Breastfeeding and Obstetric Violence during the SARS-CoV-2 Pandemic in Spain: Maternal Perceptions

Abstract

Catalan legislation, a pioneer in Europe, has defined obstetric violence (OV) as “preventing or hindering access to truthful information, necessary for autonomous and informed decision-making”. The definition also states that OV can affect physical and mental health, as well as sexual and reproductive health. Some authors have expressed concern about an increase in OV during the SARS-CoV-2 pandemic. During the pandemic, recommendations were also openly offered on the non-establishment and/or early abandonment of breastfeeding without scientific evidence to support them. Experiencing a traumatic childbirth can influence breastfeeding outcomes. Here, we conducted a cross-sectional study using a self-administered online questionnaire. The sample consisted of women who gave birth in Spain between March 2020 and April 2021. The mean age was 34.41 (±4.23) years. Of the women, 73% were employed, 78.2% had a university education, and almost all were Caucasian. Among the subjects, 3.3% were diagnosed with SARS-CoV-2 during pregnancy and 1% were diagnosed during delivery. Some of the women (1.6%) were advised to stop breastfeeding in order to be vaccinated. Women diagnosed with SARS-CoV-2 during delivery (p = 0.048), belonging to a low social class (p = 0.031), with secondary education (p = 0.029), or who suffered obstetric violence (p < 0.001) perceived less support and that the health care providers were less inclined to resolve doubts and difficulties about breastfeeding. Breastfeeding has been significantly challenged during the pandemic. In addition to all the variables to be considered that make breastfeeding support difficult, we now probably need to add SARS-CoV-2 diagnosis and OV.

Unveiling the intersection: exploring obstetric violence in the Era of COVID-19 in Ecuador

“…There are no scientific published data of this indicator during the pandemic. In Spain the prevalence of obstetric violence during the pandemic was much lower than in Ecuador with 26% [ 18 ].…”

“…The increased use of personal protective equipment such as masks and face shields, during childbirth may have hindered effective communication between healthcare providers and women. This lack of clear communication could contribute to feelings of mistreatment or violation [ 18 ].…”

“…Also, episiotomy has been a standard practice in recent years, it is evident that it produces more problems than benefits at the time of birth, for example: it does not facilitate the expulsion of the newborn, it does not prevent vaginal tears, instead, it has been related to a higher risk of tearing due to this procedure [ 18 , 19 ].…”

Enfoque de Derechos Humanos en la atención obstétrica y el parto

“…Pese a la falta de consenso, y en ausencia de una definición unívoca sobre "violencia obstétrica", este término abarcaría aquellas prácticas en las cuales confluyen de dos circunstancias fundamentales: un daño sufrido por las mujeres en los procesos de atención obstétrica, y la falta de respeto a su derecho a la autonomía (Mena-Tudela, 2022).…”

Perinatal Outcomes at Birth in Women Infected and Non-Infected with SARS-CoV-2: A Retrospective Study

“…The modification of these practices bore negative implications for the maternal experience and neonatal health, hampering mother-infant interaction and impeding breastfeeding promotion [24]. As the pandemic progressed, healthcare professionals persevered in their efforts to strike a delicate balance between preventive measures and maintaining a warm, secure environment during the birthing process.…”