A violence so normalised that it affects one in ten birthing women1 yet I imagine most people are unaware of the term.
So, what is obstetric violence?
The American Journal of Obstetrics and Gynaecology say that the term is ‘strong and emotionally charged’, they believe it can lead to misunderstandings and would prefer the term obstetric miss-treatment’2
‘International groups frame violence against women during childbirth as a form of gender based violence and a violation of human rights. Their reports draw attention to the global scale of violence during childbirth. The parallels between the normalisation of obstetric violence and domestic violence have been pointed out by researchers and advocacy groups’3
Research professor Rogelio D’Gregorio defines it as ‘The appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanised treatment, an abuse of medication, and to convert the natural process into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies’4
For many years now I have put time aside each day to read birth stories, the good and the bad. I decided to leave my career as a travel agent and re trained to work in the world of birth, to offer human rights sessions to pregnant families, and I offer birth trauma de briefs. I started this blog because I needed an outlet for my anger at the way women are treated, coerced and violated during childbirth.
Recently I have been reflecting on these words by C.S Lewis,
‘I sat with my anger for long enough until she told me her name was grief’
Those words reframed the pain and anger that I feel daily when reading birth stories.
I understand now, that its grief. A collective grief, for the women before me, my maternal grandmother being shouted at and told to be quiet whilst she laboured alone.
Grief for the women who had trust in a system that let them down.
Grief for all the times birth has been sabotaged and disrespected.
Obstetric violence is probably a term most people have never even heard. Those of us who do know about it have perhaps been too quiet. Now is time to give it attention.
Admittedly I never really saw myself as a feminist. I thought that was something women of the fifties and sixties had to worry about. I had always worked in jobs where I earned equal to my male colleagues. Growing up my household didn’t conform to gender stereotypes. My mum still keeps a motorbike in the Sahara desert now in her 60’s. Equality wasn’t really something I ever thought about, I just lived my life as though it was obvious that we had all that figured out. And then I got pregnant.
And that was where I came face to face with misogyny for the first time at 35 years old.
It took pregnancy to have my eyes opened.
Researchers have stated that obstetric violence and birth trauma are interrelated and often overlapping5, so I will use both terms. A third of women experience birth trauma, meaning that a third of all babies are starting out life with a traumatised mother, many of these women go on to experience post natal depression. With some birth workers claiming many PND diagnoses are likely to be miss diagnosed birth trauma. Women are made to feel that they cannot get help or speak about their experiences. Instead they should just be grateful.
‘Baby is here safe and well, that’s all that matters’
It is as though women do not matter.
If our baby is alive, then we have no right to complain.
To demand better for ourselves is somehow selfish.
To complain would indicate there is something a bit wrong or unhinged about us.
A third of families are starting out their lives traumatised with most having no where to turn, and seemingly no one addressing the elephant in the room - there is abuse going on in our maternity wards.
Birth guru Janine Parvati Baker once said that Peace on earth begins with birth.
I truly believe in that.
How we are treated during birth matters. How we experience birth matters.
In Australia, Bashi Kumar Hazard found herself having to say no to the doctor towering over her in her most vulnerable state as she was pushing out her baby, he demanded that she have a c section because he decided it was a big baby, she knew there was no medical need for a section and refused. He spent the entire time disrespecting her wishes as she delivered her baby, he refused to sew up her tear, refused her the pain medication she needed, and left her in stirrups for an hour. This resulted in her losing feeling in her foot and crutches for three months, all whilst looking after her newborn. What an initiation into motherhood! All caused by obstetric violence. Punished because she had not accepted how he wanted her birth to be. This is a very common form of obstetric violence, and withholding pain medication as punishment happens regularly.
Here are Bashi’s words about her postpartum;
‘I was dehumanised until it caused me suffering, and then punished for expressing my suffering. Out came the growing army of health professionals propped up to treat the harms regularly and knowingly perpetrated on mothers and babies in pregnancy and childbirth: psychologists, psychiatrists and social workers. Their ineffectual treatments putting expensive bandaids over bullet wounds. Did the health counsellor care that I had PTSD? No, she just warned me that accessing publicly funded mental health services could trigger a child protection alert’.6
Bashi just so happened to be a successful lawyer, she knew her rights, but still, she was abused. If it could happen to her she realised, it could happen to anyone.
She is now directly taking on obstetric violence. She is a director of human rights in childbirth and has been a key player in bringing birth trauma to parliament in New South Wales Australia which saw 4860 submissions detailing trauma and miss-treatment. She is also featured in the research book Birthing outside the system where they look at how to fix a system that is driven by ‘misogyny, prejudice, and care providers interests, in violation of women’s human rights’7
This form of violence has been so normalised in society that the woman experiencing it may be completely unaware why they feel so violated or blame themselves for what happened to them.
For example, The mother that agreed to a traumatic induction because she was never told about the risks, or perhaps she accepted six vaginal exams, that resulted in an infection that resulted in a c section, all because she didn’t know she could say no.
The words that are so often synonymous with pregnancy and birth - I didn’t feel like my body was my own. So many maternity policies act as though women have outsourced their bodies and signed away their autonomy.
Some cases of obstetric violence are so horrific that they make headlines. The Brazilian anaesthetist who was arrested in 2022 for raping women on the operating table8, the UK doctor who gave a patient a hysterectomy after a caesarean without her consent9, or the doctor on trail in the U.S for accidentally decapitating a baby with an instrumental delivery and then trying to cover it up and hide it from the parents10.
In part two I will look at examples from women who have spoken up, some of them received apologies and promises of extra training, but mostly this abuse has been dismissed by the courts, one woman was turned away by eighty lawyers for her clear cut battery and assault case that was caught on camera.
Join me for this bi-weekly series by subscribing below.
For further information about the topics above I recommend listening to these podcasts.
Listen to human rights lawyer Bashi talk about obstetric violence on the Midwives Cauldron podcast - HERE
Listen to midwives discussing how to change the system via the Australian Birth Trauma Inquiry - HERE
1 Great Birth Rebellion Podcast, How to Change the System - Episode 45
2 https://www.ajog.org/article/S0002-9378(23)00732-9/fulltext
3 Obstetric Violence, Realities and Resistance from around the World, Pg 15, edited by Angela N.Casteneda, Nicole Hill and Julie Johnson Searcy
4 Obstetric Violence, Realities and Resistance from around the World, Pg 212, edited by Angela N.Casteneda, Nicole Hill and Julie Johnson Searcy
5 Obstetric Violence, Realities and Resistance from around the World, Pg 211, edited by Angela N.Casteneda, Nicole Hill and Julie Johnson Searcy
6 Birthing Outside the System, The Canary in the Coal Mine, Pg 18, Edited by Hannah Dahlia, Bashi Kumar-Hazard and Virginia Schmied
7 Birthing Outside the System, The Canary in the Coal Mine,, Edited by Hannah Dahlia, Bashi Kumar-Hazard and Virginia Schmied