*Warning! some of this content may be triggering*
Obstetric violence is unfortunately a very real reality for a lot of women and birthing people across the world.
‘Obstetric violence concerns disrespectful, abusive and coercive treatment of pregnant and birthing people during obstetric care and results in a violation of their autonomy, human rights and sexual and reproductive health’.
A 2009 study by Thomson and Downe made a link between childbirth and people who experience abuse. They found that similar language was used in both experiences and the themes they analysed linked to ‘being disconnected’, ‘being helpless’ and ‘being isolated’. They concluded that ‘trauma was not related to mode of birth, but to fractured inter-personal relationships with caregivers’.
Further to this, a lecture on the concept of obstetric violence by Olza and Sadler in 2016, looked at several qualitative studies from the UK, Chile and Venezuela. Their findings linked language used by birthing women and people as being similar to that of rape victims.
“I had a retained placenta for my second birth, a young male doctor walked in, didn’t even introduce himself, put his hand up me and got the placenta out, there was no conversation and I felt a bit like a cow!”
They also identified that lots of these women and people, who had experienced obstetric violence, developed post-natal depression which affects more than 1 in every 10 women in the UK within a year of giving birth.
But it’s not only the birthing women and people who are affected by obstetric violence, many health care staff experience depression and mental health issues because of witnessing obstetric violence.
Research suggests that obstetric violence is quite often caused by obstetric doctors, however there are cases of midwifes and other health care staff causing this trauma. Several studies suggest that staff who witness obstetric violence report feeling helpless and powerless in the situation.
This article in the Guardian in 2018 gives a snap shot of what birthing women and people have and do experience across different countries.
“The doctor came in in order to turn the baby’s head, but didn’t treat me like a person – the midwifes did but the doctors didn’t”.
So what can you do if you witness obstetric violence? How can we prevent it from happening?
Often this comes down to the clinical implications that surrounds birth. In occupational therapy, we learn about being holistic in our care, using our therapeutic use of self and identifying where non-pharmaceutical interventions are necessary instead of medical intervention. Whilst therapeutic use of self is not practiced in current midwifery training, we see the value that this would have in this field.
We have found that often it isn’t only the care givers that can affect a birthing woman or person’s experience. At the beginning of this project, we talked to over 20 mothers (friends and family) who had given birth about their experience of birth. We discovered that the environment in which they gave birth in affected their birthing experience and this is reflected in some of the quotes below.
“Basic and mechanical room, felt very bare and not very nice room. Did not comfort me at all”
“I remember seeing the stirrups on the bed and being scared”
“The room felt cramped and there were no rails or handles to grab hold of to help me mobilise“
“There was no window and it felt like a prison cell”
In midwifery, there are many settings that you work in; either out in the community and people’s homes, birthing centers, hospital wards or maternity units attached to hospitals. Wherever you may be, you could witness obstetric violence, often students don’t feel that they can speak out if they do not agree with a practice, however if you feel uncomfortable or unsure about something you’ve witnessed, you should have access to a named PMA (Professional Midwifery Advocate) who can support you. You should also have access to a personal tutor and student support/guidance should you wish to seek any counselling.
There are several charities in the UK that are working towards better birthing experiences and trying to tackle this issue:
AIMS (Association for Improvements in the Maternity Services)
‘…work(ing) towards better births for all by campaigning and information sharing, protecting human rights in childbirth and helping women to know their rights, whatever birth they want, and wherever they want it’.
‘Birthrights is dedicated to ensuring women receive the respect and dignity they deserve in pregnancy and childbirth’
Reflection:
Obstetric violence is a very true reality for a lot of birthing women and people around the world and like in most cases, this can be avoided.
How do you think you could help create a better environment for birthing women and people to avoid obstetric violence happening in your care?
Maybe reflect on the training you are given and the practical placements that you go on to identify when a birthing woman or person might feel ‘less than’ or uncomfortable in a situation.
Whilst obstetric violence does exist, there is also a lot of good health care practice in obstetrics and midwifery, it might be an idea to reflect on this during your course and on placements to consider your practice and how you come across to service users.
Further reading:
(Written by Beth Hart August 2020)
