End the Denial of Obstetric Violence

Millions of women are silenced by the thoughtless, and brutal denial of total strangers. But for how long can their voices continue to be denied?

End the Denial of Obstetric Violence

Every single time a conversation about birth trauma and obstetric violence comes up, victims are shouted down. Deniers claim things like all that matters is a healthy baby, and doctors don’t do anything that is unnecessary. They tell tales about how grateful they are to have healthy babies, stories intended to shame women who speak out about their experiences of violence in maternity care. But the anecdotal evidence of violence against pregnant and labouring women is growing, and recently the World Health organisation has raised it as one of their agendas.

They have released a statement, endorsed by multiple health bodies, which can be read here.

Here is a snippet:

“…. across the world many women experience disrespectful, abusive, or neglectful treatment during childbirth in facilities. These practices can violate women’s rights, deter women from seeking and using maternal health care services and can have implications for their health and well-being”

The time has come for universal acknowledgement of poor practices within obstetric care. We have seen horror stories from hospitals, birth centers, and midwives attending homebirths, and the bottom line here is that women and babies are paying the price. But no one is afraid to dish out justice to midwives, it’s just surgeons that enjoy the backing of our obstetric culture

People start entire facebook pages and websites devoted to preventing individual midwives from practicing, but when a surgeon decapitates a baby during a birth,  or removes a woman’s limbs without consent, during a caesarean, very few people ever hear about it. These types of incidents are viewed as “unfortunate”, or one off tragedies, understandable errors. These incidents are not stand alone though, there are thousands of them that have been made public, and we’ll never know how many will always remain secret.

Following are a few examples of obstetric violence. We will include an end of trigger warning in bold, for those who prefer to scroll past this next section.

**~!!!~~TRIGGER WARNING~~!!!~**

Man's hands on pregnant belly in shape of love heart
Love pregnancy
License: Creative Commons CC0.

The actions of the surgeon Graeme Reeves went unpunished for years, despite patients, and nurses all reporting him. In the end he was arrested and charged, then jailed for a mere eighteen months. Recently he was released from prison, and sixty charges against him were dropped. To be clear about this, there were MULTIPLE REPORTS, from MULTIPLE SOURCES about the violent practices, and yet no charges will be laid against him. Apparently his illness overrides the many years of pain he caused for his victims.

The Break The Silence campaign, organised by Improving Birth, shared many stories of obstetric violence. Many people viewed these stories as controversial, but amazingly, the controversy wasn’t related to the fact that surgeons had violated so many women’s trust, it was related to the fact that women dared to say they had been violated.

Another group, Human Rights in Childbirth, shared the video evidence of a surgeon cutting an episiotomy whilst the woman was actively denying consent. (This story also featured on the Improving Birth campaign) Remarkably, this video was met with hostility and denial. How can we deny video evidence? Why are we so determined to rebuff the frighteningly prevalent evidence of violence in obstetrics?

**~~~~END TRIGGER WARNING~~~~**

Not all surgeons are violent, there are many wonderful obstetricians, but there’s no need to say that in conversations with women who have encountered violence. Derailing conversations about birth trauma by suggesting that women would lie or exaggerate their experiences, has to stop. We have not come to a point in history where one in three women gives birth in an operating theatre because obstetrics is woman centered. In fact a recent study showed that an astonishingly low number of guidelines were based on evidence.

In this study, the evidence base underlying the ‘Green-top Guidelines’ has been analysed in order to establish the quality of research underlying recommendations. During this descriptive study of 1,682 individual recommendations, the authors found that only 9-12% of the guidelines were based on the best quality (Grade A) evidence.

You can read more HERE.

In the Journal of Perinatal Education, Judith A. Lothian, PhD, RN, LCCE, FACCE, stated that

“In spite of technology and medical science’s ability to manage complex health problems, the current maternity care environment has increased risks for healthy women and their babies. It comes as a surprise to most women that standard maternity care does not reflect best scientific evidence.”

And perhaps this, rather succinctly, explains the problem traumatised women face. People are raised not to question authority, and whilst most logical people can agree that a caesarean rate of over 30% is too high, they struggle to question the factors that create it. However the caesarean rate is just one small glimpse of the problems in maternity care.

You can read the whole document HERE

The report goes on to state this crucial fact:

“Hygiene, better overall health, and antibiotics were responsible for the dramatic drop in maternal morbidity and mortality in the 20th century (Rooks, 1997). In the last half of the 20th century, advances in medicine made birth safer for high-risk women and for women with pre-existing medical conditions or serious complications in their current pregnancy. There is no scientific evidence to support that moving birth to the hospital or primary maternity care provided by obstetricians has made birth safer for healthy women with no pre-existing medical conditions (Enkin et al., 2000). Increasing evidence shows that the routine use of technology during labor and birth and the use of other routine interventions without a clear medical indication have contributed to the dramatic rise in the cesarean rate and other maternal and newborn complications, including a rise in maternal mortality in the United States”

This information is vehemently denied,  or ignored, by those who make money from obstetrics – despite the ever increasing evidence. And sadly we have reached a point in time where our cultural obedience to those we perceive as authority figures (surgeons) has so engulfed us, that empathy and humanity have departed, leaving millions of women unable to reach out.

What is most strange about the denial of obstetric violence is that people have no trouble naming the other inadequacies of standard hospital care. Complaints about other departments in hospitals are never met with such stubborn or angry disapproval. It’s perfectly acceptable for someone to say that a surgeon removed the wrong kidney or amputated the wrong limb, or misdiagnosed a life threatening illness, but the second someone – namely a woman – raises a concern about the treatment she received when she was giving birth? All hell breaks loose.  

Woman and man male loveheart with hands on pregnant belly
We must protect pregnant women.
License: Creative Commons CC0.

Millions of women are silenced by the thoughtless, and brutal denial of total strangers. But for how long can their voices continue to be denied? For how long can wealthy surgeons and medical establishments escape, passing the blame on to women who apparently misinterpret, or fail to comprehend the severity of obstetric situations. For how long can violent, completely unjustifiable obstetric practices rely on the defence of insurance companies, medical bodies, and ironically, the friends and families of those they harm?

The time has come for all decent human beings to stand shoulder to shoulder and say;

WE WILL NO LONGER TOLERATE THIS VIOLENCE AGAINST WOMEN AND BABIES

WE WILL NO LONGER DEFEND PRACTICES, WITHIN OBSTETRICS, WHICH WE FIND REPREHENSIBLE IN OTHER FIELDS OF MEDICINE

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