.

RESULTS

participants who reported that they had experienced obstetric violence were categorised into the following themes: (1) types of obstetric violence; (2) failure to meet professional standards of care; (3) reactions; and (4) awareness. Women with different sociodemographic and obstetric characteristics were exposed to diverse types of obstetric violence, causing them to feel stress, anxiety, worry, sadness, helplessness, anger and fear. They had certain expectations of health professionals (e.g. midwives, nurses and physicians), and did not have prior awareness of obstetric violence.

KEY CONCLUSIONS

obstetric violence against women during the childbirth process is a serious problem in the Turkish care system that has a negative effect on women's health.

IMPLICATIONS FOR PRACTICE

awareness of obstetric violence should be increased amongst health professionals and women receiving healthcare services. Further studies should be conducted to determine the prevalence of obstetric violence, and relevant training programmes should be developed to eliminate this type of violence against women in health facilities.

Perception of health sciences and feminist medical students about obstetric violence

OBJECTIVE

To measure the perception of obstetric violence among health sciences students.

METHOD

Cross-sectional design in which the validated questionnaire PercOV-S (Perception of Student Obstetric Violence) was used. The questionnaire was offered to the students who participated in the I Congress of Feminist Medicine of the CEEM (State Councils of Medical Students) held on March 12, 2021. This questionnaire was sent online through Google Forms.

RESULTS

The mean score obtained on the total scale was 3.83 scores (SD=0.61). For the dimension of protocolized-visible obstetric violence, the mean score is 2.79 points (SD=0.84) and for the dimension of non-protocolized-invisible obstetric violence, a mean of 4.16 points is obtained (SD=0.61). The global score of the displayed question differs statistically significantly with the variable scope (p=0.019), course (p=0.008), treatment according to ethnicity (p=0.008), treatment according to socioeconomic level, immigrant status (p<0.001), and prior knowledge about the concept of obstetric violence (p<0.001).

CONCLUSIONS

The data show a marked generalised sensitivity of the sample to the issue of obstetric violence, especially with regard to the ethnic characteristics of the women. Likewise, the need to generate ethical-attitudinal training in the response to obstetric violence is observed.

Women's voice on changes in childbirth care practices: a qualitative approach to women's experiences in Brazilian private hospitals participating in the Adequate Childbirth Project

BACKGROUND

In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA.

METHOD

Qualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the "Healthy Birth", an evaluative hospital-based research, conducted in 2017-2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement.

RESULTS

The PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced.

CONCLUSIONS

Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women's voices should be listened to not only during but also before and after childbirth.

Social inequalities in women exposed to obstetric and gyneco-obstetric violence in Ecuador: a cross-sectional study

BACKGROUND

Obstetric and gyneco-obstetric violence (OV, GOV) is a concerning public health problem, particularly in Latin America. This study aimed to determine the prevalence of OV and GOV and to assess its socio-geographical distribution in Ecuador.

METHODS

This cross-sectional study used data from a national survey conducted in 2019 (n = 17,211) among women aged 15 years and over. Independent variables included age, marital status, education, ethnicity, place of residence and region. The chosen outcomes were lifetime experience of OV and GOV. Frequency tables were calculated and crude and adjusted regression models estimating prevalence ratios and their 95% confidence intervals were computed.

RESULTS

Nearly one-third (32.8%) of the participants had experienced OV and two-fifths (41.86%) GOV at least once in their lifetime. Prevalence of OV were particularly common in women 26-35 and 46-55 years old, with primary or middle education and in urban regions. In comparison, GOV had a higher prevalence in women aged > 65 years and with no formal education. Both subtypes of violence were more common among women with current or earlier partners compared with the single ones. Also the two outcomes were more prevalent in the non-white population, OV among the populations of colour (POC), while GOV both, in the POC and Indigenous group. Additionally, women from the Highlands and Amazon reported higher OV and GOV than the Coastal group.

CONCLUSION

Our study showed that OV and GOV are common in Ecuador and identified an unequal distribution of their prevalence across different socio-geographical groups. Further studies including more social factors and a continuous monitoring of OV and GOV are recommended. Current policies, laws to protect women and guidelines regarding the treatment of women, particularly in health care settings, need to be constantly advocated for and effectively implemented in the country.

Quality aspects relating to giving birth in Switzerland: An analysis of quality indicators in inpatient obstetrics from 2013 to 2017

Quality transparency supports the reduction of information asymmetries in the health care system and enables the targeted regulation of health care. This study examines quality variation in inpatient obstetric care using the official Federal Office of Public Health Inpatient Quality Indicators (CH-IQI; vaginal births with 3rd- and 4th-degree perineal tears, vaginal births with episiotomy, and Caesarean section for low-risk births). It includes 101 maternity hospitals and 425,810 births between 2013 and 2017. For births with perineal laceration of 3rd and 4th degree, Switzerland performs 0.9% poorer in comparison to Germany (D-IQI) and Austria (A-IQI). For births with episiotomy, Switzerland is 1.1% above Germany. The Caesarean section rate for low-risk births was 26.8% in Switzerland in 2017 (Germany: 25.9%). When comparing Swiss clinics, private clinic locations in particular stand out. One possible reason for this may be the density of care, patient demands or the system of affiliated physicians at these clinics.

Obstetric violence and associated factors among women during facility based childbirth at Gedeo Zone, South Ethiopia

Introduction

Obstetric violence is a specific form of violence against women that violates their human rights. Conducted by obstetric care providers regarding the body and reproductive processes of the woman, being characterized by dehumanized assistance, abuse of interventionist actions, medicalization, and reversion of the process from natural to pathological.

Objective

To assess the magnitude of obstetric violence and associated factors among women during childbirth in Gedeo Zone, South Ethiopia.

Method

Community based cross-sectional study was conducted among randomly selected 661 mothers in Gedeo Zone, South Ethiopia, from May 1 to May 30 2020. Multi-stage sampling technique was used to get a total of 661 mothers from their kebeles. Data was collected by using face-to--to-face interview with a structured questionnaire and in-depth interview was also employed. Data entry and analysis was done by Epi data version 3.1 and SPSS 23.0 statistical software. Bivariate and multivariable logistic regression models were used to determine the important predictors of obstetric violence. Association between outcome and independent variables was presented by adjusted odds ratio with 95% CI.

Results

From the total of 661 mothers, about 79.7% (527) of mothers experienced obstetric violence with 95% CI (76.9–82.8). educational status (AOR = 2.2573, 95%CI = 1.44,3.54), ANC utilization (AOR = 2.365, 95%CI = 1.62–3.21), duration of stay (AOR = 0.5367,95%CI = 0.28,0.86)), and facing complication during labor and delivery (AOR = 3.1382, 95%CI = 2.34,5.17) were the major factors associated with obstetric violence.

Conclusion

The magnitude of obstetric violence was high. Non dignified care and non-consented care was the most common form of obstetric violence which may lead a woman to choose for home delivery instead of health facility care, this in turn leads to a great increase in maternal morbidity and mortality as supported by qualitative approach of the study.

Disrespect and abuse during childbirth in maternity hospitals in Piauí, Brazil: a cross-sectional study

OBJECTIVES

To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil.

METHODS

A cross-sectional study with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face-to-face interviews were carried out at least 6 hours after birth, with an assessment of disrespect and abuse during childbirth (D&A). Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95%CI).

RESULTS

There was evidence that 19.8% of women experienced at least one type of D&A, with verbal abuse (12.6%), non-compliance with professional standards (11.6%) and health service restrictions being more common (8.3%). There was an association of D&A with women aged 10-19 years (aPR=1.97; 95%CI 1.58-2.44), absence of companions (aPR=2.43; 95%CI 1.85-2.89), cesarean sections after labor (aPR=2.19; 95%CI 1.64-3.59), public hospitals (aPR=1.87; 95%CI1.42-2.85) and in the countryside (aPR=2.29; 95%CI 1.81-3.98).

CONCLUSIONS

There was a high prevalence of D&A in Piauí, associated with structural conditions of the services, care practices and characteristics of women.

A percepção do cuidado centrado na mulher por enfermeiras obstétricas num centro de parto normal

Resumo Objetivo compreender a percepção da atuação das enfermeiras obstétricas em relação à assistência às mulheres atendidas em um Centro de Parto Normal. Método estudo descritivo, exploratório e de abordagem qualitativa, com a realização de entrevistas semiestruturadas com 11 enfermeiras obstétricas do Centro de Parto Normal Haydeê Pereira Sena, Pará, Brasil. As entrevistas foram realizadas pelo aplicativo WhatsApp®, na função de videochamada e no período de setembro a novembro de 2020, com a gravação utilizando o aplicativo Cube ACR. Os áudios foram transcritos e submetidos à análise de conteúdo na modalidade temática, com o suporte do software ATLAS.ti 8.0. Resultados a percepção do cuidado atribuído à enfermagem obstétrica se fundamenta no campo da humanização do pré-natal e nas ações de cuidado alinhadas às evidências científicas, fisiológicas e de autonomia da mulher no cuidado obstétrico. Conclusão a enfermagem obstétrica possui como foco a humanização centrada nas evidências do parto, o que fomenta um redesenho da assistência obstétrica.

Will Brazil comply with the SDG 3.1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018

This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BACKGROUND

Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.

METHODS

Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile.

RESULTS

Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.

CONCLUSION(S)

Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

Bozlak C, A. Shaw B. Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka

Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth

BACKGROUND

obstetric violence can partially be represented by the high number of interventions and medicalization rates during the birthing process. The objective of the present study was to determine the interventionism and medicalization levels during childbirth in Spain.

METHODS

a descriptive, retrospective, and cross-sectional study was conducted between January 2018 and June 2019.

RESULTS

the intervention percentages were 34.2% for Kristeller maneuver and 39.3% for episiotomy. Differences appeared in public, private, and mixed healthcare settings (p < 0.001). The mean satisfaction, with healthcare in the different settings, was estimated at 6.88 points (SD ± 2.146) in public healthcare, 4.76 points (SD ± 3.968) in private healthcare, and 8.03 points (SD ± 1.930) in mixed healthcare (p < 0.001). No statistically significant differences were found in Spanish autonomous communities.

CONCLUSIONS

births in Spain seem to be highly intervened. In this study, a certain equity criterion was found concerning interventionism during childbirth in Spain. Healthcare influenced female intervention, satisfaction, and perception levels for obstetric violence; this evidences that female empowerment plays an important role.

Disrespect and Abuse in Obstetric Care in Mexico: An Observational Study of Deliveries in Four Hospitals

INTRODUCTION

To identify and describe the frequency and characteristics of disrespect and abuse practices towards women during facility-based delivery in four hospitals in two Mexican states in 2017, using a mixed method of direct observation and women's reports of health care experiences.

METHODS

A cross-sectional study was performed to describe disrespect and abuse practices in obstetric care (interactions or conditions that are experienced as or intended to be humiliating or undignified) committed by healthcare providers. We included all pregnant women admitted for childbirth (vaginal and cesarean). Semi-structured interviews were also conducted with women, prior to discharge, regarding their experience at delivery.

RESULTS

867 deliveries were observed. 18.8% of women (n = 163) experienced at least one disrespect and abuse event, especially at secondary care facilities. There were a total of 493 disrespect and abuse events, which, on average, represents three events per woman (39.4% were verbal abuse, 32% were physical abuse, and 28.6% were discrimination). In the majority of cases (> 50%), women did not give consent to not recommended invasive procedures and were not provided with adequate information to those procedures.

CONCLUSIONS FOR PRACTICE

Direct observation and interviews was a useful tool to identify disrespectful and abusive practices during delivery care. Our findings provide new evidence of the frequency and characteristics of disrespect and abuse during delivery care in Mexico, which can be used to inform maternal health programs. Additionally, these results encourage the creation of surveillance policies and committees in order to guarantee violence-free and dignified treatment of women during delivery care.

Obstetric Violence in Spain (Part I): Women's Perception and Interterritorial Differences

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

The magnitude of the problem of obstetric violence and its associated factors: A cross-sectional study

BACKGROUND

In recent years, the concept of obstetric violence has become visible among women and professionals, but its prevalence and the factors with which it is related in our healthcare environment are unknown.

AIM

To determine the prevalence of obstetric violence in the Spanish healthcare system and identify the associated factors.

METHODS

A cross-sectional observational study was conducted during 2019 and included 899 women who had given birth in the last 12 months. An online questionnaire was distributed through midwives and women associations in Spain. The questionnaire included sociodemographic, clinical, and assistance practices variables. The primary outcome variable was obstetric violence and its verbal, physical, and psycho-affective types. Crude odds ratios (OR) and adjusted OR (ORa) were estimated using binary logistic regression.

RESULTS

Obstetric violence was reported by 67.4% (606) of the women; 25.1% (226) verbal, 54.5% (490) physical, and 36.7% (330) psycho-affective. Overall obstetric violence was observed more frequently in women who attended maternal education programme (ORa 1.56, 95% CI 1.05-2.32), those who presented a birth plan but it was not respected (ORa 2.82, 95% CI 1.27-6.29), those who received regional analgesia (ORa 1.61, 95% CI 1.13-2.30), those who required an urgent caesarean section (ORa 3.46, 95% CI 1.79-6.69), underwent an episiotomy (ORa 3.34, 95% CI 2.21-5.38), and whose newborn was admitted to an intensive care unit (ORa 2.73, 95% CI: 1.21-6.15). The presentation of a birth plan was observed as protective factors, and the possibility of skin-to-skin (ORa 0.34, 95% CI 0.18-0.62) and felt respected (ORa 0.61, 95% CI 0.43-0.85).

CONCLUSIONS

Two out of three women perceive having suffered obstetric violence during childbirth. Practices such as skin-to-skin contact, and the use of respected birth plans, were protective factors against obstetric violence.

Respectful maternity care and its relationship with childbirth experience in Iranian women: a prospective cohort study

Background

Intrapartum respectful maternity care is defined as a fundamental human right that can affect the mother’s experiences. This study aimed to determine the status of respectful maternity care and its relationship with childbirth experience among Iranian women.

Methods

This prospective cohort study recruited 334 postpartum women in postpartum wards of two public and four private hospitals in Tabriz, Iran. Quota sampling was used based on the number of births in each hospital. Data were collected through interviews with the use of the following tools: sociodemographic and obstetrics characteristics questionnaire, respectful maternity care scale (6 to 18 h postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). The General Linear Model was used to determine the relationship between respectful maternity care and childbirth experience.

Results

The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for sociodemographic and obstetrics characteristics, a statistically significant direct correlation was found between respectful maternity care and a positive childbirth experience (P < 0.001).

Conclusions

The findings reveals a direct relationship between respectful maternity care and positive childbirth experience. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating a respectful maternity care to improve women’s child birth experience and prevent potential adverse effects of negative childbirth experiences.

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth intervention in Brazil: a cross-sectional study

BACKGROUND

Senses of Birth (SoB) is a health education intervention in Brazil that aims to reduce unnecessary cesareans in the country by providing information on reproductive rights, benefits and risks of childbirth, and use of intrapartum evidence-based practices (EBP) which are recommended by the World Health Organization (WHO) to improve childbirth outcomes and satisfaction. This study evaluates the impact of the SoB on pregnant women's perceived knowledge about normal birth (NB), cesarean, and use of EBP.

METHODS

1287 pregnant women answered a structured survey immediately after their visit to the intervention, between March 2015 and March 2016. To estimate the potential impact of the intervention on women's perceived knowledge, and possible associations between sociodemographic characteristics and perceived knowledge, statistical analyses were performed, including paired T-tests, ANOVA, and logistic and linear regressions.

RESULTS

The mean score (MS) of perceived knowledge after the intervention was higher than the MS before experiencing the intervention for all three knowledge domains: Normal Birth (MS Before = 3.71 x MS After = 4.49), Cesarean (MS Before = 3.54 x MS After = 4.26) and EBPs (MS Before = 3.14 x MS After = 4.14). The results suggest that perceived knowledge increased more for low-income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for NB), with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for NB), experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for NB; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and in their first or second trimester (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for NB; OR 1.85, 95% CI: 1.40-2.41 for cesarean).

CONCLUSION

The study showed that participation in the SoB was associated with an increase in perceived knowledge among Brazilian pregnant women. The intervention gains relevance considering the lack of evidence of the impact of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries.