Mar 8, 2018

Birth rights and the hidden threat of obstetric violence

It might seem counter-intuitive that in an activity experienced only by women, women are nonetheless pushed to the bottom of the power hierarchy and treated so appallingly, but this is the case.

Rhea Dempsey

Childbirth educator and counsellor

Today, International Women’s Day, impassioned women, their partners, midwives and doulas are marching to demand birth rights.

They are marching because on International Women’s Day — which for so many years has championed the international women’s rights agenda — and in the social and cultural moment encompassed by #MeToo, it is time to unleash the many silenced voices of women on issues of assault and “power over” violence in the Australian birth system. Time to highlight birth rights, the scourge of obstetric violence and the distressing prevalence of birth trauma.

Obstetric violence was described by UK obstetrician Dr Amali Lokugamage at the Royal College of Obstetricians and Gynecologists 2014 World Congress. She defined it as the act of disregarding the authority and autonomy that women have over their own sexuality, their bodies, their babies and in their birth experiences. It is also the act of disregarding the spontaneity, the positions, the rhythm and the time the labour requires in order to progress normally when there is no need for intervention. It is also the act of disregarding the emotional needs of mother and baby throughout the whole childbearing process. Sadly, this description of obstetric violence is what passes as standard care in far too many birth settings.

University of Queensland PhD candidate Bec Jenkinson published research in 2017 on the experience of women, midwives and obstetricians when birthing women decline recommended maternity care. She found that once a birthing woman crossed the clinician’s “line in the sand” in declining recommended care (her human right to bodily autonomy), she was subjected to “escalating intrusion”, beginning with “manipulation”, escalating to “punishment and judgement”, then onto “badgering” and possibly ending in “assault”.

Birth has its dangers, of course, and we are lucky to live in a time and place that gives us access to life-saving medical procedures. But access to these procedures on the rare occasions that they are medically necessary is not a privilege to be paid for by forgoing other rights to dignity, autonomy and choice.

I hear too many stories like Emily’s, whose experience of birthing her baby can only be called out as obstetric violence: “I was greeted by the on-call consultant obstetrician. She was more than rude, she was aggressive — pressuring me to consent to both an epidural and a drip despite having regular contractions and my birth plan stating not to even offer me pain relief,” Emily told me. “My body was touched and prodded without warning, so aggressive was one unconsented vaginal exam, the student midwife asked the obstetrician to stop (but she didn’t). I now know that what happened to me is called ‘obstetric violence’.”

It might seem counter-intuitive that in an activity experienced only by women, women are nonetheless pushed to the bottom of the power hierarchy and treated so appallingly, but this is the case.

Applying a human rights framework to childbirth, we see that birthing women do not hold the power. Rebecca Schiller, from charity BirthRights, in her book Why Human Rights in Childbirth Matter, states that birth rights are: the right to receive safe and appropriate care; the right to care that respects the birthing woman’s fundamental human dignity; the right to privacy and confidentiality; the right to equality and freedom from discrimination; and the right to make choices about her own pregnancy and childbirth even if her caregivers do not agree.

Yet it does not appear that birthing women hold the power when we note the rising rates of unnecessary birth interventions. Restrictive timing protocols are just one example of the way our medical system lags on implementing current research — and the way the system results in unnecessary intervention in birth. In the US in 2017, the American College of Obstetricians and Gynecologists (ACOG) recommended restricting the use of many routine labour and birth interventions because they are not the safest care for women and babies, and are definitely known to initiate a “cascade of interventions”. These routine procedures include screening for GBS; routine continuous electronic fetal monitoring; restrictive timing protocols for stages of labour and for going past supposed due date; restriction on mobility with suggestions to remain on the bed; the use of epidurals and managed third stage — all standard practice in Australia.

Fired by movements like #MeToo, women’s silenced voices about “power over” structures and individuals are being heard. In the birth arena, when we listen to women’s voices, what birthing women want, as well as dignity and autonomy, is choice. And the choice so many want to make is for midwifery “continuity of care” programs — the evidence-based “gold standard” for maternity care. Presently, only 8% of women in Australia can access such care.

Definitely a long way to go then — come join the march.

*Rhea Dempsey is a childbirth educator, counsellor and the author of Birth with Confidence: savvy choices for normal birth, published by Boat House Press


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9 thoughts on “Birth rights and the hidden threat of obstetric violence

  1. Clare McKay

    I’m sorry to see there has been little improvement in the treatment of women during childbirth. Nearly 40 years ago I was told I had to be induced because I was too old to be having my first child (34). It turned out she was going away and wanted my baby born before she left. On the labour table I was called stupid, when I didn’t want her to use stirrups she used straps to tie my legs up, because my cervix was too slow opening she used her hands to open it. She even pushed away the midwife who was trying to stop her. And I found out when you are in labour, lying on a labour table, you can’t sack your doctor. I was so traumatized by her I couldn’t allow her to touch me again. Fortunately my baby survived unscathed.

    1. zut alors

      You’ve answered the question I was about to pose ie: is there any evidence that female obstetricians are more empathic to the needs & best interests of birthing women? Clearly not in your case.

  2. Bob the builder

    Great article.

    This issue was only recently brought to my attention as pregnancy and childbirth and often relegated to “women’s issues” – but it’s an issue for all of us and we need more articles like this that get it out in public where it should be.

    The health system as a whole disempowers patients, but in that most intimate and vulnerable and treasured experience, bringing life to the world, that disempowerment is multiplied manifold.

  3. Richard

    An opportunity for disaffected, dissatisfied and genuinely maltrreated to speak up.
    The biology of childbirth is apolitical.
    The pregnant woman and people around her are not.
    The great majority of medical practitioners, male and female, do the best for their patients.. as in safest. Unfortunately, the politics of power can so easily and insidiously come between safe obstetric practice, common sense and often self serving first world political mumbo jumbo.
    How many women having “fulfilling” home births have regretted it or died?
    You won’t get too many women crouching behind a bush in the third world, with a difficult labour, (and maternal mortality in the double %ages) complaining about “wanting to have more control in the birth process and experience”.. Odd that.

    1. Bob the builder

      Richard, a great collection of non-evidence based generalities.
      The stupidest is probably the comment about women crouching behind a bush in the third world, as if women and their long-esteablished cultures hadn’t developed ways of giving birth, as if they were just ignorantly walking along and suddenly found themselves about to give birth.

  4. AR

    Another aspect of medicalised birthing intended for the convenience & comfort of the ‘professionals’ is mother lying on her back attempting to push the baby uphill through the birth canal to the wide open world.
    The houses of the first city, Catal Hayuk, had the birthing footstones at the front door, any number of early tales refer to women standing up, usually holding onto tree branches and then there is Sarah telling Abraham, “go into my maid that she may give birth on my knees”. Gen 16:2-3.
    Given the joys of puerperal fever in the doctor created, 19thC UK birthing factories, it’s a wonder enough survived to continue the Empire.

    1. Bob the builder

      Despite what the article hints at, my recent experience was that lying down giving birth is a thing of the past, particularly among midwives, who actively encouragement movement, shifting positions and standing or sitting in whichever way is comfortable.
      Apparently my parents’ generation were subjected to enemas before giving birth, then strapped into those horrible contraptions on their back … unbelievable!

  5. nino

    It is appalling that nothing has changed since the 70s when Leboyer wrote so eloquently about the violence of birth. Odent wrote about it throughout the 80s, and Robbie Davis-Floyd wrote the excellent Birth as an American Rite of Passage in 1992, which covers similar ground. It seems to me though, that most women are mainly thinking about themselves here, rather than the future health impacts on the baby. Having had a traumatic birth I can attest to its devastating consequences, which only increase as you age. Leboyer wrote that of you want to understand where the madness of the world comes from look at the violence of birth. This will forever remain the most important fact ever written.

  6. mary wood

    I am conflicted about this. I know from personal experience that when something unexpected happens during childbirth it can become an emergency very very quickly. Whilst the treatments described can never be described as best practice, but as abuse of the birthing mother, the thing I wanted above everything else was a live, healthy baby. I really don’t think this would have happened in a home birth.

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