Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Population, and Sample
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Satisfaction and Interventions while Giving Birth and Their Relation to Received Healthcare Type
3.2. Interventions While Giving Birth and Their Relation to Cluster Groups
3.3. Obstetric Interventions Related to Women Perceiving OV
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Healthcare Type | Feeling about Received Healthcare Type | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Empowered and Satisfied | Unsure, Vulnerable, Guilty, Incapable | Do Not Know/No Answer | Indifferent | ||||||||
n | % | n | % | n | % | n | % | X2 | df1 | p2 | |
Public | 3551 | 31.0 | 4728 | 41.3 | 839 | 7.3 | 2330 | 20.4 | 2419.76 | 6 | <0.001 |
Private | 577 | 31.5 | 1016 | 55.5 | 74 | 4.0 | 163 | 8.9 | 1089.59 | 6 | <0.001 |
Mixed | 2651 | 62.2 | 713 | 16.7 | 278 | 6.5 | 619 | 14.5 | 913.06 | 6 | <0.001 |
Total | 6779 | 38.7 | 5467 | 36.8 | 1191 | 6.8 | 3112 | 17.7 |
Unnecessary and/or Painful Procedures | Perceiving OV | ||||||||
---|---|---|---|---|---|---|---|---|---|
Public | Private | Mixed | |||||||
Yes % (n) | No % (n) | Yes % (n) | No % (n) | Yes % (n) | No % (n) | X2 | df1 | p2 | |
Yes | 76.1 (3705) | 23.9 (1161) | 89.8 (906) | 10.2 (103) | 48.8 (466) | 51.2 (489) | 461.16 | 2 | <0.001 |
No | 11.2 (538) | 88.8 (4266) | 5.8 (38) | 94.2 (619) | 4.3 (121) | 95.7 (2670) | 114.09 | 2 | <0.001 |
Do not know | 44.1 (220) | 55.9 (279) | 37.5 (21) | 62.5 (35) | 24.7 (36) | 75.3 (110) | 17.95 | 2 | <0.001 |
Total | 43.9 (4463) | 56.1 (5706) | 56.0 (965) | 44.0 (757) | 16.0 (623) | 84.0 (3269) |
Interventions | Cluster Group | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | ||||||||||
n | % | n | % | n | % | n | % | n | % | X2 | df1 | p2 | ||
Using cupping glass or forceps | Yes | 786 | 23.4 | 622 | 23.8 | 355 | 23.9 | 323 | 23.4 | 8 | 20.5 | 0.46 | 4 | 0.977 |
No | 2569 | 76.6 | 1987 | 73.2 | 1128 | 76.1 | 1057 | 76.6 | 31 | 79.5 | ||||
Hamilton maneuver | Yes | 749 | 22.3 | 544 | 20.9 | 311 | 21.0 | 288 | 20.9 | 10 | 25.6 | 2.96 | 4 | 0.564 |
No | 2606 | 77.7 | 2065 | 79.1 | 1172 | 79.0 | 1092 | 79.1 | 29 | 74.4 | ||||
Accompanied by no-one | Yes | 922 | 27.5 | 704 | 27.0 | 420 | 28.3 | 419 | 30.4 | 9 | 23.1 | 6.12 | 4 | 0.190 |
No | 2433 | 72.5 | 1905 | 73.0 | 1063 | 71.7 | 961 | 69.6 | 30 | 76.9 | ||||
Lack of information | Yes | 1414 | 42.1 | 1084 | 41.5 | 618 | 41.7 | 601 | 43.6 | 18 | 46.2 | 1.89 | 4 | 0.756 |
No | 1941 | 57.9 | 1525 | 58.5 | 865 | 58.3 | 779 | 56.4 | 21 | 53.8 | ||||
Shaving vulva | Yes | 227 | 6.8 | 212 | 8.1 | 100 | 6.7 | 143 | 10.4 | 5 | 12.8 | 21.74 | 4 | <0.001 |
No | 3128 | 93.2 | 2394 | 91.9 | 13.83 | 93.3 | 1237 | 89.6 | 34 | 84.7 | ||||
Using enema | Yes | 332 | 9.9 | 229 | 8.8 | 93 | 6.3 | 146 | 10.6 | 3 | 7.7 | 21.06 | 4 | <0.001 |
No | 3023 | 90.1 | 2380 | 91.2 | 1390 | 93.7 | 1234 | 89.4 | 36 | 92.3 | ||||
Women not being allowed to eat/drink | Yes | 1122 | 33.4 | 920 | 35.3 | 509 | 34.3 | 476 | 34.5 | 16 | 41.0 | 2.97 | 4 | 0.563 |
No | 2233 | 66.6 | 1689 | 64.7 | 974 | 65.7 | 904 | 65.5 | 23 | 59.0 | ||||
Restricting movements | Yes | 1290 | 38.5 | 1038 | 39.8 | 588 | 39.6 | 574 | 41.6 | 15 | 38.5 | 4.19 | 4 | 0.380 |
No | 2065 | 61.4 | 1571 | 60.2 | 895 | 60.4 | 806 | 58.4 | 24 | 61.5 | ||||
Amniorrhexis | Yes | 1166 | 34.8 | 982 | 37.6 | 555 | 37.4 | 495 | 35.9 | 18 | 46.2 | 8.05 | 4 | 0.090 |
No | 2189 | 65.2 | 1627 | 62.4 | 928 | 62.6 | 885 | 64.1 | 21 | 53.8 | ||||
Using oxytocin | Yes | 1636 | 48.8 | 1240 | 47.5 | 738 | 49.8 | 644 | 46.7 | 23 | 59.0 | 5.44 | 4 | 0.245 |
No | 1719 | 51.2 | 1369 | 52.5 | 745 | 50.2 | 736 | 53.3 | 16 | 41.0 | ||||
Constant vaginal palpations | Yes | 1032 | 30.8 | 825 | 31.6 | 475 | 32.0 | 479 | 34.7 | 13 | 33.3 | 7.16 | 4 | 0.128 |
No | 2323 | 69.2 | 1784 | 68.4 | 1008 | 68.0 | 901 | 65.3 | 26 | 66.7 | ||||
Kristeller maneuver | Yes | 1161 | 34.7 | 941 | 36.1 | 459 | 31.0 | 454 | 32.9 | 13 | 33.3 | 12.68 | 4 | 0.015 |
No | 2192 | 65.3 | 1668 | 63.9 | 1024 | 69.0 | 923 | 67.1 | 26 | 66.7 | ||||
Early umbilical cord clamping | Yes | 664 | 19.8 | 604 | 23.2 | 312 | 21.0 | 277 | 20.1 | 7 | 17.9 | 11.51 | 4 | 0.025 |
No | 2691 | 80.2 | 2005 | 76.8 | 1171 | 79.0 | 1103 | 79.9 | 32 | 82.1 | ||||
Episiotomy | Yes | 1321 | 39.4 | 1026 | 39.3 | 557 | 37.6 | 570 | 41.3 | 9 | 23.1 | 8.52 | 4 | 0.074 |
No | 2034 | 60.6 | 1583 | 60.7 | 926 | 62.4 | 810 | 58.7 | 30 | 76.9 | ||||
Cesarean section | Yes | 535 | 15.9 | 457 | 17.5 | 272 | 18.3 | 230 | 16.7 | 8 | 20.5 | 5.46 | 4 | 0.243 |
No | 2820 | 84.1 | 2152 | 82.5 | 1211 | 81.7 | 1150 | 83.3 | 31 | 79.5 | ||||
Manually removing placenta | Yes | 354 | 10.6 | 292 | 11.2 | 175 | 11.8 | 171 | 12.4 | 4 | 10.3 | 3.94 | 4 | 0.414 |
No | 3001 | 89.4 | 2318 | 88.8 | 1308 | 88.2 | 1209 | 87.6 | 35 | 89.7 | ||||
Separated from baby | Yes | 1128 | 33.6 | 1017 | 39.0 | 584 | 39.4 | 530 | 38.4 | 15 | 38.5 | 26.63 | 4 | <0.001 |
No | 2227 | 66.4 | 1594 | 61.0 | 899 | 60.6 | 850 | 61.6 | 24 | 61.5 | ||||
Bottle feeding baby | Yes | 447 | 13.3 | 343 | 13.1 | 206 | 13.9 | 207 | 15.0 | 3 | 7.7 | 4.24 | 4 | 0.374 |
No | 2908 | 86.7 | 2266 | 86.9 | 1277 | 86.1 | 1176 | 85.0 | 36 | 92.3 | ||||
Taking baby away | Yes | 1018 | 30.3 | 867 | 33.2 | 496 | 33.4 | 456 | 33.0 | 13 | 33.3 | 8.09 | 4 | 0.088 |
No | 2337 | 69.7 | 1742 | 66.8 | 987 | 66.6 | 924 | 67.0 | 26 | 66.7 | ||||
Others | Yes | 325 | 9.7 | 246 | 9.4 | 175 | 11.8 | 149 | 10.8 | 4 | 10.3 | 7.34 | 4 | 0.119 |
No | 3030 | 90.3 | 2363 | 90.6 | 1305 | 88.2 | 1231 | 89.2 | 35 | 89.7 |
Factors | Wald | OR 2 (95% CI) | p |
---|---|---|---|
Cluster group | 2.796 | - | 0.593 |
Received healthcare type 1 | 208.594 | - | <0.001 |
Public | 102.884 | 0.451 (0.387–0.526) | <0.001 |
Private | 193.914 | 0.173 (0.135–0.221) | <0.001 |
Unnecessary and/or painful procedures 1 | 219.795 | 0.244 (0.202–0.294) | <0.001 |
Cupping glass or forceps 1 | 14.63 | 0.702 (0.585–0.841) | <0.001 |
Hamilton maneuver 1 | 20.992 | 0.656 (0.548–0.786) | <0.001 |
Accompanied by no-one 1 | 25.713 | 0.639 (0.537–0.759) | <0.001 |
Lack of information 1 | 131.523 | 0.420 (0.362–0.487) | <0.001 |
Shaving vulva 1 | 3.792 | 0.728 (0.529–1.002) | 0.051 |
Using enema | 0.267 | 1.072 (0.823–1.396) | 0.605 |
Not being allowed to eat/drink | 0.007 | 1.007 (0.858–1.180) | 0.936 |
Restricting movements 1 | 44.978 | 0.589 (0.505–0.688) | <0.001 |
Amniorrhexis | 1.669 | 0.907 (0.782–1.052) | 0.196 |
Using oxytocin | 0.154 | 0.971 (0.840–1.123) | 0.695 |
Constant palpations 1 | 46.231 | 0.577 (0.492–0.676) | <0.001 |
Kristeller maneuver 1 | 42.399 | 0.604 (0.519–0.703) | <0.001 |
Early umbilical cord clamping 1 | 19.402 | 0.640 (0.525–0.781) | <0.001 |
Episiotomy 1 | 16.555 | 0.723 (0.618–0.845) | <0.001 |
Cesarean section 1 | 11.642 | 0.701 (0.572–0.860) | 0.001 |
Manually removing placenta 1 | 5.905 | 0.740 (0.580–0.943) | 0.015 |
Separated from baby 1 | 10.565 | 0.768 (0.655–0.901) | 0.001 |
Bottle feeding baby 1 | 32.499 | 0.494 (0.387–0.629) | <0.001 |
Taking baby away 1 | 5.007 | 0.833 (0.710–0.978) | 0.025 |
Others 1 | 14.137 | 0.659 (0.530–0.819) | <0.001 |
Interventions | Received Healthcare Type | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Public Healthcare | Private Healthcare | Mixed Healthcare | ||||||||
n | % | n | % | n | % | X2 | df1 | p2 | ||
Using cupping glass or forceps | Yes | 1541 | 24.2 | 282 | 24.7 | 271 | 19.8 | 13.14 | 2 | 0.001 |
No | 4817 | 75.8 | 858 | 75.3 | 1097 | 80.2 | ||||
Hamilton maneuver | Yes | 1413 | 22.2 | 277 | 24.3 | 212 | 15.5 | 36.52 | 2 | <0.001 |
No | 4945 | 77.8 | 863 | 75.7 | 1156 | 84.5 | ||||
Accompanied by no-one | Yes | 1778 | 28.0 | 464 | 40.7 | 232 | 17.0 | 174.28 | 2 | <0.001 |
No | 4580 | 72.0 | 676 | 59.3 | 1136 | 83.0 | ||||
Lack of information | Yes | 2760 | 43.4 | 640 | 56.1 | 335 | 24.5 | 270.69 | 2 | <0.001 |
No | 3598 | 56.6 | 500 | 43.9 | 1033 | 75.5 | ||||
Shaving vulva | Yes | 499 | 7.8 | 126 | 11.1 | 62 | 4.5 | 37.29 | 2 | <0.001 |
No | 5859 | 92.2 | 1014 | 88.9 | 1306 | 95.5 | ||||
Using enema | Yes | 589 | 9.3 | 122 | 10.7 | 92 | 6.7 | 13.11 | 2 | 0.001 |
No | 5769 | 90.7 | 1018 | 89.3 | 1276 | 93.3 | ||||
Women not being allowed to eat/drink | Yes | 2275 | 35.8 | 443 | 38.9 | 325 | 23.8 | 84.16 | 2 | <0.001 |
No | 4083 | 64.2 | 697 | 61.1 | 1043 | 76.2 | ||||
Restricting movements | Yes | 2633 | 41.4 | 563 | 49.9 | 309 | 22.6 | 220.02 | 2 | <0.001 |
No | 3725 | 58.6 | 577 | 50.6 | 1059 | 77.4 | ||||
Amniorrhexis | Yes | 2374 | 37.3 | 428 | 37.5 | 414 | 30.3 | 25.29 | 2 | <0.001 |
No | 3984 | 62.7 | 712 | 62.5 | 954 | 69.7 | ||||
Using oxytocin | Yes | 3182 | 50.0 | 568 | 49.8 | 531 | 38.8 | 58.11 | 2 | <0.001 |
No | 3176 | 50.0 | 572 | 50.2 | 837 | 61.2 | ||||
Constant vaginal palpations | Yes | 1995 | 31.4 | 500 | 43.9 | 329 | 24.0 | 114.75 | 2 | <0.001 |
No | 4363 | 68.6 | 640 | 56.1 | 1039 | 76.0 | ||||
Kristeller maneuver | Yes | 2195 | 34.5 | 394 | 34.7 | 439 | 32.1 | 3.14 | 2 | 0.208 |
No | 4163 | 65.5 | 744 | 65.3 | 929 | 67.9 | ||||
Early umbilical cord clamping | Yes | 1407 | 22.1 | 318 | 27.9 | 139 | 10.2 | 134.32 | 2 | <0.001 |
No | 4951 | 77.9 | 822 | 72.1 | 1229 | 89.8 | ||||
Episiotomy | Yes | 2571 | 40.4 | 435 | 38.2 | 477 | 34.9 | 15.33 | 2 | <0.001 |
No | 3787 | 59.6 | 705 | 61.8 | 891 | 65.1 | ||||
Cesarean section | Yes | 1082 | 17.0 | 256 | 22.5 | 164 | 12.0 | 48.52 | 2 | <0.001 |
No | 5276 | 83.0 | 884 | 77.5 | 1204 | 88.0 | ||||
Manually removing placenta | Yes | 720 | 11.3 | 182 | 16.0 | 94 | 6.9 | 51.75 | 2 | <0.001 |
No | 5638 | 88.7 | 958 | 84.0 | 1274 | 93.1 | ||||
Separated from baby | Yes | 2442 | 38.4 | 521 | 45.7 | 311 | 22.7 | 161.99 | 2 | <0.001 |
No | 3916 | 61.6 | 619 | 54.3 | 1057 | 77.3 | ||||
Bottle feeding baby | Yes | 877 | 13.8 | 221 | 19.4 | 108 | 7.9 | 70.56 | 2 | <0.001 |
No | 5481 | 86.2 | 919 | 80.6 | 1260 | 92.1 | ||||
Taking baby away | Yes | 2150 | 33.8 | 428 | 37.5 | 272 | 19.9 | 117.66 | 2 | <0.001 |
No | 4208 | 66.2 | 712 | 62.5 | 1096 | 80.1 | ||||
Others | Yes | 618 | 9.7 | 178 | 15.6 | 103 | 7.5 | 48.96 | 2 | <0.001 |
No | 5740 | 90.3 | 962 | 84.4 | 1265 | 92.5 |
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Mena-Tudela, D.; Iglesias-Casás, S.; González-Chordá, V.M.; Cervera-Gasch, Á.; Andreu-Pejó, L.; Valero-Chilleron, M.J. Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth. Int. J. Environ. Res. Public Health 2021, 18, 199. https://doi.org/10.3390/ijerph18010199
Mena-Tudela D, Iglesias-Casás S, González-Chordá VM, Cervera-Gasch Á, Andreu-Pejó L, Valero-Chilleron MJ. Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth. International Journal of Environmental Research and Public Health. 2021; 18(1):199. https://doi.org/10.3390/ijerph18010199
Chicago/Turabian StyleMena-Tudela, Desirée, Susana Iglesias-Casás, Víctor Manuel González-Chordá, Águeda Cervera-Gasch, Laura Andreu-Pejó, and María Jesús Valero-Chilleron. 2021. "Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth" International Journal of Environmental Research and Public Health 18, no. 1: 199. https://doi.org/10.3390/ijerph18010199