Who is afraid of obstetric violence? / Quem tem medo da violência obstétrica?

Abstract Despite being a relatively new term, obstetric violence is an old problem. In 2014, the World Health Organization declared: "Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination". This problem, named as "abuse", "disrespect" and/or "mistreatment" during childbirth, has been addressed in several studies. However, there has been no consensus on how to properly name this problem, although its typology has been well described. Considering the magnitude of this problem, it is essential to give the correct terminology to this important health and human rights issue. Naming it as obstetric violence and understanding it as gender-based violence will ensure appropriate interventions to avert this violation of women's rights.

Resumo Apesar de ser um termo relativamente novo, a violência obstétrica é um problema antigo. Em 2014, a Organização Mundial da Saúde declarou: "Muitas mulheres sofrem tratamento desrespeitoso e abusivo durante o parto em instalações de saúde em todo o mundo. Esse tratamento não só viola os direitos das mulheres a cuidados respeitosos, mas também pode ameaçar seus direitos à vida, saúde, integridade corporal e liberdade de discriminação". Esse problema, denominado "abuso", "desrespeito" e /ou "maus-tratos" durante o parto, foi abordado em vários estudos. No entanto, não houve consenso sobre como nomear adequadamente esse problema, embora sua tipologia tenha sido bem descrita. Considerando a magnitude desse problema, é essencial dar a terminologia correta para essa importante questão de saúde e direitos humanos. Nomear como violência obstétrica e entendê-la como violência baseada em gênero garantirá intervenções apropriadas para evitar essa violação dos direitos das mulheres.

The role of the respectful maternity care model in São Paulo, Brazil: A cross-sectional study.

INTRODUCTION: The promotion of a positive birth experience has been a main goal of the World Health Organization's (WHO) recent work on improving maternity care. The purpose of this study was to assess the cesarean rates, the prevalence of birth practices, perinatal outcomes, and maternal satisfaction, in women involved with the respectful maternity care (RMC) support groups in Sao Paulo, Brazil. METHODS: This was a cross-sectional study of women with low-risk pregnancies who were assisted by professionals recommended by the RMC groups. An online questionnaire was administered. Variables to assess birth practices were classified as positive, negative, or unspecified according to the WHO guidelines. The Pearson chi-square tests and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were computed to assess differences between the groups. RESULTS: Five-hundred and eighty women completed the questionnaire. The cesarean rate was 14.7%, and the operative vaginal birth rate was 9.5%. The VBAC rate was 87.1%, and there was no significant difference in risk for cesarean between women with or without a prior cesarean. Of all women, 83.1% had a midwife's assistance and 75.5% hired a doula; 81.4% gave birth in a nonlithotomic position. The practices of enema, fasting and episiotomy were all under 2%. All 5-minute Apgar scores were ≥7. Most (83.1%) women reported having a positive birth experience. CONCLUSIONS: Woman's engagement with the birth support groups and a transdisciplinary team focused on RMC are key elements to achieve positive perinatal outcomes and high women's satisfaction.

The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study.

PURPOSE: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. MATERIALS AND METHODS: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. RESULTS: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. CONCLUSIONS: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.

The burden of eclampsia: results from a multicenter study on surveillance of severe maternal morbidity in Brazil.

OBJECTIVE: Maternal mortality (MM) is a core indicator of disparities in women's rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). METHODS: Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO's obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect). RESULTS: Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48-3.59) were associated with SMO. CONCLUSIONS: Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia.