Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia

Abstract

Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence.

Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil

“…However, as highlighted in the wider literature, multifaceted approaches are needed and there is evidence that even well-developed policies for evidence-based and personcentered care may not be implemented owing to the range of structural and power factors influencing care provision, particularly where the change involved requires deimplementation of established authoritative and routinized practices (Altaweli et al 2018). The finding that stands out in this study is the major contribution of planned caesarean section to the high rate of caesarean sections in low-risk women in the South of Brazil.…”

Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth

“…Another study from Afghanistan documents women compared doctors to butchers, emphasizing this forceful and aggressive behavior in cutting episiotomies and c-sections ( 41 ). Bed confinement, with limited mobility, is also routinely practiced, having bladder catheters inserted rather than allowing women to walk to the bathroom was subsequently mentioned by women in Egypt ( 33 , 34 ), Iran ( 35 ), Jordan ( 36 ), Saudi Arabia ( 37 , 42 ) and Yemen ( 43 ). Moreover, most of the women birthing in hospitals across the Region are not granted the choice of preferred positions in labor and birth due to hospital policies and routine practices favoring the routine use of lithotomy in childbirth ( 44 ).…”

“…The normalization of overmedicalized care in the Region enables women to expect overused routine interventions. However, the problem extends that these interventions are commonly done without women realizing or consenting ( 27 , 33 , 35 , 42 ) ( Supplementary Table 3 ). For instance, one study from the largest medical complex in Saudi Arabia found 19% ( n = 358) of women underwent episiotomies, 3.6% underwent c-sections, 1.4% underwent tubal ligations, and .3% underwent hysterectomies, all of which had routinely administered without consent ( 49 ).…”

“…Another study from a large urban teaching hospital in Sudan identified a notable discrepancy regarding consent and type of intervention as 77.5% of study-participants were asked permission for an exam but only 22% before a procedure ( 50 ). Another study reported a midwife inserted a urinary catheter without the woman's consent, causing violation and pain, in an effort to prevent her from pushing before allowing the woman to use the toilet; the same study highlighted providers' rationalizing these unconsented routines with the hospitals' policies to maintain patient flow ( 42 ).…”

“…One Irani woman confirmed: “ Women are not involved in decision-making, they trust their caregivers to make decisions for them and don't challenge their [providers] who are more knowledgeable ” ( 40 )., One Yemeni woman highlighted that “ to be in-authority meant sharing decision-power with the care provider ” ( 26 , 43 ). Shared decision-making remains a novel concept to the Region's generally patriarchal health systems, as physicians do not expect women “to interfere” with their medical practice and often follow their own decisions rather than hers ( 42 ). The lack of decision-making power and bodily autonomy especially at birth leaves women feeling powerless as reported extensively across the Region ( Supplementary Table 3 ).…”