Midwives and protection of pregnant workers in Western Switzerland: Practices, difficulties and contributions.

Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be-and deserves to be-formally and legally recognised and integrated into Switzerland's maternity protection legislation

Implementation of maternity protection legislation: Gynecologists' perceptions and practices in French-speaking Switzerland.

In several countries, maternity protection legislations (MPL) confer an essential role to gynecologist-obstetricians (OBGYNs) for the protection of pregnant workers and their future children from occupational exposures. This study explores OBGYNs' practices and difficulties in implementing MPL in the French-speaking part of Switzerland. An online survey was sent to 333 OBGYNs. Data analysis included: 1) descriptive and correlational statistics and 2) hierarchical cluster analysis to identify patterns of practices. OBGYNs evoked several problems in MPL implementation: absence of risk analysis in the companies, difficult collaboration with employers, lack of competencies in the field of occupational health. Preventive leave was underused, with sick leave being prescribed instead. Training had a positive effect on OBGYNs' knowledge and implementation of MPL. Hierarchical cluster analysis highlighted three main types of practices: 1) practice in line with legislation; 2) practice on a case-by-case basis; 3) limited practice. OBGYNs with good knowledge of MPL more consistently applied its provisions. The implementation of MPL appears challenging for OBGYNs. Collaboration with occupational physicians and training might help OBGYNs to better take on their role in maternity protection. MPL in itself could be improved

Evaluation of a pilot consultation for maternity protection at work in Switzerland.

Switzerland's Labour Law and its Ordonnance on Maternity Protection aim to protect the health of pregnant employees and their unborn children while enabling them to continue to pursue their professional activities. Some companies encounter difficulties implementing the law's provisions. The Department of Occupational and Environmental Health, part of the Center for Primary Care and Public Health (Unisanté), has provided specialist occupational medicine consultations for pregnant employees since 2015. This study aimed to evaluate how well Swiss' maternity protection legislation is implemented by examining a list of relevant indicators measured during the occupational health consultation. The study also sought to investigate the consultation support provided to the relevant stakeholders and the adjustments made to pregnant employees' working conditions. Descriptive variables and indicators relative to the application of the Swiss maternity protection legislation for 83 pregnant employees were collected during the consultation's pilot phase (between 2015 and 2016). Descriptive statistics and cross-analyses of these indicators were made. Most pregnant employees faced multiple exposures to occupational risks. Preventive risk analyses were rare. Few adjustments to workstations were proposed. We found a tendency for employees to leave their workstations early on in their pregnancies due to sick leave certificate prescriptions. Specialist consultation and collaboration with occupational health physicians to recommend interventions for pregnant employees can provide significant benefits and help some pregnant women to continue at their workstations with appropriate adjustments. A specialised occupational health consultation is a useful instrument for identifying occupational hazards for both the pregnant woman and her unborn child. It is also an opportunity to explain employers' legal responsibilities and obligations to safeguard the health of their pregnant employees and to give specific advice for their company's situation. This consultation also enables employers to maintain their employees' valuable professional competencies in the workplace for as long as possible. Finally, occupational health consultation helps and supports healthcare providers who must, according to the law, make decisions about whether pregnant employees can continue working safely or not

Evolution of gynaecologists' practices regarding the implementation of Swiss legislation on maternity protection at work between 2008 and 2017.

In accordance with the International Labour Organization’s Maternity Protection Convention (No. 183) and European Union Directive 92/857CEE (1992), Switzerland’s Labour Law and its Maternity Protection Ordinance (OProMa) aim to protect the health of pregnant employees and their future children while enabling them to pursue their working activities. Gynaecologists-obstetricians have a key role in this legislation, particularly through the prescription of preventive leave for patients who would otherwise face dangerous or arduous tasks in the absence of an adequate risk analysis or suitable protective measures. However, international and national literature suggests that gynaecologists-obstetricians may encounter difficulties in fulfilling their role. This study aimed to: (1) describe the practices and difficulties encountered by gynaecologists-obstetricians in the practical implementation of the OProMa; and (2) compare the evolution of these practices and difficulties between 2008 and 2017. A survey by questionnaire was conducted in 2008 and repeated in 2017. Both surveys focused on gynaecologists-obstetricians working in the French-speaking part of Switzerland (in private practices, hospitals or both). Descriptive and comparative analyses were carried out. 83 gynaecologists-obstetricians responded in 2008 and 93 in 2017: response rates of 47% and 32%, respectively. In 2017, gynaecologists-obstetricians were more likely to ask questions about occupational risks faced by their patients when consulted by working mothers about their pregnancies. The estimated percentage of patients exposed to an occupational risk remained constant (20% in 2008 and 22% in 2017). Communication and collaboration with employers were reported to be difficult in both surveys, even though these are key elements in the implementation of the OProMa. Collaboration with occupational physicians, however, was more frequent in 2017. In 2017, gynaecologists-obstetricians showed a greater awareness of occupational risks and collaborated more frequently with occupational health specialists. However, the application of the OProMa remained limited over the studied time period. Improving training of gynaecologists-obstetricians in this field could be a significant factor in encouraging better implementation of the current legislation. Moreover, gynaecologists-obstetricians need to be given the necessary support to enable their clinical practice to evolve towards a more preventive type of medicine. Collaboration with relevant stakeholders, including occupational physicians, midwives and workers, should be encouraged

Health workers’ perspectives on the quality of maternal and newborn health care around the time of childbirth: Results of the Improving MAternal Newborn carE in the EURO Region (IMAgiNE EURO) project in 12 countries of the World Health Organization European Region

Background Health workers’ (HWs’) perspectives on the quality of maternal and newborn care (QMNC) are not routinely collected. In this cross-sectional study, we aimed to document HWs’ perspectives on QMNC around childbirth in 12 World Health Organization (WHO) European countries. Methods HWs involved in maternal/neonatal care for at least one year between March 2020 and March 2023 answered an online validated WHO standards-based questionnaire collecting 40 quality measures for improving QMNC. A QMNC index (score 0–400) was calculated as a synthetic measure. Results Data from 4143 respondents were analysed. For 39 out of 40 quality measures, at least 20% of HWs reported a ‘need for improvement’, with large variations across countries. Effective training on healthy women/newborns management (n = 2748, 66.3%), availability of informed consent job aids (n = 2770, 66.9%), and effective training on women/newborns rights (n = 2714, 65.5%) presented the highest proportion of HWs stating ‘need for improvement’. Overall, 64.8% (n = 2684) of respondents declared that HWs numbers were insufficient for appropriate care (66.3% in Portugal and 86.6% in Poland), and 22.4% described staff censorship (16.3% in Germany and 56.7% in Poland). The reported QMNC index was low in all countries (Poland median (MD) = 210.60, interquartile range (IQR) = 155.71, 273.57; Norway MD = 277.86; IQR = 244.32, 308.30). The ‘experience of care’ domain presented in eight countries had significantly lower scores than the other domains (P 0.05). Multivariate analyses confirmed large QMNC variation by country. HWs with <10 years of experience, HWs from public facilities, and midwives rated QMNC with significantly lower scores (P < 0.001). Conclusions HWs from 12 European countries reported significant gaps in QMNC, lacking association with COVID-19 pandemic trends. Routine monitoring of QMNC and tailored actions are needed to improve health services for the benefit of both users and providers. Registration ClinicalTrials.gov NCT04847336. © (2024), (University of Edinburgh). All rights reserved.This study was supported by the Ministry of Health, Rome, Italy, in collaboration with the Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo,’ Trieste, Italy. Raquel Costa was supported by the Social European Fund and Foundation for Science and Technology under a post-doctoral grant (SFRH/BPD/117597/2016). Epidemiology Research Unit (EPIUnit) – UIDB/04750/2020, Laboratory for Integrative and Translational Research in Population Health (ITR) – LA/P/0064/2020, and Human-environment Interaction laboratory (HEI-Laboratory) – UIDB/05380/2020 (https://doi.org/10.54499/UIDP/05380/2020) are financed by Portuguese fundings through Fundação para a Ciência e a Tecnologia, Instituto publico

Implementation of the Swiss ordinance on maternity protection at work in companies in French-speaking Switzerland.

Switzerland's Ordinance on Maternity Protection at Work (OProMa) requires that companies take the necessary measures to ensure that pregnant employees can continue working without danger. To investigate the extent of compliance with OProMa within companies in French-speaking Switzerland as well as factors which facilitate and obstruct the ordinance's implementation. A stratified random telephone survey of 202 companies from the healthcare and food industry was conducted. Descriptive and correlational statistics were calculated. Responses to open questions were analysed thematically. Only a minority of companies performed risk analyses or adapted employees' workstations, as per the legislation. OProMa was implemented more effectively in larger companies than smaller ones, in public rather than private ones, in the healthcare sector rather than the food industry, and when the person responsible for the wellbeing of pregnant employees within the company had undergone specific training on the subject. Data extrapolation suggested that only 2% of pregnant employees in French-speaking Switzerland's food industry and 12% in its healthcare sector are properly protected according to OProMa's provisions. Maternity protection in French-speaking Switzerland's companies urgently requires improvement. In addition to the apparent need for stronger incentives and for monitoring of companies, our findings indicate a need to provide them with resources to meet OProMa's provisions

Protection des travailleuses enceintes et allaitantes en Suisse : guide pratique [Protection of pregnant and breastfeeding workers in Switzerland: a practical guide]

Specific working conditions may endanger pregnant women's and their children's health. Switzerland has specific legislation for the protection of pregnant and breastfeeding employees. However, the implementation of these provisions presents important shortcomings. Attending physicians or gynaecologists-obstetricians who care for pregnant women have a central role in controlling the efficacy of protective measures put in place for their patients at work. What are the occupational exposures at risk and their health impact ? What are the collaboration with the different actors involved in the protection of maternity at work ? What steps should be taken if occupational dangers are identified? What tools can be used ? This article answers and explore these questions

COVID-19 et femmes enceintes: une action de plaidoyer en temps réel

Maria-Pia Politis Mercier, maître d’enseignement et sage-femme (HESAV), Alessia Abderhalden-Zellweger, chargée de recherche et psychologue (HESAV et ­Unisanté), Isabelle Probst, professeure associée et ­psychologue (HESAV), Brigitta Danuser, Professeure honoraire et médecin du travail (Unisanté) et Peggy Krief, médecin adjointe et médecin du travail ­(Unisanté), témoignent dans cet article de leur action pour alerter des impacts du COVID-19 sur les femmes enceintes et protéger les travailleuses. Un défi de ­santé publique, relevé en temps réel