We need to talk about obstetric violence

A reproductive rights rally in 2011.

A reproductive rights rally in 2011. Photo: Getty Images

Trigger warning: contains discussion of assault and graphic content.

A horrifying video recently appeared in my news feed. Earlier this year in California, during the birth of her baby, ‘Kelly’ has an episiotomy cut against her will. Human Rights in Childbirth shows Kelly, who had earlier disclosed to staff she had been raped twice in her life, flat on her back with her legs up in stirrups. Kelly clearly begs, “No, don’t cut me.” Despite her repeated protestations, and without any urgent medical reason, she is belittled by the doctor before he makes 12 cuts to her perineum.

Remove the crowning baby, gowns and masks, and put this same situation in another setting, what would we have? Sexual assault. Lawsuits. Worldwide outrage. And yet, because this occurred between hospital walls and beneath the gloved hands of a doctor, the woman remains powerless. As yet unable to find a lawyer who will take her case, Kelly has been told, “The problem is, you don’t have any damages. Your baby is fine and you are alive.”

A woman in Ireland recently underwent a court-ordered caesarean section after being denied an abortion. Another Irish woman, who alleged her membranes were ruptured without her consent, leading to an emergency caesarean, had her case dismissed in court with the judge remarking, “The midwife was the person entitled, authorised and qualified to make the decision.”

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Countless stories are emerging from women being verbally abused, held down and forcibly examined, having their perineum torn or cut, or being threatened, bullied and coerced into surgery.

Foetal personhood laws in the United States have seen women prosecuted for smoking, drinking and taking drugs during pregnancy. Closer to home, ‘Zoe’s Law’, a bill granting legal personhood to a 20-week foetus, was passed through the NSW lower house.

This erosion of women’s rights in favour of a foetus is frightening.

Ann Catchlove, solicitor and president of the Victorian branch of Maternity Coalition said, “Women have a legal right to make decisions about their care. And care providers have a legal obligation to obtain women’s informed consent before carrying out medical procedures. The fact that a woman is carrying a baby has no impact … on her legal right to accept or refuse treatment.”

A 2012 study of low-risk births in NSW demonstrated an alarming rate of otherwise healthy women undergoing medical intervention including induction of labour, instrumental delivery, epidural or episiotomy.  Australia’s 31.5 per cent caesarean section rate is double the World Health Organization’s recommended 15 per cent.  Risks of caesarean include increased need for blood transfusion, admission to intensive care, hysterectomy, or in extreme cases – death.

Dr Hannah Dahlen, Associate Professor of Midwifery at the University of Western Sydney, says of safety in childbirth, “While the birth of a live baby is of course a priority, [the rate of] perinatal mortality [should not be ignored]. Cultural, emotional, social, psychological and spiritual safety rarely appear in the mainstream debates ... Not only [do these factors] dominate women’s thinking, research indicates ignoring its importance is potentially deadly.”

Almost one in five Australian mothers suffer postnatal depression. Some studies indicate a link between postnatal depression and instrumental birth, caesarean section, and the separation of mother and baby. Post-traumatic stress disorder affects three to five per cent of women following childbirth, and one of the leading causes of Australian maternal death is suicide.

Australian organisation Birthtalk, describes traumatic birth, “A birth that you can’t let alone. It stays with you … It might not look ‘that bad’ to an outsider. It might not look ‘that bad’ to your partner … It could have been a caesarean or a natural birth. It might have taken 30 hours or 3 hours. A bad birth is defined by the way you feel, not just the events that occurred.”

Discussion about birth can be volatile, blamed for fuelling the so-called ‘mummy wars’ or inciting judgment. Women who speak out are called ‘selfish’ and criticised as ungrateful for living in a first world country, or for their live baby. Our cultural view of pregnancy and birth, it seems, stems from a patriarchal attitude that feminism seeks to dismantle: that women must be submissive, passive, and let the experts who know better do the work.

Advocacy for women to regain decision-making over their births, and for care providers to face greater accountability, is not about superiority or one-up-womanship, it is about recognising that childbirth trauma is happening every day, and can have far-reaching physical, emotional and social consequences.

So how do we talk about this? How do we address that birthing women, their partners, and their babies are increasingly suffering, without being accused of dishing out guilt? When a woman voices her trauma, can we say, “I’m sorry that happened to you”? Can we validate a woman’s pain, whilst understanding her gratitude that she and her baby are alive? Why is her care provider considered more entitled to make decisions about her care than an adult, autonomous woman?

Acknowledging that obstetric violence happens is not to imply that all intervention is violent or unnecessary, nor a criticism of women who make informed choices to undergo obstetric or surgical care and intervention, nor a suggestion that obstetricians are not quality care providers. On the contrary, birth trauma can and does occur at the hands of midwives, and at homebirths, and we are lucky to have access to good medical care when complications arise.

However, to insist that medical maternity care is an infallible authority over women, or to maintain that a live baby and/or live mother is the singular benchmark for birth is misguided at best, and oppressive at worst. A woman always has a right to informed consent or refusal. And just as a woman’s clothing is no excuse for violence against her—neither is the presence of a baby.

 

 

 

4 comments so far

  • Obstetric violence happened to me. Twice. Twice I was given syntocinin against my will. Twice I had major haemorrhage. I was blamed for my child not attaching after he had been vac extracted and was jaundiced and they tried to send me home less than 24 hours after giving birth. I had panic attacks when I got pregnant the second time 5 years later. I describe what happened to me as assault. I still remember the name of the midwife who did it the second time around.

    Commenter
    Kerri
    Date and time
    October 01, 2014, 9:41AM
    • Great article Kim! I'm noticing more and more public commentary about obstetric violence, and mistreatment of women in maternity care. I had a most ho-hum routine hospital experience but I was still coerced into interventions I didnt want and threatened with violence when I didn't behave exactly as was wanted. I don't even consider my experience traumatic because compared to hundreds of stories I've heard mine was a walk in the park with a Sunday picnic. The whole system needs to be completely overhauled. I won't birth in hospital again unless its life or death, but not everyone has that choice.

      Commenter
      Murasaki
      Date and time
      October 01, 2014, 10:51AM
      • I think it's tricky because whilst I believe that the mothers safety is paramount, at some stage the baby should have a right to life as well. Please note I fully support the right to an abortion up to 20 or 22 weeks (whatever the legal limit is in various states) and am talking here about a baby which is near or at full term and would survive otherwise. If the mothers decision not to have an episiotomy, or another medical procedure which doesn't compromise her health or safety, is going to majorly affect the health and safety of a baby which would otherwise survive then that's not fair to the baby in my opinion.

        And yes, obviously it's a lot easier to advocate for it when you will never have to have to be cut yourself. As an anecdote though my wife had an episiotomy (with her consent) two weeks ago as the baby's heart rate was dropping, we now have a beautiful baby boy which might not have been the case without the surgery.

        Commenter
        Hurrow
        Date and time
        October 01, 2014, 11:06AM
        • While as a woman I agree with the underlying message of this article (necessity for informed consent, autonomy and shared decision making, abortion rights)..I really feel like it fails to inform readers of the complexity of health law and ethics. Especially that attaining to the complexity of informed consent during labour... first time methods change their minds regarding birth plans and pain relief after onset of painful labour. Also, the definition, law surrounding and legal obligation of obstetricians to provide emergency treatment under the emergency treatment act. This article has highlighted a few, specific cases from around the world which are incredibly horrible, but give a completely warped view of medical intervention in child birth; "Remove the crowning baby, masks and gowns and what do we have - sexual assult" ??? Really? This is not a representation of what a majority of women experience due to medical intervention in child birth...and is certainly not my own experience.

          Being the sister a mother who went against medical advice of induction of labour which consequently lead to death of baby inutero at 37 weeks - I have witnessed 'birth trauma' from a different perspective. While this article highlights that survival of the mother/baby in childbirth should not be the benchmark of medical care, I think everyone should stop an consider how much more difficult it would have been if intervention during labour had not been carried out (e.g forceps/vacuum/episiotomy) and their baby had died during birth.

          Commenter
          K88
          Date and time
          October 01, 2014, 11:59AM

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