Our birth stories are often worn as a badge of honor, symbolizing the transition into motherhood, but for many women, this transition is marked by trauma.
Not the physical kind of trauma from childbirth itself, but from abuse experienced during pregnancy, labor, and delivery at the hands of healthcare providers. This is called “obstetric violence” and includes physical and verbal abuse of pregnant women during birth. Reports of obstetric violence against women are oftentimes dismissed. Mothers are silenced when we don’t take their claims seriously, when we default to telling them that they should just be grateful to have a healthy baby.
A shocking 2019 World Health Organization study reported that 42% of women in Ghana, Guinea, Myanmar, and Nigeria had experienced some sort of physical or verbal abuse during childbirth, including reports of being punched, slapped, shouted at, mocked, or forcibly held down, and providers often failed to obtain informed consent for interventions.
Also in 2019, the United Nations sought to find the root cause of obstetric violence around the world and how to best address systemic issues that allow this abuse to happen. The report pinpoints several factors that contribute to obstetric abuse, some of which are the working conditions of staff, quality of facilities, and “the historical overrepresentation of men in the gynecological and obstetrical field.” Regardless of the cause, why is this behavior considered acceptable in a healthcare setting when anywhere else it would be defined as assault?
Common Doesn’t Mean Normal
Obstetric violence may be a relatively new term for what women have been experiencing in delivery rooms for decades. In 1958, Ladies Home Journal published a scandalous article titled “Cruelty in Maternity Wards” which detailed horrifying abuse that women endured during delivery. The stories were taken from patients and nurses that exposed the damaging treatment. Women were left in the delivery position for hours, nurses prevented women from delivering by tying their legs together or literally holding or pushing the baby back into the mother’s body, and episiotomies were cut and sutured without anesthetic. A follow-up on this article published nearly 50 years later found that very little progress had been made with how women are treated in the delivery room.
In case you’re thinking, this only happens in poorer countries, not in America, a quick search will bring up dozens of stories from women recounting abuse from healthcare providers. Obstetric violence is all too commonplace in delivery rooms, with one in six American women reporting some form of abuse, according to a 2019 study. This is more likely to happen in women who are young, unmarried, uneducated, or are a minority. This directly correlates to maternal outcomes – according to the CDC, a woman of color is almost three times more likely to die from pregnancy and childbirth complications than a white woman.
In 2016, an Alabama jury awarded Caroline Malatesta $16 million in a lawsuit against Brookwood Medical Center for medical negligence and reckless fraud. Malatesta had chosen the hospital after seeing an advertisement that promoted autonomous and natural birth, but her experience was far from that. While she had planned for an unmedicated birth where she could freely move, she was forcibly held down on her back by nurses and her baby’s head was held inside of her vagina for six minutes while waiting for the doctor to arrive. This resulted in PTSD and severe pelvic pain caused by nerve damage that prevents her from having sex or ever bearing children again.
Women who are young, unmarried, uneducated, or a minority are more likely to suffer obstetric violence.
Her win in court is rare. Many women never get this kind of validation or vindication from the justice system. What women are most often told is to take a seat and let the medical community do the decision making, they do know what’s best after all. Many hospitals have policies in place that allow providers to exert their will over women when they feel that their recommendations aren’t readily accepted by patients, and in many cases, they’re able to do this at their own discretion and without a court order. This completely removes the process of true informed consent and the right to deny medical treatment and it violates the principles of medical ethics. Currently, there are very limited legal options to address obstetric violence in the United States, and there are only a handful of countries that have laws against it.
In 2011, physicians at Staten Island University Hospital decided to override Rinat Dray’s refusal to have a C-section stating that the benefit to the unborn baby outweighed any risk to the mother. However, medical records show that there was no distress to the unborn baby, and while the mother had “decisional capacity,” the on-call physician decided to “override her refusal to have a C-section.” Dray had had two previous C-sections and had opted to try for a VBAC (vaginal birth after cesarean), noting that the American College of Obstetrics and Gynecology says that this can be done safely. The physician continued to pressure Dray to have the surgery, threatening her with a court order and telling her “my license is more important than you.” Ultimately, a group of physicians and the hospital legal counsel decided the surgery could be done against her will. After years of litigation, the court ruled against Dray, agreeing with the hospital that physicians can undermine pregnant women’s choices in favor of their own.
Countless other women have suffered similar abuses with hospitals using the court system to their advantage to basically medically kidnap women in an effort to exert their authority during the delivery process. This is not only a violation of basic human rights, but constitutional rights as well; it lets pregnant women know that they do not have the same right to choose or refuse treatment as other patients do.
Physicians are allowed to continue performing procedures and surgeries on women without their consent or knowledge, and society and the legal system don’t deem this as abuse because it’s in the best interest of the unborn baby. The systems in place give these abusers a pass because it’s for a “greater good,” telling women that in the birthing industry, they don’t matter. This happens while American women abort their unborn children by the thousands every day, and society tells these women that this choice will maintain their right to bodily autonomy and reproductive rights.
“No” Is a Complete Sentence
You can tell your provider “no.” You can refuse any treatment or intervention that you choose. Healthcare providers are providing you with a service, and while they make recommendations based on your health history, they’re not an authority figure over you.
This isn’t to bash the role of healthcare providers or to say that some interventions are not necessary or even lifesaving. However, there is a power struggle and a hierarchy that plays out between provider and patient, which directly impacts birth and recovery. In a hospital system, doctors are often the highest-ranking person in the building, followed by nurses and other healthcare personnel. This system implies that doctors and nurses have a position of authority over patients. One study reported that 5% of women who gave birth at home reported mistreatment when compared to almost 30% of women who had hospital deliveries.
5% of women who had homebirths reported mistreatment, compared to almost 30% of women who had hospital births.
Women are mocked for preparing a birth plan instead of letting her providers make all of the decisions for her. There is often pushback when mothers choose not to subscribe to social norms when it comes to pregnancy and birth; this often frustrates physicians and nurses who feel that these mothers are unrealistic and inflexible. Yet, birth is treated like a pathological event that requires a cure, instead of a normal, physiological event that can happen naturally and with little intervention. Physician interference in birth usually results in a cascade of interventions that mask the primal instincts of birth. Instead of listening to our own mothering instincts, we let the experts dictate when, where, and how to birth.
The question remains, how can women avoid becoming another statistic of obstetric violence? Unfortunately, there is no easy answer, but it starts with empowering yourself. Do your research and know what to expect. Have these conversations with your team of healthcare providers before you deliver. Have a good understanding of interventions and procedures that could be done. Write a birth plan and have a backup. Make sure that your partner or support person is on the same page and supports your decisions and will advocate for you.
Obstetric violence is a new term for a decades-old problem that the modern world still doesn’t recognize, which is why there is no clear solution. We have relinquished our bodily autonomy and the sacredness of birth to physicians and hospital policy – maybe it’s time that women reclaim their birth experiences.
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