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Obstetric violence: Assigning responsibility

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
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When I wrote my first article on obstetric violence I got varied feedback. A huge number of comments were along the lines of: “But that’s illegal. No doctor is going to risk their licence by doing something illegal.” But here’s the truth – obstetricians and midwives are perpetrating obstetric violence every day in Australian hospitals. And, despite the fact that these acts are illegal, their licences are not at risk. Not really. And just why not? Because women aren’t making complaints. Because women aren’t supported. Because the law pays lip service to protecting women’s rights while actively protecting hospitals and their staff. And because they are protected by a code of silence amongst their peers.

Just as the domestic violence campaigns have earned the oppositional hashtag #notallmen, so too have obstetric violence campaigns earned the argument #notallobs. Which is true. Not ALL obs or midwives commit obstetric violence. Every time an article is published about obstetric violence there is a mad rush of people jumping in to defend “the good ones”. “We’re not all bad!” is the catch cry.

Yes there are many care providers out there who help women to achieve the births they want. Supported and free of violence. Image courtesy of Wikimedia Commons.

Disclaimer time: THIS ARTICLE IS NOT AIMED AT YOU: If you report acts of obstetric violence to the authorities. If you refuse to coerce women into submitting to hospital policy or care provider preference. If you ensure that EVERY woman is aware of the benefits, risks and alternatives of recommended courses of action. If you refuse to hold down a woman while an ob performs a VE or episiotomy without valid consent. If you assist women in making complaints against staff who perpetrate obstetric violence.

“The only thing that is necessary for the triumph of evil is that good men do nothing.” – John F Kennedy.

If you stand by and allow an ob or midwife to coerce a woman into a procedure that she doesn’t want, if you watch a woman get bullied without reporting it, if you brush off a woman’s complaint of obstetric violence – YOU ARE A PART OF THE PROBLEM. Regardless of whether you actually performed the violent act or did the actual bullying. Because what you are doing is telling not just that woman and her family but also the perpetrator that this is okay. You are saying that you don’t believe that there needs to be consequences for the routine abuse of pregnant and birthing women.

Many women that I spoke to relayed stories of being bullied or coerced into caesareans without all the necessary information. This is a common form of obstetric violence. Image courtesy of Wikimedia Commons.

Don’t get me wrong (although many will…) I don’t necessarily believe that every single act of obstetric violence happens because the perpetrator is a “bad person”. I would hazard a guess that most perpetrators of obstetric violence are actually good people. They are just doing their job as dictated by their boss. Obstetric violence is far more than simply an act of violence perpetrated by one individual, against another individual. It is ongoing acts of violence perpetrated by an entire system against all women. It is hospitals who make women believe their policies are law. It’s a system that tells women they must submit to whatever the doctor wants. A system which puts the needs of women below the needs of hospitals, obs, midwives and the baby. It’s care providers who base their recommendations on what they want rather than the woman’s birth goals. It’s a society that tells women that birth doesn’t matter.

And really…what can I say about a system that protects those who violate women? That protects those who break the law. A system that would reprimand a midwife for respecting her client, but praise a midwife that coerces a woman into an unnecessary procedure simply because it is “hospital policy”. If you will excuse my language for a second, our maternity care system is fucked up. Its priorities are fucked up. And as a result it is fucking up the lives of many women.

Pregnant woman
A system which performs procedures on women without advising all the risks is a broken system. Image courtesy of Wikimedia Commons.

And for some reason women are always told that they need to be the ones to change the system. “Change care providers”; “Have a homebirth”; “Take an advocate with you”. Campaigns against domestic violence promote messages towards the need for men to change their behaviour. Yet campaigns against obstetric violence promote a message towards the need for women to change theirs. It’s called “victim blaming”. Where are the voices saying “It is not okay to perpetrate obstetric violence”? Where are the voices telling obs and midwives that THEY must change the way they practice so as to ensure woman are respected? Women do not need to “earn” the respect of their care providers – they are deserving of it simply by virtue of the fact that they are human.

What sort of systemic changes would I like to see?

In some parts of Australia we have mandatory reporting for domestic violence. What this means is that if you hear your neighbour bashing his wife you are legally obligated to telephone the police (if it is safe to do so). There was quite a large television ad campaign to promote this law. So why are pregnant women not afforded the same protections? Why are witnesses to obstetric violence not encouraged to come forward and lodge complaints? The partners, mothers, sisters, doulas and other hospital staff.

I find it very strange that while obs have no problems reporting independent midwives when they have an issue with them (bear in mind that the issue may simply be that the midwife is following the law and supporting a woman in her informed choice) but when it comes to reporting obs and other hospital based staff the onus is on the woman herself to make the complaint.

Pregnant woman
Pregnant women need to be able to relax and not be preparing for battle. We need YOU to do battle for us. Image courtesy of Wikimedia Commons.

Pregnant and birthing women need to be able to count on “the good ones” to stand up for them. We all know how vulnerable a heavily pregnant or labouring woman is. It is unreasonable, and rather unsafe, to send her in to do battle for her rights. I’d like to see laws that encourage witnesses of obstetric violence to report it. Let’s start encouraging “the good ones” to stand up and say:

Enough is enough. Obstetric violence is not okay. And we will not allow it to continue!

And let’s start assigning responsibility to where it belongs – with the perpetrators and the system that protects them.

Further reading about obstetric violence:

Obstetric violence: Stop burying your head in the sand

Why Australia NEEDS a maternity care revolution

Why I'm joining the birthing revolution

The vessel

Just one day

What being bullied says about you

Reasonable woman syndrome - An epidemic sweeping our maternity care system

Birth Trauma - We need to STOP Blaming the Victim!

#Birth Revolution
#Birth Trauma
#March Contest
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Thank you for this article, it is enlightened and informative. As a hypnobirthing teacher in UK,we need to get this message across to care providers and stop women being emotionally violated.
Thank you for this... we have issues like this in the US, as well. I've been the victim of, and witnessed obstetric violence to varying degrees in my work as a birth doula. The system is flawed, and women are paying the price. I hope our generation can fuel change!
Care in our obstetric units today are fuled by litigation. At the end of the labour all the doctors want is a mum and baby pair that are alive and fairly intact. It is not change that takes time but resistence to change. If we truly want change then it has to come from all corners. Everyone has to seek it out and it will be doable. This post is brilliant in that is makes our clients and care providers think about change. Well done.
hi lizzi, I am a prenatal-postnatal-mama/baby yoga teacher. I am also an R.N. formerly working in L&D, as well as NICU and Well-Baby nursery. (I am familiar with the violence you speak of) I want to share with you a segment from a letter that I encouraged one of my yoga students to write after she birthed her baby. It was her 3rd time around in my class and the only mantras she ever heard from me is "all women are powerful" "your body is design capable of birthing your baby" "your ancestral memory is encoded in your DNA and you have access to that wisdom." Here is a segment of the letter that she sent to the hospital (Upon my insistence).
At no point during the birth of my natural footling vaginal delivery did I accept I needed a Caesarean. Not when a foot popped out of my vagina during a contraction in triage. Not when I was being wheeled into the Operating Room. Not when a dozen doctors and nurses were of singular mind to give me general anesthesia and surgically remove my baby within the next five minutes. I worked hard on the tiny Operating Room table to stall – giving them a pep talk about how we were doing a vaginal breech delivery today - and allow the hospital staff time to align with the eventuality that my baby was coming into this world vaginally and perfectly. Alone, naked, and grossly outnumbered by faceless doctors, nurses, and anesthesiologists, I pushed out a healthy 8lb, 3oz baby boy. I pulled from the wisdom available to me and everybody in that bright, cold room. I became my birth-self, singular in purpose like every other laboring ancestor of mine before me, and we did it."

I cannot say my experience is my recommendation for others, only that I was able to tap into my instincts and they guided me and my baby through his birth. He is healthy and happy and my little sweetheart, hitting every milestone and showing me the worries imposed upon me by the medical staff during and immediately after his birth are baseless.

Thank you again for connecting with me. I do hope my experience may help other mothers trust their instincts and advance the medically trained "professionals" to broaden their idea of care and skills in assisting with births.

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