Obstetric violence and quaternary prevention: what it is and what to do

Abstract

This article aims to justify the necessity of quaternary prevention in face of ‘obstetric violence’ (OV), expression that comprises all forms of harms and violence originated by professional obstetric care, as well as to discuss actions and strategies of quaternary prevention to be taken by family physicians,
primary care providers and their professional associations. The prevalence of obstetric violence in Brazil is high: ¼ of women report that they have suffered abusive treatment during birth delivery, besides the excess of unnecessary interventions (i.e. venoclisis, routine oxitocin, and episiotomy),
consequently denying them a best practice care such as vertical position, allowing the pregnant woman to freely move, eat, and have a companion during labour process. There is an excess of caesareans (55.6% of the total births) in Brazil, most prevalent on the private sector (85%) than in the public health system (40%). We propose and discuss actions of quaternary prevention against obstetric violence: (1) the elaboration (individual and collective) of birth plans oriented by primary care teams during antenatal care (for which we suggest a guideline); (2) the introduction of other qualified professionals on the caring for low risk birth (including qualified family physicians); and (3) the participation of family physicians and other primary care providers and their associations on the social and political movement for “humanization of birth”, supporting the changes on currently functioning maternity wards and new initiatives on birth delivery care.