Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
BMC Pregnancy Childbirth. 2021 May 10;21(1):369. doi: 10.1186/s12884-021-03826-1.
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.
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.
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.
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.
在许多国家，医疗机构分娩的增加伴随着产科干预措施的高比率。较低的出生率或升高的风险因素，如女性分娩时的年龄较大，以及对控制和安全的需求增加，都不能完全解释产科干预措施的增加。另一个可能的因素是，女性被迫同意接受干预，但瑞士强制性干预的流行程度尚不清楚。
在一项全国性的横断面在线调查中，我们评估了分娩期间非正式强制的发生率、女性对分娩的满意度以及产后抑郁风险女性的比例。通过 Facebook 广告或通过各种线下渠道招募在瑞士分娩后 12 个月内的 18 岁或以上的女性在线填写问卷。我们使用多变量逻辑回归来估计与多个个体和环境因素相关的风险比。
共有 6054 名女性完成了问卷（弃答率为 16.2%）。估计有 26.7%的女性在分娩期间经历了某种形式的非正式强制。与阴道分娩相比，剖宫产（CS）和器械性阴道分娩与非正式强制的风险增加相关（计划 CS 的风险比 [RR]：1.52，95%置信区间 [1.18,1.96]；非计划 CS RR：1.92 [1.61,2.28]；紧急 CS RR：2.10 [1.71,2.58]；器械性阴道分娩 RR：2.17 [1.85,2.55]）。此外，移民女性（RR：1.45 [1.26,1.66]）和对自主阴道分娩更重要的女性（RR：1.15 [1.06,1.24]）更常报告非正式强制。紧急剖宫产（RR：1.32 [1.08,1.62]）、转院（RR：1.33 [1.11,1.60]）和经历非正式强制（RR：1.35 [1.19,1.54]）均与产后抑郁风险增加相关。最后，非器械性阴道分娩的女性报告了更高的分娩满意度，而经历非正式强制的女性报告了较低的满意度。
四分之一的女性在分娩期间经历非正式强制，这种经历与产后抑郁风险增加和分娩满意度降低有关。为了防止创伤后影响，医护人员应努力防止非正式强制，并确保所有新妈妈都得到敏感的产后护理。
