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BMC Pregnancy and Childbirth

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Open Access 01-12-2021 | Postpartum Depression | Research article

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland

Authors: Stephan Oelhafen, Manuel Trachsel, Settimio Monteverde, Luigi Raio, Eva Cignacco

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown.

Methods

In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors.

Results

In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction.

Conclusions

One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers.

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Because of a programming error, initially, SIL items were not randomized; this was corrected after 29% of responses had been collected. An additional multivariable linear regression incorporating the factor SIL randomized yes/no revealed no significant differences in predictor estimates.

Because of a wording error in the survey, the frequencies for gestational age categories are likely to be imprecise. The original gestational age item defined the categories (in weeks) as < 32, 32–36, 37–41, and > 42. As this made it impossible to correctly enter a gestational age of 42 weeks, the last category was adjusted to > 41 after 65% of the data had been collected. However, this still leaves room for interpretation. While gestational age did not significantly affect any of the outcomes, we cannot exclude possible effects of this error.

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Title: Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland
Authors: Stephan Oelhafen
Manuel Trachsel
Settimio Monteverde
Luigi Raio
Eva Cignacco
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Postpartum Depression
Sectio Ceasarea
Postpartum Depression
Sectio Caesarea
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03826-1

2024 ASCO Annual Meeting

Springer Medicine

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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