Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

Abstract

Background In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women's higher age at childbirth and thus a higher need for control and security cannot entirely explain this rise in obstetric interventions. Another potential factor is that women feel coerced to agree to interventions; however, the prevalence of coercive interventions is unknown. Methods In a nationwide cross-sectional online survey, we assessed mothers' satisfaction with childbirth and the prevalence of informal coercion during childbirth and of women at risk for postpartum depression. We used multivariable logistic regression to estimate the risk associated with multiple individual and contextual factors. Women at least 18 years old who gave birth in Switzerland within the previous 12 months were recruited online via Facebook ads or offline via various channels. Results A total of 6'054 women completed the questionnaire (drop-out rate 16.2%). An estimated 26.7% experience some form of informal coercion during childbirth. Having a cesarean section or instrumental vaginal birth was associated with an increased risk to experience informal coercion (all risk ratios > 1.5). The risk was also increased for women with a migrant background, women living in more urban regions and women with a risk pregnancy. Also, women to whom having a self-determined vaginal birth is important reported on informal coercion more often. Being at risk for postpartum depression was mostly associated with having an emergency cesarean section, having been transferred to hospital and the experience of informal coercion. Also, women with a migrant background seem to be at a higher risk to develop postpartum depression or having other mental health issues. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth experience and women who experienced informal coercion reported lower satisfaction. Conclusions One in four women experience informal coercion during childbirth, and this experience is associated with being at risk for postpartum depression and lower satisfaction with childbirth. Health care professionals should make every effort to prevent informal coercion and ensure sensitive aftercare for all new mothers in order to prevent traumatic effects.

A true choice of place of birth? Swiss women’s access to birth hospitals and birth centers

“…Related to this, a recent nationwide Swiss study revealed that 26.7% of women experienced informal coercion in childbirth (i.e. opposition, intimidation, manipulation) and that the likelihood of experiencing informal coercion was higher (a) for in-hospitals births than for births in birth centers, (b) for women with a higher preference for autonomous decisions, and (c) for births with interventions [ 46 ]. Moreover, findings from the US found higher rates of mistreatment in hospital settings than in community birth settings such as birth centers and when women’s and providers’ preferences for care did not match one another [ 38 ].…”

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“…Over the past years more and more women opened up about instances of mistreatment in childbirth, such as physical or verbal abuse, discrimination, unconsented interventions, loss of autonomy, or informal coercion. The current state of research suggests that mistreatment of women in childbirth occurs regularly and is not limited globally to particular geographical areas [38,[44][45][46][47]. Spanning 34 countries, a systematic review from the World Health Organization highlighted that mistreatment can occur at the levels of interpersonal interaction and…”

Untitled

“…Over the past years more and more women opened up about instances of mistreatment in childbirth, such as physical or verbal abuse, discrimination, unconsented interventions, loss of autonomy, or informal coercion. The current state of research suggests that mistreatment of women in childbirth occurs regularly and is not limited globally to particular geographical areas [38,[44][45][46][47]. Spanning 34 countries, a systematic review from the World Health Organization highlighted that mistreatment can occur at the levels of interpersonal interaction and…”