Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of 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 an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown. Methods In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors. Results In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction. Conclusions One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers.

“We felt like part of a production system”: a qualitative study on women’s experience of mistreatment during childbirth in Switzerland

“…These risk factors pertained to the woman (e.g., "not being able to think"), to interactions with the HCP or her partner (e.g., the power imbalance between HCP and patients) or to the situation (e.g., prolonged labour). While this finding is consistent with studies that have demonstrated effects of socio-demographic factors such as nationality or race on mistreatment, the present study does not allow any causal interpretations and future research should investigate the link between these potential risk factors and mistreatment [2,6].…”

“…Health system conditions and constraints 0.3 1 Percentage out of all women who wrote a comment relevant to mistreatment. 2 Physical and sexual abuse were taken together due to their small number as well as a high degree of overlap or unclear distinction between the two.…”

“…A number of Latin American countries for instance have acknowledged obstetric violence as a form of gender-based violence and have passed laws to combat it, following the combined efforts of activists, governmental and non-governmental organisations and researchers, the first of which was Venezuela in 2007 [1]. However, mistreatment during childbirth continues to be a widespread problem around the world, including in high-income countries: Recent studies in Switzerland, Italy, Spain, the Netherlands and the US for instance have shown that a significant proportion of women report that they are mistreated by healthcare professionals (HCP) during childbirth [2][3][4][5][6]. Women have the right to safe, respectful and dignified obstetric care and any form of mistreatment violates fundamental human rights [7][8][9][10][11].…”

“…The present project adopted a mixed methods approach to explore the experiences of women who gave birth in Switzerland. The first, quantitative part was an online survey on childbirth experience among over 6000 mothers in Switzerland that focused on informal coercion [2]. According to the Swiss Academy of Medical Sciences, medical measures are considered coercive if they are carried out against a patient's will or despite their opposition or resistance, which highlights the importance of patient autonomy in healthcare [29].…”

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

“…Following publication of the original article [ 1 ], the authors identified an error in the author name of Eva Cignacco.…”