Abstract：
OBJECTIVE: To assess the frequency and determinants of medical interventions during childbirth without women\'s consent at the population level.
METHODS: The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition.
RESULTS: Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96).
CONCLUSIONS: Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women\'s involvement in decision making during childbirth.
METHODS: The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition.
RESULTS: Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96).
CONCLUSIONS: Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women\'s involvement in decision making during childbirth.
摘要：
目的：在人口层面评估未经妇女同意的分娩过程中医疗干预的频率和决定因素。
方法：2021年全国横断面调查提供了在法国大都市分娩的妇女的代表性样本，并进行了2个月的产后随访（n=7394）。分娩期间干预措施的比率和95%置信区间(CI)(催产素给药，未经同意，计算会阴切开术或紧急剖宫产）。与母亲的关系，产科,和组织特征使用稳健方差泊松回归进行评估，在对缺失的协变量进行多次填补后，并加权计算2个月的减员。
结果：报告催产素给药失败的妇女为44.7％（CI：42.6-47.0），60.2%（CI：55.4-65.0）用于会阴切开术，急诊剖宫产率为36.6%(CI:33.3-40.0)。缺乏对催产素的同意与国外分娩有关（调整后的患病率[aPR]1.20;95％CI：1.06-1.36），教育水平低,催产素开始时宫颈扩张增加，而有生育计划的女性报告缺乏同意的频率较低(aPR0.79;95%CI:0.68-0.92).产科医生协助分娩更常与未同意会阴切开术相关(aPR1.46;95%CI:1.11-1.94为自发分娩,aPR1.39;95%CI:1.13-1.72为器械性分娩,参考：助产士自发分娩）。胎儿宫内窘迫剖腹产与紧急剖宫产未能征得同意相关(aPR1.58;95%CI:1.28-1.96)。
结论：妇女经常报告说，围产期专业人员未能在分娩期间寻求同意干预措施。重组护理，特别是在紧急情况下，注重充分沟通和促进生育计划的培训对于提高妇女在分娩决策中的参与度是必要的。
方法：2021年全国横断面调查提供了在法国大都市分娩的妇女的代表性样本，并进行了2个月的产后随访（n=7394）。分娩期间干预措施的比率和95%置信区间(CI)(催产素给药，未经同意，计算会阴切开术或紧急剖宫产）。与母亲的关系，产科,和组织特征使用稳健方差泊松回归进行评估，在对缺失的协变量进行多次填补后，并加权计算2个月的减员。
结果：报告催产素给药失败的妇女为44.7％（CI：42.6-47.0），60.2%（CI：55.4-65.0）用于会阴切开术，急诊剖宫产率为36.6%(CI:33.3-40.0)。缺乏对催产素的同意与国外分娩有关（调整后的患病率[aPR]1.20;95％CI：1.06-1.36），教育水平低,催产素开始时宫颈扩张增加，而有生育计划的女性报告缺乏同意的频率较低(aPR0.79;95%CI:0.68-0.92).产科医生协助分娩更常与未同意会阴切开术相关(aPR1.46;95%CI:1.11-1.94为自发分娩,aPR1.39;95%CI:1.13-1.72为器械性分娩,参考：助产士自发分娩）。胎儿宫内窘迫剖腹产与紧急剖宫产未能征得同意相关(aPR1.58;95%CI:1.28-1.96)。
结论：妇女经常报告说，围产期专业人员未能在分娩期间寻求同意干预措施。重组护理，特别是在紧急情况下，注重充分沟通和促进生育计划的培训对于提高妇女在分娩决策中的参与度是必要的。
