Disrespect and abuse during childbirth and postpartum depression: a scoping review

Conceição, Haylane Nunes da; Gonçalves, Claudio Fernando Gomes; Mascarenhas, Márcio Dênis Medeiros; Rodrigues, Malvina Thaís Pacheco; Madeiro, Alberto Pereira

doi:10.1590/0102-311XEN236922

Haylane Nunes da Conceição

conception

design

data analysis

data interpretation

writing

review

final version approvement

Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, Brasil.

https://orcid.org/0000-0001-9508-9615

Claudio Fernando Gomes Gonçalves

conception

design

data analysis

data interpretation

writing

review

final version approvement

Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, Brasil.

https://orcid.org/0000-0002-4425-987X

Márcio Dênis Medeiros Mascarenhas

conception

design

data analysis

data interpretation

writing

review

final version approvement

Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, Brasil.

https://orcid.org/0000-0001-5064-2763

Malvina Thaís Pacheco Rodrigues

conception

design

data analysis

data interpretation

writing

review

final version approvement

Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, Brasil.

https://orcid.org/0000-0001-5501-0669

Alberto Pereira Madeiro

conception

design

data analysis

data interpretation

writing

review

final version approvement

Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, Brasil.

https://orcid.org/0000-0002-5258-5982

Correspondence
H. N. Conceição Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí. Av. Frei Serafim 2280, Teresina, PI 64000-020, Brasil. lanenunes_@hotmail.com

Additional information

ORCID: Haylane Nunes da Conceição (0000-0001-9508-9615); Claudio Fernando Gomes Gonçalves (0000-0002-4425-987X); Márcio Dênis Medeiros Mascarenhas (0000-0001-5064-2763); Malvina Thaís Pacheco Rodrigues (0000-0001-5501-0669); Alberto Pereira Madeiro (0000-0002-5258-5982).

DATABASE/GREY LITERATURE	SEARCH STRATEGY
Embase	(‘violence’/exp OR violence OR disrespect OR abuse OR ‘maternal health service’ OR ‘positive maternity care’ OR ‘obstetric violence’) AND childbirth AND ‘postnatal depression’
LILACS	violência OR desrespeito OR abuse OR maus-tratos OR violência institucional OR violência de gênero OR humanização da assistência OR saúde materna AND parto AND depressão pós-parto
MEDLINE	((((((((((((violence [MeSH Terms]) OR (disrespect)) OR (abuse)) OR (mistreatment)) OR (institutional violence)) OR (gender violence)) OR (humanization of assistance)) OR (maternal health services)) OR (maternal health)) OR (positive maternity care)) AND (parturition[MeSH Terms])) OR (childbirth)) AND (depression postpartum[MeSH Terms])
PsycINFO	parturition OR Title: childbirth AND Title: abuse OR Title: disrespect OR Title: mistreatment OR Title: “institutional violence” OR Title: “positive maternity care” AND Title: “depression postpartum” OR Title: “postnatal depression”
Web of Science	disrespect (Título) OR abuse (Título) AND parturition (Título) OR childbirth (Título) depression postpartum (Título)
CAPES Portal of Theses and Dissertations	“violência” AND “parto” AND “depressão pós-parto”

STUDY	REFERENCE	PLACE/YEAR	STUDY TYPE	OBJECTIVE	POPULATION (SAMPLE SIZE)
E1	Souza et al. ³²32. Souza KJ, Rattner D, Gubert MB. Institutional violence and quality of service in obstetrics are associated with postpartum depression. Rev Saúde Pública 2017; 51:69.	Brazil/2017	Cross-sectional	To investigate the association between institutional violence in obstetrics and postpartum depression and the potential effect of race, age, and schooling on this outcome	Mothers with children up to three months of age in the Federal District (n = 10,468)
E2	Silveira et al. ³³33. Silveira MF, Mesenburg MA, Bertoldi AD, Mola CL, Bassani DG, Domingues MR, et al. The association between disrespect and abuse of women during childbirth and postpartum depression: findings from the 2015 Pelotas birth cohort study. J Affect Disord 2019; 256:441-7.	Brazil/2019	Prospective cohort	To examine the effect of different types of disrespectful and abusive experiences on the occurrence of maternal postpartum depression and to explore whether the association differs according to the presence of prenatal depressive symptoms in women	Women living in the urban area of Pelotas (Rio Grande do Sul State) (n = 3,065)
E3	Leite et al. ³⁴34. Leite TH, Pereira APE, Leal MC, Silva AM. Disrespect and abuse towards women during childbirth and postpartum depression: findings from Birth in Brazil Study. J Affect Disord 2020; 273:391-401.	Brazil/2020	Cross-sectional	Investigate the association between disrespect and abuse during childbirth and postpartum depression	Women admitted for child delivery in selected hospitals (hospital based) (n = 23,378)
E4	Martinez-Vázquez et al. ³⁵35. Martinez-Vázquez S, Hernández-Martínez A, Rodríguez-Almagro J, Delgado-Rodríguez M, Martínez-Galiano JM. Relationship between perceived obstetric violence and the risk of postpartum depression: an observational study. Midwifery 2022; 108:103297.	Spain/2022	Cross-sectional	Determine the relationship between perceived obstetric violence and the risk of postpartum depression	Women who had given birth in the last 12 months (n = 782)
E5	Paiz et al. ³⁶36. Paiz JC, Castro SMJ, Giugliani ERJ, Ahne SMS, Dall'Aqua CB, Giugliani C. Association between mistreatment of women during childbirth and symptoms of postpartum depression. BMC Pregnancy Childbirth 2022; 22:664.	Brazil/2022	Cross-sectional	Verify the association between maltreatment during childbirth and symptoms suggestive of postpartum depression	Puerperal women who gave birth in two maternity hospitals (public and private) in Porto Alegre (Rio Grande do Sul State) (n = 287)
E6	Puppo et al. ³⁷37. Puppo S, Cormick G, Gibbons L, Rodríguez R, Correa M, Smith J, et al. The peripartum period involvement in the development of post-partum depression: a prospective cohort study. J Psychosom Res 2022; 155:1107480.	Argentina/2022	Prospective cohort	To evaluate the incidence of postpartum depression in women who did not present symptoms of depression in pregnancy and the impact of the peripartum period on the development of depressive symptoms	Pregnant women attended at two health institutions (n = 112)
E7	Yakupova et al. ³⁸38. Yakupova V, Suarez A, Karchenko A. Birth experience, postpartum PTSD and depression before and during the pandemic of COVID-19 in Russia. Int J Environ Res Public Health 2022; 19:335.	Russia/2022	Cross-sectional	Investigate birth experiences, symptoms of post-traumatic stress disorder and postpartum depression, frequency of medical interventions, and forms of obstetric violence as a result of restrictive measures and the diagnosis of COVID-19	Women who gave birth before (n = 611) and during the first year of the COVID-19 pandemic (n = 1,645)

STUDY *	INSTRUMENT FOR EVALUATION OF DISRESPECT AND ABUSE DURING CHILDBIRTH	INSTRUMENT FOR EVALUATION OF POSTPARTUM DEPRESSION	SELF-REPORTED DISRESPECT AND ABUSE DURING CHILDBIRTH TYPES	MAIN RESULTS
E1	Questionnaire developed by the authors encompassing the following indicators: violence in the relationship between the parturient and the health system; institutional violence in the relationship between the parturient woman and the health services; and violence in the relationship between the parturient and health professionals	EPDS-6	Painful vaginal exams, inadequate pain relief, lack of communication and explanations by the professional regarding obstetric procedures, and use of offensive language by health professionals	(i) Women who experienced violence due to neglect during childbirth had a seven times higher risk of developing postpartum depression; (ii) Physical and verbal violence were also associated with the occurrence of postpartum depression, with a higher risk among women under 20 years of age and non-white women
E2	Four-question questionnaire elaborated by the authors about: verbal abuse; denial of care; physical abuse; and unwanted procedures during childbirth	EPDS	Verbal and physical abuse, refusal of care, and unwanted procedures during the delivery process	(i) Women who reported one or more types of disrespect and abuse during childbirth were more likely to develop moderate and/or severe postpartum depressio; (ii) Women who experienced physical and verbal abuse were, respectively, 2.3 and 1.6 times more likely to develop postpartum depression symptoms; (iii) The effect of verbal abuse was greater among women without antenatal depression
E3	Seven-question questionnaire elaborated by the authors encompassing: absence of verbal/psychological/physical abuse; respectful treatment of hospitalized women; respect for intimacy in the physical examination; level of care received after birthing until hospital discharge; transparency of the information provided; time allotted to ask questions; and ability to talk to a professional about care	EPDS	In the public health sector, disrespect and abuse during childbirth was related to maternal hospitalization, uterine pressure maneuver, and not receiving the desired type of delivery; In the private sector, not having the desired mode of delivery was the reported type of disrespect and abuse during childbirth	(i) Disrespect and abuse of women during childbirth increased the occurrence of postpartum depression in the public and private health sector, as well as vaginal deliveries and cesarean sections
E4	Questionnaire developed specifically for the study, encompassing: verbal obstetric violence; physical violence; psychoaffective violence; and global violence (verbal, physical, and psychoaffective)	EPDS	Verbal, physical, psycho-affective, and global obstetric violence were the types of disrespect and abuse during childbirth reported by women	(i) Obstetric violence is a risk factor for postpartum depression; (ii) Women who experienced psycho-affective or verbal obstetric violence were more prone to developing postpartum depression
E5	Questionnaire prepared by the authors with questions on: having had a companion during labor; having understood the information provided by the professionals; having had privacy during labor; having felt comfortable asking questions; having participated in the decisions about their care; having felt welcomed and safe in the childbirth environment; and having had immediate skin-to-skin contact with the baby	EPDS	15.1% did not feel comfortable asking; 32% did not have skin-to-skin contact with their babies; 12.5% did not understand the information offered	(i) After adjusting for age, schooling, skin color, and mental health history, there was a significant association between maltreatment of women during childbirth and symptoms suggestive of postpartum depression
E6	Questionnaire prepared by the authors (without discriminating criteria for “abuse during childbirth”)	EPDS and MINI	Abuse during childbirth (21.4%) and lack of a companion during childbirth (35.7%)	(i) 12.5% of women were at risk of developing postpartum depression; (ii) Postpartum depression was significantly associated with abuse during childbirth (8.6-fold increase) and lack of a companion in childbirth (3.8-fold increase)
E7	Questionnaire prepared by the authors, encompassing: medical interventions without consent; verbal aggression and bullying; physical aggression; threats and accusations; Kristeller’s maneuver; refusal of pain relief; and not meeting the needs of the parturient	EPDS	22.6% of the women reported at least one type of obstetric violence; Verbal aggression and bullying (11.3%) and medical interventions without consent (6.2%) were the most common types	(i) Symptoms of postpartum depression were significantly higher in women who experienced obstetric violence; (ii) The greater the magnitude of violence, the more frequent the symptoms of depression were, both before and during the COVID-19 pandemic

[1] Correspondence
H. N. Conceição Programa de Pós-graduação em Saúde e Comunidade, Universidade Federal do Piauí. Av. Frei Serafim 2280, Teresina, PI 64000-020, Brasil. lanenunes_@hotmail.com