Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy.
Clin Ter. 2024 Jan-Feb;175(1):57-67. doi: 10.7417/CT.2024.5034.
Historical mistreatment and violence directed toward women's bodies extend to the field of medicine, and obstetric and gynecological practices are not immune to such misconduct. Obstetric violence (OV) refers to actions involving disrespectful, abusive, or coercive treatment directed at pregnant and birthing women. This includes institutional and personal attitudes that lead to the violation of women's autonomy, human rights, and sexual and reproductive health. Despite various international legislative initiatives and recommendations from the World Health Organization (WHO) addressing disrespectful and abusive treatment, OV is still poorly known to Italian public opinion. This study aims to investigate whether the concept of OV has been conversely assimilated in judicial decisions.
A retrospective analysis was conducted to scrutinize judgments in Italy until June 2023 related to OV. The Italian legal database 'De Jure Giuffrè', which collects sentences by various Courts, and the terms 'obstetric' and 'violence' as keywords were used for the research.
The full-text revision of the results (n. 41 sentences) al-lowed the selection of 5 eligible contributions covering the following issues: Informed Consent, Kristeller maneuver, Vaginal Birth After Cesarean (VBAC), Acceleration of childbirth without indication, and Episiotomy. The analysis of individual judgments was complemented by an examination of the key issues involved.
The reviewed judgments frequently seemed to be grounded in technical aspects and inclined towards a predominant evaluation of childbirth outcomes. However, some encouraging aspects emerged, particularly in terms of attention to the female body, acknowledgment of consequences within the intimate-relational dimension, and a commitment to the principle of self-determination through the provision of free and informed consent. Ensuring the psychophysical well-being of women and unborn children, fostering positive interactions between pregnant women and medical staff, and actively working to reduce the grounds for litigation are among actual emerging priorities in healthcare. In this sense, fundamental elements include the implementation of continuous staff training and education as well as a focus on promoting the self-determination of women, leveraging new technologies for this purpose, and ensuring legal protection of their rights.
历史上针对女性身体的虐待和暴力行为延伸到医学领域，妇产科实践也不能免受这种不当行为的影响。产科暴力（OV）是指针对孕妇和产妇的不尊重、虐待或强制治疗行为。这包括导致侵犯妇女自主权、人权以及性健康和生殖健康的机构和个人态度。尽管有各种国际立法举措和世界卫生组织（WHO）的建议来解决不尊重和虐待问题，但意大利公众对 OV 知之甚少。本研究旨在探讨 OV 的概念是否在司法判决中得到了相反的理解。
回顾性分析了截至 2023 年 6 月意大利与 OV 相关的判决。使用了意大利法律数据库 'De Jure Giuffrè'，该数据库收集了各种法院的判决，以及关键词 '产科' 和 '暴力' 进行了研究。
对结果的全文审查（n=41 个判决）允许选择 5 个符合条件的贡献，涵盖以下问题：知情同意、Kristeller 手法、剖宫产后阴道分娩（VBAC）、无指征加速分娩和会阴切开术。对个别判决的分析补充了对所涉关键问题的审查。
所审查的判决似乎常常基于技术方面，并倾向于对分娩结果进行主要评估。然而，出现了一些令人鼓舞的方面，特别是在关注女性身体、承认亲密关系维度的后果以及通过提供自由和知情同意来承诺自主原则方面。确保妇女和未出生儿童的身心健康、促进孕妇和医务人员之间的积极互动以及积极努力减少诉讼理由是医疗保健中的实际新兴优先事项。在这方面，基本要素包括实施持续的员工培训和教育，以及专注于促进妇女的自主决定，为此利用新技术，并确保保护其权利的法律保护。
