Department of Population Health, The University of Toledo, Toledo, Ohio.
Department of Human Ecology, University of California, Davis, California.
J Midwifery Womens Health. 2024 Sep-Oct;69(5):718-726. doi: 10.1111/jmwh.13655. Epub 2024 May 24.
In the United States, 1 in 6 women reports obstetric violence in the form of physical and verbal abuse, coercion, and lack of informed consent. Despite recommendations against routine episiotomy, its use in the United States remains notable and varies considerably. This study aimed to analyze the various forms of obstetric violence associated with undergoing an episiotomy and having a choice in undergoing an episiotomy.
Data from the cross-sectional Listening to Mothers in California survey were analyzed using weighted sample. Logistic regression models were conducted to compute adjusted odds ratios (aORs) and 95% CIs for undergoing episiotomy and having a choice in it.
Overall, 21% of the respondents reported undergoing an episiotomy, and 75% of them reported not having a choice in undergoing this procedure. After adjusting for covariates, feeling pressured to induce labor (aOR, 1.31; 95% CI, 1.28-1.35) and to use an epidural analgesia (aOR, 1.82; 95% CI, 1.77-1.88) increased the odds of undergoing an episiotomy. Having a midwife during childbirth significantly reduced the odds of an episiotomy. Respondents who indicated being handled roughly by health care providers were 95% less likely to have a choice in receiving an episiotomy (aOR, 0.05; 95% CI, 0.04-0.06).
This is the first study to examine other forms of obstetric violence as correlates of episiotomy and having a choice in it. Standardized institutional measures against obstetric violence, patients' ability to make autonomous decisions through informed consent, and engaging midwives could decrease medically unnecessary labor procedures and associated complications.
在美国，1/6 的女性报告称在分娩过程中经历过身体和言语虐待、强制和缺乏知情同意等形式的产科暴力。尽管不建议常规行会阴切开术，但在美国，其使用率仍然很高，且差异很大。本研究旨在分析与行会阴切开术相关的各种形式的产科暴力，以及在行会阴切开术时是否有选择权。
使用加权样本对横断面加利福尼亚州倾听母亲调查的数据进行分析。采用逻辑回归模型计算行会阴切开术和在行会阴切开术时有选择权的调整后优势比（aOR）和 95%置信区间（CI）。
总体而言，21%的受访者报告行会阴切开术，其中 75%的受访者在行会阴切开术时没有选择权。调整了协变量后，感到被迫引产（aOR，1.31；95%CI，1.28-1.35）和使用硬膜外镇痛（aOR，1.82；95%CI，1.77-1.88）增加了行会阴切开术的可能性。分娩时有导乐显著降低了行会阴切开术的可能性。受访者表示曾被医护人员粗暴对待，在行会阴切开术时选择的可能性降低了 95%（aOR，0.05；95%CI，0.04-0.06）。
这是第一项研究检查其他形式的产科暴力与会阴切开术及其选择的相关性。针对产科暴力的标准化机构措施、患者通过知情同意做出自主决策的能力以及导乐的参与，可能会减少不必要的医疗性分娩程序和相关并发症。
