Drivers of sedative administration in hospitals following intrauterine death
Paul Richard Cassidy
PhD student, Universidad Complutense de Madrid; Researcher, Umamanita (Stillbirth charity)
Routine sedative administration (SA) in Spanish hospitals following intrauterine death has been previously reported (48% of cases). The objectives were to establish the primary drivers of SA and possible contextual predictors.
A cross-sectional descriptive design with an online questionnaire, including cases of stillbirth or TOPFA within 5 years prior to participation in the study. 796 women were asked if they had been “sedated or tranquilized (not analgesics, epidural anesthetic or sleeping pills)” during the hospital stay as well as the main reason for SA. CHAID (decision tree analysis) was used to test for statistically significant (p<0.05) relationships between SA and contextual predictors.
In the SA sub-group (48%), 32.5% stated that they “asked for something to calm me”, 50.3% that healthcare professionals (HPs) “told me to take something to calm me” and 17.1% that HPs “gave me sedatives without consulting me”. The CHAID analysis found no significant differences between sedative and non-sedative groups based on socio-demographic or pregnancy variables, but did find significant relationships with structural care variables, though with small effect sizes: Nodes 1 & 2) women who saw a mental health professional (59.2% vs. 45.3%, p=0.002), Nodes 3 & 4) women in private rooms (49.1% vs. 34.2%, p=0.003), Nodes 5 & 6) women unaccompanied during the birth (59.1% vs. 45.3%, p=0.021) and Nodes 7 & 8) women who were alone when they receive the diagnosis (50.0% vs. 26.6%, p=0.010).
HPs are the primary drivers of SA, although a significant proportion of women asked for sedatives, which may relate to wide cultural trends and discourses and be a form of taking control in a stressful situation. Statistically significant associations between SA and unaccompanied women (during diagnosis, accommodation, birth) may suggest that SA is associated with structural weaknesses related to staffing or that SA has a symbolic care value for poorly trained HPs.
The author’s institution (Universidad Complutense de Madrid) did not require ethics approval for non-clinical studies. Consent was given through informed participation in the online survey.