Sedative administration in Spanish hospitals in the context of perinatal loss: findings from a mixed-methods study

ABSTRACT

This article explores the contexts, processes and motivations behind the administration of sedatives (minor tranquilisers) in the time around perinatal loss. Using a mixed methods design, an online survey of 796 women and 13 narrative interviews were conducted. The participants had experienced a stillbirth or termination of pregnancy from 16 weeks or a neonatal death in Spanish hospitals. The quantitative (univariate and CHAID decision-tree) and qualitative (narrative-linguistic) analysis found that sedative administration was pervasive across care contexts and appears to be naturalised despite contradicting practice recommendations. Sedative administration was associated with emotional control and avoidance of loss, lack of accompaniment and on occasion with managing disruptive patients. Lack of informed consent was very common, with little explanation of side-effects prior to administration. In the participants’ narratives, health professionals tended to construct sedatives as benign, but for some women the effects were counterproductive to loss and grief and related to persistent regrets about decisions. The study concludes that, in the context of perinatal loss, sedative administration was highly integrated into the fabric of medicalised care. As a socio-political and cultural practice underscored by gender-based care dynamics, there seems to be an imbalance between benefit and risk to women’s welfare.

KEYWORDS:

• Childbirth
• psychotropic medication
• medicalisation
• obstetric violence
• stillbirth
• termination of pregnancy

Acknowledgements

Sonia Pastor Montero (University Hospital Juan Ramón Jiménez, Spain), Paloma Martínez Serrano (Madrid Regional Midwifery Teaching Unit, Spain), Carolina Rodríguez Palenzuela (Association Cometa, Spain), Fran Boyle (The Centre of Research Excellence in Stillbirth, Australia) and the anonymous reviewers for their very thoughtful observations.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The survey data from the study is openly available at: https://www.umamanita.es/wp-content/uploads/2021/09/Data-set-Umamanita-Survey-public.zip. The qualitative data is not publicly available due to privacy concerns.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.