School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland / Center for Primary Care and Public Health (Unisanté), Occupational Health and Environment Department (DSTE), University of Lausanne (UNIL), Switzerland.
Center for Primary Care and Public Health (Unisanté), Occupational Health and Environment Department (DSTE), University of Lausanne (UNIL), Switzerland.
Swiss Med Wkly. 2021 Jul 28;151:w20537. doi: 10.4414/smw.2021.20537. eCollection 2021 Jul 19.
In accordance with the International Labour Organization’s Maternity Protection Convention (No. 183) and European Union Directive 92/857CEE (1992), Switzerland’s Labour Law and its Maternity Protection Ordinance (OProMa) aim to protect the health of pregnant employees and their future children while enabling them to pursue their working activities. Gynaecologists-obstetricians have a key role in this legislation, particularly through the prescription of preventive leave for patients who would otherwise face dangerous or arduous tasks in the absence of an adequate risk analysis or suitable protective measures. However, international and national literature suggests that gynaecologists-obstetricians may encounter difficulties in fulfilling their role.
This study aimed to: (1) describe the practices and difficulties encountered by gynaecologists-obstetricians in the practical implementation of the OProMa; and (2) compare the evolution of these practices and difficulties between 2008 and 2017.
A survey by questionnaire was conducted in 2008 and repeated in 2017. Both surveys focused on gynaecologists-obstetricians working in the French-speaking part of Switzerland (in private practices, hospitals or both). Descriptive and comparative analyses were carried out.
83 gynaecologists-obstetricians responded in 2008 and 93 in 2017: response rates of 47% and 32%, respectively. In 2017, gynaecologists-obstetricians were more likely to ask questions about occupational risks faced by their patients when consulted by working mothers about their pregnancies. The estimated percentage of patients exposed to an occupational risk remained constant (20% in 2008 and 22% in 2017). Communication and collaboration with employers were reported to be difficult in both surveys, even though these are key elements in the implementation of the OProMa. Collaboration with occupational physicians, however, was more frequent in 2017.
In 2017, gynaecologists-obstetricians showed a greater awareness of occupational risks and collaborated more frequently with occupational health specialists. However, the application of the OProMa remained limited over the studied time period. Improving training of gynaecologists-obstetricians in this field could be a significant factor in encouraging better implementation of the current legislation. Moreover, gynaecologists-obstetricians need to be given the necessary support to enable their clinical practice to evolve towards a more preventive type of medicine. Collaboration with relevant stakeholders, including occupational physicians, midwives and workers, should be encouraged.
根据国际劳工组织《产妇保护公约》（第 183 号）和欧盟指令 92/857CEE（1992 年），瑞士的《劳动法》及其《产妇保护条例》（OProMa）旨在保护孕妇及其未来子女的健康，同时使她们能够继续从事工作活动。妇产科医生在这项立法中发挥着关键作用，特别是通过为那些在没有充分风险分析或适当保护措施的情况下可能面临危险或艰苦任务的患者开具预防性休假单。然而，国际和国家文献表明，妇产科医生在履行其职责时可能会遇到困难。
本研究旨在：（1）描述妇产科医生在实际实施 OProMa 时的做法和遇到的困难；（2）比较 2008 年和 2017 年这些做法和困难的演变。
2008 年和 2017 年进行了问卷调查。两次调查均针对在瑞士法语区工作的妇产科医生（私人诊所、医院或两者兼有）。进行了描述性和比较性分析。
2008 年有 83 名妇产科医生做出回应，2017 年有 93 名妇产科医生做出回应：回应率分别为 47%和 32%。2017 年，当工作中的母亲向妇产科医生咨询怀孕问题时，妇产科医生更有可能询问患者所面临的职业风险。估计接触职业风险的患者比例保持不变（2008 年为 20%，2017 年为 22%）。在两次调查中，与雇主沟通和合作都被报告为困难，尽管这是实施 OProMa 的关键要素。然而，与职业医生的合作在 2017 年更为频繁。
2017 年，妇产科医生对职业风险的认识有所提高，并且更频繁地与职业健康专家合作。然而，在研究期间，OProMa 的应用仍然有限。加强妇产科医生在这一领域的培训可能是鼓励更好地执行现行立法的一个重要因素。此外，还需要为妇产科医生提供必要的支持，使他们的临床实践朝着更具预防性的医学方向发展。应鼓励与相关利益攸关方（包括职业医生、助产士和工人）合作。
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