REPRODUCTIVE JUSTICE

MEDICALIZATION IN MATERNAL HEALTHCARE

EUROPE

2019

Pajalić, Pajalić, O., & Saplacan, D. (2019). Women’s education and profession midwifery in Nordic countries. Journal of Health Sciences (Sarajevo), 9(3), 127–. https://doi.org/10.17532/jhsci.2019.820

From Article: "today, midwifery education is at the university level in all Nordic countries, and the certified midwife is responsible for pre- and post-natal care and normal birth. In Sweden, Norway, and Iceland, the midwife’s responsibility also includes contraception counseling and prescription of drugs for birth control purposes."

DENMARK

2022

Stina, L., Dahlen, H., Hansen, H., Rodkjer, L and Maimburg, R. (2022). Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women's motivations and preparations for freebirth. Accessed https://www.sciencedirect.com/science/article/pii/S1877575622000957

In this study, we explored Danish women's motivation and preparation for freebirth. Our study demonstrates that freebirth is not undertaken lightly or without preparation by women. Rather, our results demonstrate the significant amount of emotional, educational, and relational work involved in achieving the desired holistic and autonomous birth. The experiences of these women reveal shortcomings in the mainstream maternity care system. A further improved continuity of care as well as greater flexibility in hospital guidelines and organisation of maternity care are necessary to support women's demand for autonomy and for a trusting relationship with potential birth assistants.

ENGLAND

2023

Birthrights Organization (2023). Human rights in maternity care; key facts. Accessed https://www.birthrights.org.uk/factsheets/human-rights-in-maternity-care/

Every human being has the same human rights. Human rights law means that public organisations like hospitals must treat you with dignity and respect. They must consult you about decisions and follow your choices. Every health professional who cares for you must respect your human rights in all the care they give.

Care Quality Commission - England. (2023). National survey shows decline in positive maternity experiences. Accessed https://www.cqc.org.uk/press-release/national-survey-shows-decline-positive-maternity-experiences

Findings from a survey of more than 20,900 women who gave birth in February 2022 show fewer reporting positively about their experience of maternity care, with a notable decline in the number able to get help from staff when they needed it, compared to five years ago.

2022

House of Commons (2022). Reading the signals. Maternal and neonatal services in East Kent -the report of the independent investigation. Accessed https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1111992/reading-the-signals-maternity-and-neonatal-services-in-east-kent_the-report-of-the-independent-investigation_print-ready.pdf

Our assessment of the clinical outcomes, set out in Chapter 2, shows that: l Had care been given to the nationally recognised standards, the outcome could have been different in 97, or 48%, of the 202 cases assessed by the Panel, and the outcome could have been different in 45 of the 65 baby deaths, or 69% of these cases. l The Panel has not been able to detect any discernible improvement in outcomes or suboptimal care, as evidenced by the cases assessed over the period from 2009 to 2020. 1.6 We have no doubt that these numbers are minimum estimates of the frequency of harm over the period. We made no attempt to review other records or to contact families who did not volunteer themselves. It was our judgement that we had enough evidence based on the existing 202 cases to identify the problems and their causes, and we did not wish to delay publication of our findings.

McEvoy, L. (2022) Systemic racism in maternity care putting BAME people at risk, study finds. Accessed https://www.nursinginpractice.com/latest-news/systemic-racism-in-maternity-care-putting-bame-people-at-risk-inquiry-finds/

Ms Rahman said: ‘Black women in the United Kingdom are four times more likely to die in pregnancy and childbirth than white women; Asian and mixed-race women are twice as likely. This glaring inequity prompted Birthrights to bring together experts with lived experience, healthcare professionals, lawyers and academics to examine how race discrimination impacts upon maternity care.’

2021

elson, A., & Romanis, E. C. (2021). The Medicalisation of Childbirth and Access to homebirth in the UK: Covid-19 and Beyond. Medical Law Review, 29(4), 661–687. https://doi.org/10.1093/medlaw/fwab040

In this article, we explore how the law has perpetuated the medicalisation of childbirth, and outline why this may limit the ability of birthing persons to access and opt for homebirth. We argue that this is inherently problematic because it restricts choice and autonomy in childbirth. We suggest that the widespread blanket withdrawals of homebirthing services by National Health Service trusts during the Coronavirus (COVID-19) pandemic serves as an illustrative example of the broader failure to recognise, both socially and legally, the significance of homebirth for some. We argue that, if framed correctly, the law has the potential to support, rather than restrict, choice regarding place of birth

2016

Chapman, S. (2022, August 24). Midwife-led continuity models versus other models of care: Review and reflections. Evidently Cochrane. Retrieved December 10, 2022, from https://www.evidentlycochrane.net/midwife-led-care/

Midwife-led care was associated with a number of important benefits for mothers and babies and had no more adverse effects than other models of care. Women who had midwife-led care were less likely to experience regional analgesia, instrumental vaginal birth, preterm birth less than 37 weeks and fetal loss before 24 weeks gestation. They were more likely to have a longer labour, spontaneous vaginal birth and be attended at birth by a known midwife. There was no difference between the groups for a number of other outcomes including caesarean birth or intact perineum.

ITALY

2022

Valente, E. P., Mariani, I., Covi, B., & Lazzerini, M. (2022). Quality of Informed Consent Practices around the Time of Childbirth: A Cross-Sectional Study in Italy. International Journal of Environmental Research and Public Health, 19(12), 7166–. https://doi.org/10.3390/ijerph19127166

The study findings confirm and expand previous evidence showing that gaps in consent request are frequent. However, while there is a lack of consensus on how to better improve this practice in routine women-centred care, it is important to recognise the possible role of systemic factors (e.g., low quality of standard forms, timing of requests).

NORWAY

2022

Vedeler, Nilsen, A., Blix, E., Downe, S., & Eri, T. (2022). What women emphasise as important aspects of care in childbirth – an online survey. BJOG : an International Journal of Obstetrics and Gynaecology, 129(4), 647–655. https://doi.org/10.1111/1471-0528.16926

From article: "Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Sense of Continuity and Consistency, and Sense of Security. Overarching theme: Coherence in Childbearing"

2021

Fladeby, L., Raunedokken, M., Fonkujsrud, H., Hvidtjorn, D., and Lukasse, M. (2021). Midwives experiences of using Obstetric Norwegian Early Warning System: A national cross-system study. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059414/

'Conclusion: Maternity units in Norway implementing ONEWS use an almost identical scoring system but varying criteria for whom to score and how often. Midwives considered ONEWS particularly suited for high-risk women and not for low-risk childbearing women.

SLOVENIA

2013

Prosen, M. and Krajnc, M. (2013). Sociological conceptualization of the medicalization of pregnancy and childbirth: The implications in Slovenia. DOI http://dx.doi.org/10.5613/rzs.43.3.3 Accessed https://www.researchgate.net/publication/287476236_Sociological_Conceptualization_of_the_Medicalization_of_Pregnancy_and_Childbirth_The_Implications_in_Slovenia

From article: "Childbirth is an important event in every society; biologically, of course, but also culturally and socioloigically. This importance reflects wider sociological values and, through them, everything that society values most: the course of childbirth is inextricably bound to the development of society."

SPAIN

2021

Mena-Tudela, Iglesias-Casás, S., González-Chordá, V. M., Valero-Chillerón, M. J., Andreu-Pejó, L., & Cervera-Gasch, Á. (2021). Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas. International Journal of Environmental Research and Public Health, 18(7), 3359–. https://doi.org/10.3390/ijerph18073359 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037882/ **This is part 3 of a series - see 2020 for parts 1 and 2

CONCLUDED: "The present study reflected on the main professionals with whom OV occurs in Spanish centers, namely midwives and gynecologists. Surprisingly, it also identified other healthcare professionals such as anesthetists or “other”. This poses a basic training problem in physiological processes for women’s sexual and reproductive health and communication skills, which are two keys to be considered to bring about a true change in paradigm. Time of birth and hospitals were also the most frequent areas that women identified where OV peaked. Therefore, it is necessary to truly reflect on the care received during the perinatal period in hospitals with a view to improve the care received at this time."

Martinez-Vázquez, Rodríguez-Almagro, J., Hernández-Martínez, A., & Martínez-Galiano, J. M. (2021). Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study. Journal of Personalized Medicine, 11(5), 338–. https://doi.org/10.3390/jpm11050338 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145360/

CONCLUDED: "There are clinical practices that are related to the risk of PTSD, including the type of delivery a woman has, formula-fed newborn at hospital discharge, mother-child separation, her birth plan not being respected, and verbal and psycho-affective obstetric violence. Partner support and initiation of breastfeeding in the first hour were identified as protective factors against PTSD. Practices such as breastfeeding or feeling supported during the birthing process can provide resources for women to empower themselves and cope with a possible risk of postpartum post-traumatic stress disorder, and prevent its onset. Professionals need to be sensitized to this topic since the treatment and care they provide to women can influence the probability of developing PTSD."

2020

Mena-Tudela, D., Iglesias-Casas, S., Gonzales-Chorda, V. Cervera-Gasch, A., Andreu-Pejo, L and Valero-Chilleron, M. (2020). Obstetric Violence in Spain Part 1: Women’s Perceptions and Interterritorial Differences. Int J Environ Res Public Health. 2020 Nov; 17(21): 7726. Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660046/ **This is one part of a three part series - see citation below and also in 2021 for other parts.

CONCLUDED: "What the present study seems to reflect is that Spain has a serious public health problem and one of respecting human rights in relation to OV. The fact that the health system has been decentralized in SACs and their respective healthcare models may have influenced their outcomes, it is necessary to consider the major differences in how OV is perceived by the various analyzed groups. It is also necessary to contemplate that private health care can act as a context that is more predisposed to OV in Spain. Action protocols and training for health personnel must continue to be updated and put into practice, as must transparency policies that contribute real data about how women are treated in these centers." (material omitted)

Mena-Tudela, Iglesias-Casás, S., González-Chordá, V. M., Cervera-Gasch, Á., Andreu-Pejó, L., & Valero-Chilleron, M. J. (2020). Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth. International Journal of Environmental Research and Public Health, 18(1), 199–. https://doi.org/10.3390/ijerph18010199 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794951/ **This is one part of a three part series - see citation above and also in 2021 for other parts.

CONCLUDED: "This interventionism (while giving birth) presents major differences when receiving public, private, or mixed healthcare (understood as that which each woman chooses when being attended to by public or private healthcare). As such, private healthcare has a high interventionism rate, less satisfaction, women feel more insecure and vulnerable, and they perceive more OV. Conversely, mixed healthcare presents lower intervention levels, more satisfaction, and fewer women perceiving OV, which allows us to think that female empowerment plays a very important role. Finally, the logistic regression model shows that most analyzed interventions are representative of OV, without forgetting that interventionism and medicalization during childbirth form only a small part of the OV problem." (material omitted)

SWITZERLAND

2022

Rauch, S., Arnold, L., Stuerner, Z., Rauh, J., & Rost, M. (2022). A true choice of place of birth? Swiss women’s access to birth hospitals and birth centers. PloS One, 17(7), e0270834–e0270834. https://doi.org/10.1371/journal.pone.0270834 Accessed https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270834

Swiss women are insufficiently empowered to exercise their reproductive autonomy as their choice of place of birth is significantly limited by geographical constraints. It is an ethical and medical imperative to provide women with a true choice. We provide high-resolution insights into the accessibility of birth settings and strong arguments to (re-)examine the need for further birth centers (and birth hospitals) in specific geographical areas. Policy-makers are obligated to improve the accessibility of birth centers to advance women’s autonomy and enhance maternal health outcomes after childbirth. The Covid-19 pandemic offers an opportunity to shift policy.

INTRODUCTION PAGE