When I use the term “obstetric violence” people often say “isn’t that a bit harsh? I mean, it’s not ACTUAL violence”. The term “birth rape” gets even more criticism – “it’s not REAL rape” – because apparently it’s only rape if it happens in a dark alley way. Or maybe people simply believe that highly educated people (ie: obstetricians) are unable to commit rape. Or that by engaging the services of an obstetrician or midwife to care for them women are somehow consenting to anything that happens to them. Whenever I use the term obstetric violence, once people get over the shock of what such a term could possibly mean, questions come up: What is it? Who commits it? Why is it an issue? Is that really “abuse”, isn’t birth just meant to be that way? Which women are more likely to be victims of obstetric violence?
Domestic violence, in all its forms, is evil. It is very widely acknowledged that this form of violence is not acceptable and midwives routinely screen women to help assess whether they are at risk of domestic violence. The domestic violence crisis service, ACT defines domestic violence as occurring “when a family member uses violent and/or abusive behaviour to control another family member or members. Domestic Violence can include physical, verbal, emotional, economic or sexual abuse.”
Domestic Violence is NEVER okay. Image courtesy of Wikimedia Commons
What I would like to discuss, though, is obstetric violence. Women are not screened to see if they are at risk of obstetric violence. Women and their partners are not informed of the “warning signs” that their care provider may be abusive. Women are not encouraged to seek help if they are subjected to obstetric violence. You don’t see brochures in public service offices telling you to call a hotline if you suspect your neighbour has been subjected to obstetric violence. Why not? Because the general public don’t see obstetric violence as a problem? Because pregnant women deserve to be treated poorly? Because it’s all for “the good of the baby”?
I’d like to put obstetric violence into the same definition of domestic violence. It is very confronting to see just how abusive some care providers are, but very important to know what obstetric violence is. We can’t help women and we can’t stop the abuse if people keep burying their heads in the sand.
Obstetric violence can include any or all of the same features of domestic violence:
PHYSICAL ABUSE: Physical abuse can take the form of performing a procedure on a woman without her informed consent. Or by coercing her to give consent. It is very widely accepted that if a medical practitioner performs a procedure on a woman without consent then that is assault. I hear a LOT of stories about women who are subjected to this form of obstetric violence, and of women who report this to the appropriate authorities. I’m yet to hear of any obstetrician being charged with a criminal offence in relation to the physical assault of a labouring woman. (If you know of any please feel free to contact me...I don't claim to know all and would be interested to hear of these experiences / cases.)
Physical abuse of a birthing woman can also take the form of patient neglect. Kylie from QLD was left to bleed for four hours following the birth of her fourth baby. She was found when a new midwife came on duty and she was rushed to surgery to repair a 6 and a half cm tear in her cervix. Her previous midwife had ignored her concerns about the bleeding.
VERBAL ABUSE: Verbal obstetric violence occurs when a care provider yells at, insults, ridicules or threatens a pregnant, labouring or post partum woman. I hear stories everyday about women who are ridiculed by medical staff for refusing pain relief “You don’t need to be a super hero”; or for verbalising through contractions “Be quiet – you sound ridiculous!” It’s also fairly common for women to be threatened with physical violence “If you show up here in labour we will simply take you straight for a caesarean” is commonly said to women planning a vbac at non-supportive hospitals.
Kylie from QLD was ridiculed by her midwife when she expressed serious concerns about her bleeding - “she told me it was because I had so many kids and to stop being a baby”.
EMOTIONAL ABUSE: Pregnant women are especially at risk of emotional abuse. With all those hormones, doubts, fears and concerns it’s easy to scare a pregnant woman. Just suggest that she doesn’t care about her baby. This form of abuse is VERY prevalent. Here are some actual quotes from care providers I encountered during my pregnancy that certainly constitute emotional abuse: “You must get induced. Your risk of stillbirth is increasing and it would be very traumatic for the staff if your baby died”. “I have been unable to sleep all week as I’m so scared your baby will die”. “You obviously want a vaginal birth more than a live baby”. These quotes are from: The head of midwifery, my allocated midwife and a senior obstetrician. At 42 4 there was no indication that I was experiencing anything other than an exceptionally healthy pregnancy with an exceptionally healthy baby. Yet these care providers felt the need to bully me into consenting to an induction…while I did not have any support person present. As Ina May Gaskin said “It is very easy, even profitable, to scare pregnant women. But it is not nice, so we shouldn’t do it.” Truer words have never been spoken.
Bullying pregnant women is NEVER okay. Image courtesy of Wikimedia Commons
ECONOMIC ABUSE: We have free health care here in Australia so there could never be any economic abuse of pregnant women…could there? If a woman, particularly one who is deemed by the hospital to be “high risk” wishes to access evidence based, woman centred care from a known midwife (gold standard care and shown time and time again to improve outcomes for mothers and babies) she needs to be able to pay anywhere from $2000 - $6000 for an independent midwife to attend her at home. If a woman doesn’t have that sort of money she is then unable to access the care of her choice and must subject herself to “standard care”. While you can find good quality care for free in a lot of locations, many women find that they can't afford the care that they feel will be best for them. I'm by no means suggesting that independent midwives shouldn't charge appropriately for their service, but the patriarchal system decides who can attend a woman through financial control.
We also see a level of economic abuse from private obstetricians. I hear of many women who are told by their private ob that they will not discuss birth plans until very late in the pregnancy. Even telling some women that they won’t advise whether or not they will support a vbac until 38 weeks. By this stage the woman has paid a large amount of non-refundable fees to the obstetrician. Due to this fact many women feel that they are unable or unwilling to switch to a supportive care provider if their current one proves unsupportive.
SEXUAL ABUSE: Many people dislike the term “birth rape”. For a huge variety of reasons. But it is important to remember that it is a woman’s sexual organs that are generally subject to the physical abuse. In any other setting if someone puts their hands inside your vagina while you tell them (or scream) “NO” that is rape. Yet this is not just not considered rape if it happens in hospital. In fact it is usually downplayed as “for the good of the baby” or “necessary”. Rape is NEVER necessary! Phoebe from WA explains the impact of her experience of birth rape: “Every time I was naked and in the shower for the first year of my son’s life I cried. I felt so vulnerable and exposed. I remembered some of the experiences of my son’s birth, I’d have images in my head of all the hands in my vagina. I remember things happening to me that I hadn’t consented to.”
Sexual abuse of women involves physical abuse of the sexual organs. Image courtesy of Wikimedia Commons.
Now that YOU know what obstetric violence is, the next time you hear a friend relay a story where she feels that she was violated, bullied or assaulted let her know that what she experienced has a name. Many women such as Phoebe from WA found that being able to put a name to her experiences was a part of being able to commence her healing journey. Let her know that she is not crazy and she is not alone.
In a future article I will look more into other aspects of obstetric violence, such as the withholding of information, risk factors for obstetric violence and how we can begin to stamp out this obscene practice. In the meantime, if you would like to chat more about what constitutes obstetric violence or share your stories please feel free to contact me at firstname.lastname@example.org or via my facebook page Sprout Doula and Hypnobirthing Services.
Paying for services is not consent. It's rape then robbery. I heard of a woman screaming "I do not consent!" All the way to the OR where they knocked her out. Even if the doctor thinks it's for the best, he/she should NEVER proceed without approval and coercion is NEVER justification. Mothers are being threatened into surgery and have perfectly healthy babies with no signs of complications during labor and the mother/baby duo are left broken and torn emotionally unnecessarily only to be told "oh well, at least you two are healthy." Well, they would've anyway and now instead of bonding and celebrating, they are grieving.
I've seen plenty of obstetric violence & iatrogentic complications in hospitals, by docs & CNMs. But you can't call it rape if the women is willingly paying for these services. If she doesn't like the way they handle birth, she should hire someone who shares her birth philosophy. Just asking the HCP what their C/S, mortality, & morbidity rates are will go a long way to helping the woman choose the type of care she wants to get.