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

Mena‐Tudela, Desirée; Iglesias-Casás, Susana; Chorda, Víctor Manuel González; Cervera‐Gasch, Águeda; Andreu‐Pejó, Laura; Valero‐Chillerón, María Jesús

doi:10.3390/ijerph18010199

Cited by 29 publications

(27 citation statements)

References 31 publications

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“…The main variables were analyzed according to the maternity times (pregnancy, giving birth, puerperium) when women perceived OV according to the type of care received, the cluster group established in a previous study [15], and by the involved professionals. The bivariate analysis and its results with cluster groups continued to indicate a certain degree of inequality in the different regions of Spain for OV, which falls in line with previous studies [15,29]. So, we believe that our study results could provide healthcare professionals, organizations,…”

Section: Discussionsupporting

confidence: 91%

“…Women attended to for pregnancy, childbirth, or abortion during the 2009-2018 period, and who completed the questionnaire, were included in the study. In these previous studies, it was noted that some practitioners' behaviors were not perceived as OV by women [15,29]. However, these behaviors really occurred, and analyzing who performed them and at what time is interesting.…”

Section: Design Population and Samplementioning

confidence: 97%

“…A descriptive, retrospective and cross-sectional study was conducted between January 2018 and June 2019. The followed methodology is set out in detail in the previous publications Part I and Part II [15,29]. Women attended to for pregnancy, childbirth, or abortion during the 2009-2018 period, and who completed the questionnaire, were included in the study.…”

Section: Design Population and Samplementioning

confidence: 99%

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Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

Mena‐Tudela

Iglesias-Casás²,

Chorda

et al. 2021

IJERPH

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Background: Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence. Methods: This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women. Results: Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and “other” professionals repeatedly appeared. Conclusions: Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System’s structure and management but also on healthcare professionals’ training.

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Section: Discussionsupporting

confidence: 91%

Section: Design Population and Samplementioning

confidence: 97%

Section: Design Population and Samplementioning

confidence: 99%

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Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

Mena‐Tudela

Iglesias-Casás²,

Chorda

et al. 2021

IJERPH

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“…More than 20 years after the first WHO recommendations, the use of interventions lacking scientific evidence during labor remains a challenge in several countries [6,[11][12][13]. A study carried out in Spain has shown high levels of interventions during labor.…”

Section: Introductionmentioning

confidence: 99%

“…A study carried out in Spain has shown high levels of interventions during labor. Kristeller maneuver stood out among them, although scientific evidence has already shown the risks posed by this maneuver both to the mother and the baby [11]. Two out of three pregnant women in Turkey were subjected to elective labor induction, and this procedure contradicts the current evidence that discourages this practice [6].…”

Section: Introductionmentioning

confidence: 99%

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

Souza

Silva

Damasceno

et al. 2021

BMC Pregnancy Childbirth

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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.

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Individual and country‐level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

Miani

Wandschneider

Batram‐Zantvoort

et al. 2022

Intl J Gynecology & Obste

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Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level.Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure.Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy.Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001).Country-level variables contributed to explaining some of the variance between countries. Conclusion:We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.

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

Cited by 29 publications

References 31 publications

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

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

Individual and country‐level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

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