Protecting pregnancy at work: Normative safety measures and employees' safety strategies in reconciling work and pregnancy

Background: In Switzerland, occupational risks for pregnant workers are covered by specific maternity protection legislation (MPL); however, studies show significant shortcomings in the implementation of these policies among companies. Aims: Analyse the gaps between the provisions of Switzerland's MPL, the protective measures companies plan to take and actual protection practices. We also aim to understand how employees develop their own strategies in order to make up for the shortcomings or contradictions of companies' measures. Methods: Interviews with 46 different stakeholders from organisations in the healthcare sector and the food industry were transcribed and analysed thematically. Results: Some of the organisations used procedures apparently in line with legislation, while others planned more informal approaches to managing on a case-by-case basis. Normative safety measures within the framework of national legislation served as resources for both managers and their employees. However, implementing these measures ran up against real-world workplace constraints, which sometimes rendered them impracticable. Employees adapted some measures considered insufficient or developed their own strategies to reconcile work and pregnancy. Conclusions: Being pregnant is challenging to represent in occupational settings; it is not a disease, but it involves important physical and biopsychosocial changes, which affect women's occupational life. The multidimensional, evolving, and yet temporary nature of pregnancy represents a significant challenge to the implementation of MPL within companies. Linking the normative safety measures stipulated in the legislation with pregnant employees' needs-and their job-related knowledge and skills-could be an interesting pathway towards improving maternity protection at work

Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic : a cross-sectional study based on WHO quality standards

Objective: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. Methods: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. Results: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n= 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 4 87, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. Conclusion: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies

Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020–2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P< 0.001). Country-level variables contributed to explaining some of the variance between countries. Conclusion: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care

Regards croisés sur l’application des mesures de protection de la grossesse au travail : entre dispositifs légaux, pratiques et expériences

Des expositions spécifiques sur le lieu de travail peuvent affecter négativement la santé des femmes, leur bien- être au travail, les issues de grossesse et le développement de l'enfant. En Suisse, à l’instar d’autres pays, ces risques font l’objet d’une protection via une réglementation spécifique : l’Ordonnance sur la protection de la maternité (OProMa). Dans une perspective de santé publique et en intégrant certaines notions issues de l’ergonomie de l’activité, la présente thèse vise à : 1) acquérir des connaissances sur le degré d’application de la législation en Suisse romande ; 2) identifier les obstacles et les appuis à l’application de ces mesures de protection ; 3) comprendre comment les différents acteurs impliqués dans la protection des collaboratrices enceintes et les femmes ayant vécu une grossesse en cours d’emploi perçoivent et appliquent de manière située ces mesures. Afin d’obtenir des données quantitatives concernant l’application de l’OProMa en Suisse romande nous avons mené deux enquêtes, l’une en ligne auprès des gynécologues obstétriciens et l’autre téléphonique auprès de 202 entreprises de deux secteurs économiques (santé et industrie alimentaire). La faible application de l’OProMa témoigne d'un nombre important de femmes qui ne bénéficient pas des mesures protectrices auxquelles elles auraient droit. Nous avons ensuite mené une étude qualitative par le biais d’études de cas au sein de six entreprises appartenant aux mêmes secteurs économiques. En premier lieu, nous avons interrogé les perceptions des travailleuses qui ont vécu une grossesse en cours d’emploi et d’autres parties prenantes au sein de l’entreprise vis-à-vis des risques professionnels, des mesures protectrices proposées et des effets de l’application de telles mesures. Les données montrent que dans une même entreprise, les acteurs peuvent avoir des perceptions différentes ; certaines actions de protection adoptées par l’entreprise peuvent occasionner des effets inattendus et être perçues négativement par les travailleuses. Deuxièmement, nous avons investigué les pratiques de protection concernant la grossesse au travail en entreprises et les stratégies développées par les travailleuses elles-mêmes afin de concilier grossesse et travail. Dans les cas étudiés, nous avons observé des réalités très contrastées entre les entreprises. La présence de mesures protectrices prévues encadrées par la législation représente une ressource pour les managers et les travailleuses, cependant la mise en œuvre de ces mesures peut se heurter à des contraintes propres à l’activité elle-même. L’articulation entre des mesures prévues d’office et la prise en compte des connaissances des travailleuses enceintes vis-à-vis du travail réel s’avère être une piste intéressante. Dans une perspective d’amélioration des connaissances et des pratiques, la présente thèse propose des pistes de réflexion sur les difficultés d’application et les limites des politiques de protection actuelles. Au vu des lacunes mises en évidence sur plusieurs niveaux d’analyse, une amélioration de la protection des travailleuses enceintes ne peut se faire qu’en adoptant une perspective systémique et en s’appuyant sur des alliances solides entre les différentes parties prenantes. -- Specific exposures in the workplace can negatively affect women's health, their well-being and represent a risk to pregnancy and the unborn child. In Switzerland, as in other developed countries, these risks are protected against by specific regulation: the Maternity Protection Ordinance (OProMa). Using a public health perspective, and by integrating some notions developed in the ergonomics of activity approach, the present thesis aims to: 1) develop an understanding of the degree to which the OProMa is applied in French-speaking Switzerland; 2) identify the obstacles to and the facilitators of the appropriate implementation of that legislation, and; 3) comprehend how the different actors involved in the protection of pregnant employees, and women who had experienced pregnancy while employed, perceived and applied maternity protection measures in workplaces. We carried out two surveys to obtain the necessary quantitative data about the implementation of the OProMa in French-speaking Switzerland. The first was on-line and aimed at gynaecologist obstetricians; the second was conducted by telephone and aimed at 202 companies from two economic sectors (the healthcare and the food industry). The poor implementation of the OProMa across the region was witness to the significant numbers of women who do not benefit from the maternity protection measures which they are entitled to. We subsequently carried out a qualitative study among six companies from the same two economic sectors. First, we interviewed employees who had experienced pregnancy in the workplace and other stakeholders within their organisations about their perceptions of occupational risks, the protective measures proposed and the effects of the implementation of those measures. Data showed that the actors in a single organisation could have different perceptions; some of the protective measures adopted by the company can have unexpected effects on employees and be perceived negatively by them. Secondly, we investigated the real-world maternity protection measures implemented by companies and the strategies developed by employees themselves in order to reconcile pregnancy and work. The case studies revealed that the realities within companies were very contrasted. The existence of normative safety and protective measures enshrined in legislation act as a basic resource for managers and their employees. However, their implementation might well run up against the real-world constraints of carrying out a professional activity. Linking protective measures in line with the regulations with pregnant employees’ knowledge and skills with regards to their activities would seem to be an interesting pathway towards better maternity protection in the workplace. To improve knowledge and practices with regards to maternity protection at work, the present thesis reflects on the challenges of implementing current legislation and their limits. Given the shortcomings in the implementation of Switzerland’s maternity protection legislation—revealed at different levels of our analysis— improving protective measures for pregnant employees will only be achieved by adopting a systemic view and by relying on a solid alliance between all the different stakeholders involved

Soins périnatals gérés par les sage-femmes ::définitions et principes

Les auteures de cet article offrent ici un aperçu du modèle de soin périnatals gérés par les sage-femmes, et exposent ses particularités, ses principes et ses apports tels que décrits dans la littérature scientifique

Les futures mères sont mal protégées au travail

Une enquête menée auprès de 202 entreprises romandes montre que les prescriptions légales en matière de protection des travailleuses enceintes ne sont que peu appliquées

Impact of the COVID-19 pandemic on maternity services in Europe ::a mixed methods systematic review protocol

Objective: This review will synthesize and integrate the best available evidence on the changes caused by the COVID-19 pandemic in access to and the provision of maternity services in Europe. The review will also consider health care professionals’ experiences in providing maternity care during the COVID-19 pandemic in Europe. Introduction: Governments and maternity services have introduced various protective sanitary and organizational measures to reduce the spread of COVID-19 and protect the global population, including health care professionals. Since March 2020, the number of publications on this topic has soared, yet little is known about the effect of the pandemic and the accompanying measures on access to and the provision of maternity care in Europe. Inclusion criteria: The review will consider quantitative, qualitative, and mixed methods studies on the impact of COVID-19 on European maternity services. For the quantitative component, the review will consider studies evaluating maternity services outcomes across all types of maternity care settings. For the qualitative component, the review will consider studies exploring maternity health care providers’ experiences and perceptions of the impact of the pandemic on care provided to women and their babies. Methods: Six bibliographic databases will be searched for published and unpublished studies since March 2020. Study selection, critical appraisal, data extraction, and data synthesis will follow JBI's segregated mixed methods approach. The quantitative component will be adapted to follow the JBI requirements for systematic reviews of etiology and risk. Systematic review registration number: PROSPERO CRD4202128387

Maternity Protection at Work and Safety Climate: The Perceptions of Managers and Employees in Three Healthcare Institutions in Switzerland

The literature on the application of legal maternity protection measures in the workplace reveals that many organizations are failing to develop and maintain an in-house safety climate that manages to accommodate work and pregnancy. This study sought to understand managers’ and employees’ perceptions vis-à-vis different ways of managing pregnancy in healthcare settings. Further, the study aimed to identify pathways towards establishing a safety climate that makes pregnant employees feel protected and able to continue their work without discrimination or danger to their health or that of their unborn child. We investigated three healthcare institutions in Switzerland, carrying out 30 interviews with different stakeholders involved in maternity protection at work and analyzing their transcripts thematically. Managers and employees in the same healthcare institution can have divergent perceptions of maternity protection measures and their effects. Elements associated with pregnant employees perceiving a positive safety climate included their direct superiors’ perceived commitment to safety, shared perceptions of risks, the perception of adequate levels of information, the presence of an occupational health unit, and formal institutional procedures for managing and supporting pregnant employees. Incorporating and considering different stakeholders’ experiences is essential to understanding and improving the institution’s safety climate and women’s overall experience of pregnancy at work

Les sages-femmes et la protection des ­travailleuses enceintes

Les femmes enceintes qui travaillent ne sont pas ­toujours bien informées quant à leur protection, et les sages-femmes elles-mêmes manquent parfois de compétences en la matière. Une recherche a été menée en Suisse romande sur le sujet et propose quelques pistes de réflexions et des ­recommandations