[OBSTETRIC VIOLENCE - SINCE WHEN AND WHERE TO: IMPLICATIONS AND PREVENTIVE STRATEGIES].

Obstetric violence has recently gained wide recognition and is defined as inappropriate or disrespectful treatment given by medical staff to women throughout the antepartum period, delivery and postpartum. It includes verbal violence, denial of patient autonomy, the practice of unconsented or unnecessary medical procedures, discrimination based on race or ethnic background, and physical violence. The source of obstetric violence has been vastly studied by psycho-sociologists who have conceptualized it as stemming back to ancient gender role theories. In the medical literature, obstetric violence has been devoted increasing attention only in recent years. Clinical studies show it is a widespread phenomenon and reports indicate that up to 30% of women, both from low- and high-income regions, claim to have experienced a subtype of obstetric violence during childbirth. Obstetric violence may have a profound psychological impact: post-partum acute stress disorder (ASD), post-traumatic stress disorder (PTSD), and post-partum depression (PPD) are all well-documented mental health consequences of maternal mistreatment. Reactivation of past PTSD may also occur, as obstetric violence may be experienced as re-victimization by post-traumatic women. Currently, obstetric violence is defined with legislative backing only in a few countries in Latin America and medical research on the topic is still scarce. Both worldwide and at a local level, effective prevention and management of obstetric violence requires multidisciplinary cooperation and organizational changes. Those include greater social awareness, adjusted treatment protocols, improved training of healthcare professionals in the field of trauma-sensitive care, focused clinical research and targeted legislation.