OBSTETRIC VIOLENCE IN TIMES OF COVID-19

Obstetric violence is defined as the violence exerted by health personnel in the process of care for pregnancy and childbirth, these range from humiliation, threats, yelling, denial of treatment, ironic and mocking comments towards the patient, separation from the newborn after of delivery, prohibition of the companion in labor and delivery, as well as the performance of unnecessary procedures without a scientific basis, without the proper explanation and / or informed consent (repeated vaginal examinations, rupture of the amniotic membrane, indiscriminate use of oxytocics, Kristeller's maneuver, unjustified cesarean section, performance of instrumented delivery, etc). All this violence, whether psychological or physical, leads to a negative impact on the quality of life of women (higher incidence of postpartum depression and post-traumatic stress), in the newborn (alteration of infection prevention mechanisms) and a negative assessment health services as it is considered a risk factor for maternal death in vulnerable populations.

Obstetric violence is framed within the violation of human rights because it is institutional violence, it affects the sexual and reproductive rights of women. There are several Latin American studies that show that obstetric violence is institutionalized in many public hospitals and private clinics, as recorded in a study carried out in 2019 in Aguas Calientes - Mexico, where 58% of general obstetric violence was identified in patients, but when This variable is broken down into psychological and physical violence, it was found that 79% of the patients were victims of physical violence. In Spain, a study was carried out over a period of 9 years on the basis of 17 677 patients, identifying that 34% of patients reported having suffered obstetric violence. At present in many countries such as Brazil, Argentina, Uruguay, Chile and even Peru, the strict isolation protocols directed for pregnant women with severe COVID-19 infection have been extended to all women and babies with mild COVID-19 infections or asymptomatic.

Now in a pandemic situation; it is recognized that health systems have collapsed in many countries; there is also a decrease in the number of health personnel, many of them isolated due to risk factors or being infected by the SARS-CoV-2 virus; In this context, pregnant women are being evaluated in newly equipped obstetric units with few personnel who require suitable personal protective equipment. If pregnant women are infected by COVID-19; They are exposed to some form of obstetric violence being exerted on them due to the conditions described. Already in 2014 the World Health Organization issued a statement stating that "all women have the right to receive the highest level of health care, which includes the right to dignified and respectful care during pregnancy and childbirth and the right not to suffer violence or discrimination ". Recognizing the pandemic situation, the World Health Organization issued guidelines in March 2020 emphasizing that all pregnant women with confirmed or suspected COVID-19 infection should have access to specialized and timely care. Delivery should be individualized and cesarean section performed only when justified. The pregnant woman should be given all the interventions that have shown beneficial results for the mother and the newborn, such as accompaniment during delivery, labor analgesia, mobility in labor when possible, among others. Likewise, with respect to the newborn, immediate skin-to-skin contact, joint accommodation and breastfeeding should be maintained. Many pregnant women are experiencing fear, uncertainty, not only at the risk of contracting COVID-19 but also fear being forced to undergo unnecessary obstetric interventions without adequate information; In short, it is the right of all women, whether or not they have a confirmation of the COVID-19 infection, the possibility of living a positive experience during their labor and birth of their baby.

Before the pandemic, a long way was advanced in incorporating obstetric interventions and procedures in the care of the pregnant woman and newborn based on research with good results in the physical and mental health of women and children; It is the obligation of health personnel not to allow outdated medical practices to return and contribute to obstetric violence, therefore if we witness any similar situation raise our voice and with this information a call that as health personnel we reflect and avoid this type actions that further affect our patients who are already suffering distress from COVID-19 infection.