Violent experiences during obstetric care

Birth is a significant event in the lives of mother and child, which can have far-reaching health consequences for both (Elmir et al. 2010; Forssén 2012; Thomson and Downe 2008). Whether the birth experience becomes a resource or a risk factor for mother and child later in life is strongly related to the quality of obstetric care (Bailham and Joseph 2003; Elmir et al. 2010; Grieshop 2013; Grieshop and Schücking 2012). The adoption of the National Health Goal "Health around Childbirth" in 2017 underlines the importance of this topic. The goal of a low-intervention, physiological birth and the associated further development of woman-centred care by all professional groups involved is also anchored in it (BMG and Kooperationsverbund Gesundheitsziele.de 2017).

Birth experiences that are experienced as violence by women giving birth can result in post-traumatic stress disorders and have a negative impact on the mother-child bond (Kukura 2018). Early surveys from the 1990s and 2000s indicate that pregnant women and women giving birth experience degradation and violence at the hands of staff in obstetric facilities worldwide (Bowser and Hill 2010; d'Oliveira et al. 2002; Freedman and Kruk 2014). This prompted the World Health Organization (WHO) to issue a statement in 2014 calling on all member states to record the situation through scientific research (WHO 2014). In the following years, several studies were published on this topic, but in Germany there is still a considerable need for research.

In an analysis of 65 studies from 34 countries, the obstetric violence experiences reported worldwide were summarised in the following categories: Physical violence, sexualised violence, verbal violence, stigmatisation and discrimination, treatment below professional standards, inadequate relationship building between professionals and women in labour, and structural conditions and constraints of the health system (Bohren et al. 2015). However, this form of categorisation does not necessarily provide an answer to the question of what and how, frequency, severity and dynamics, which is relevant for the development of prevention approaches.

For partner violence, Johnson (2006, 2011) therefore developed a differentiation of forms of violence beyond individual acts of violence into initially four types of violence, which was reduced to two types in later analyses. With this approach, partner violence could be better understood analytically and prevention concepts better grounded theoretically.

We are interested in the experiences of women who have given birth in Germany in the last two years and who, according to their perception, have experienced violence during professional birth care. Based on the questions of what and how, the severity and dynamics, a typology of violence during birth events will be attempted. Secondarily, we are interested in the extent to which the categorisation of Bohren et al. (2015) is applicable or can be further developed and what can be learned from it about risk factors and protective factors.

Narrative interviews are conducted with affected women according to Schütze (1983). The data material is analysed according to Kelle and Kluge (2010), as the aim is to develop typologies. A "case" is any event described by the women as an experience of violence.

The interviews will be conducted after an appropriate vote by the ethics committee and in compliance with all ethical standards and rules of data protection. When conducting the interviews, strict attention is paid to avoiding re-traumatisation of the women. If necessary, the women are also offered contact to an appropriate counselling centre.

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