Development of an instrument to measure mistreatment of women during childbirth through item response theory

Abstract

The objective of this study was to structure a proposal for an instrument to measure the mistreatment level of women during childbirth, through item response theory, based on the birth experience of postpartum women. A cross-sectional study was conducted, with the inclusion of 287 women who did not suffer complications during childbirth, randomly selected from two maternity hospitals in the capital of Rio Grande do Sul—Brazil, in 2016. Approximately 30 days after delivery, the women answered questions in a face-to-face interview about their birth experience (practices and interventions applied) and were inquired about their perception of having suffered disrespect, mistreatment or humiliation by health professionals. The set of practices was included in the item response theory model to design the instrument. Of the 36 items included in the model, 21 dealt with practices applied exclusively to women who went into labor, therefore two instruments were developed. The instrument including all women, containing 09 items, identified 23.7% prevalence of mistreatment to women during childbirth, while the instrument for women going into labor included 11 items and identified 22% prevalence. The items with the highest discrimination were: not having had a companion during labor (2.05; and 1.26), not feeling welcome (1.81; and 1.58), and not feeling safe (1.59; and 1.70), for all women and for those who went into labor, respectively. For those who went into labor, the items, did not have a companion during labor (1.22; PE 0.88) and did not feel comfortable asking questions and participating in decisions (1.20; PE 0.43) also showed greater discrimination. In contrast, when directly questioned, only 12.5% of women said they had experienced disrespect or mistreatment, suggesting that harmful practices are often not recognized as violent. Standardizing the measurement of mistreatment of women during childbirth can create more accurate estimates of its prevalence and contribute to the proposal of strategies to eliminate obstetric violence.