Much is said about the importance of good medical follow-up during pregnancy. Keeping up with prenatal exams, knowing the risks, and listening to recommendations are actions that ensure a successful pregnancy. However, things do not always go as expected and, amid so many exams and professionals involved, there is a risk that a woman may suffer some type of obstetric violence and, worse, not even realize she has been a victim.
Yes, we all need a certain tolerance for pain and discomfort. And a woman who decides to face pregnancy knows that not everything will be easy. But what if the discomfort exceeds the limits? How do you identify it and what should you do?
That’s why we’ll discuss in detail here the term known as “obstetric violence,” defining some characteristics that will help to identify this problem, which causes so much suffering. The more information we have on the subject, the better, right? So follow our article to the end to learn all about it.
- What is obstetric violence?
- How do you identify obstetric violence?
- What measures should you take if you are a victim of obstetric violence?
- Ways to prevent obstetric violence
What is obstetric violence?
The World Health Organization (WHO) defines violence as the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, poor development, or deprivation.
Following this idea, obstetric violence is precisely what a woman suffers when seeking healthcare services during pregnancy, childbirth, or postpartum care. Abuse or mistreatment can be of a physical or psychological nature and can end up transforming the experience of motherhood into something traumatic for both woman and baby.
It’s important to stress that this type of violence is not necessarily committed by doctors or limited to them. Anyone connected to the healthcare system and responsible for monitoring the pregnant woman may be a perpetrator of violence.
How do you identify obstetric violence?
When we talk about violence, it’s common to imagine only actions involving physical assaults, profanity, or yelling. But it isn’t quite that. Violence can come disguised and be almost imperceptible, especially if the woman is convinced she must endure it and that certain procedures are normal. Adding to this is the fact that she may be feeling vulnerable, making the situation ideal for such aggressions to occur.
In general, the types of obstetric violence include:
- Physical abuse;
- Sexual abuse;
- Verbal abuse;
- Discrimination based on age, ethnicity, social class or medical conditions;
- Non-compliance with professional standards of care;
- Poor relationship between the mother and the team;
- Poor conditions of the healthcare system.
More specifically, the situations that can be considered obstetric violence also include forced medical interventions, invasive practices, disregard for the woman’s needs and pain, and even the use of unnecessary medical procedures.
This is a delicate issue, because we really do need to trust our doctors. They are the ones with the obstetric expertise and experience. However, we also need to know about the procedures that will be performed and request clarification about their use.
This is a right of the pregnant woman: to have all the information needed about what will be done to her body. There are many situations where procedures are performed that could have been avoided, or where more comfortable alternatives could be found if the woman had been consulted and not just informed.
Of course, it is difficult to judge in isolation whether a procedure was abusive or not. However, the mother-to-be should be alert to some instances that may result in obstetric violence:
- Not offering pain relief – as we said, a woman is prepared to experience some pain, especially at the moment of delivery. However, it is her right to have access to pain relief methods. If she is denied this, or if her complaints are not heard, this may constitute violence.
- Preventing a woman from screaming or moving – during labor, screaming relieves and even helps withstand contractions. In a vaginal birth, the woman needs to be in a comfortable position and there should be agreement with the medical team as to what this is. Telling a woman to be quiet, preventing her from expressing herself, from screaming, or even tying her arms and legs to prevent her from seeking a better position, are all forms of violence.
- Unnecessary restriction of food and drink – obviously, a woman knows her diet will be restricted in the hours before delivery. However, the practice of absolute fasting is outdated and no longer has medical support. Subjecting a woman to unnecessary fasting, depriving her of water and food, can be an abusive behavior.
- Intestinal cleansing – in some cases, an enema before delivery might even be recommended, but this practice is no longer recommended by the World Health Organization (WHO) and should never be performed without the woman’s consent. Doing this procedure without her permission is obstetric violence.
- Questionable medical procedures – as we’ve said, the final say on the application of a procedure should be the doctor’s. However, using them without consent, or indiscriminately, can result in obstetric violence.
The episiotomy, for example, which is the cut made between the vagina and the anus to facilitate the baby’s exit, has become a routine procedure, often performed without proper assessment or need. After this procedure, the cut, in some cases, is sutured with the so-called “husband stitch” – done to make the vaginal opening smaller, providing more pleasure to the partner but causing more discomfort for the woman.
In addition to the procedures listed above, there is also the excessive use of synthetic oxytocin (used to speed up dilation), which also intensifies the mother’s pain. And there is also the Kristeller maneuver, where the upper part of the uterus is pressed to help the baby come out more quickly. These practices can cause trauma to both mother and baby.
The list of situations that may lead to obstetric violence is lengthy, and also includes:
– refusal to admit a woman to a hospital or maternity ward;
– prohibition of a companion to enter;
– refusal to answer the patient’s questions;
– successive examinations by several people;
– leaving the woman naked and isolated;
– shaving her pubic hair;
– separating mother and baby after birth for the convenience of the health service;
– preventing or making breastfeeding in the first hour difficult;
– artificial rupture of the membranes as a routine procedure;
– unnecessary c-sections, performed without the woman’s consent or merely for the physician’s convenience.
What measures should you take if you are a victim of obstetric violence?
Obstetric violence can be difficult to identify. As a result, many occurrences end up being ignored, whether out of lack of information, vulnerability at the moment, or even a lack of courage to proceed with a complaint.
Many women, in addition, only realize years later that they suffered abuse during their childbirth. If you notice that you have been or are being a victim of obstetric violence, here are some practical steps you can take:
- Gather information: the woman should have access to the medical records and all the information regarding the procedures that were or will be performed. It’s also important to talk to people who witnessed the events, so there are supporting accounts for your claim.
- Seek psychological support: Filing a complaint can be as exhausting as the violence itself. There’s a risk that the woman won’t be taken seriously, especially due to her vulnerable state. So, before pursuing this, it’s important for the mother to take care of herself and recover from the trauma. Therapy will help her see the facts more clearly and give her the strength needed to move forward.
- Seek legal advice: The lack of knowledge about the law prevents many women from recognizing or reporting abuse. Being treated with dignity and respect isn’t a favor—it’s a right. Therefore, in addition to gathering evidence and documents, it’s essential to seek legal guidance and give your claim the support of the law. Refusing admission to a hospital or maternity unit, for example, breaks Law 11.634/07, as does barring a companion, which is against Law 11.108/2005. Having this information is fundamental, and a lawyer will certainly know how to proceed.
- Contact the appropriate bodies: There are several channels for reporting that women can use to report violence. For example, there’s the ombudsman’s office at the hospital where the woman was treated, or the Municipal, State, or District Department of Health. Another alternative is to contact the relevant professional councils (Regional Medical Council—CRM, in the case of doctors, or the Regional Nursing Council—COREN, in the case of nurses or nursing assistants). All these authorities can and should be contacted.
It’s also possible to file a report via number 180, which is the Women’s Service Hotline, and number 136 (Health Hotline). There’s also the possibility of going to the Women’s Police Station—if there is one in your municipality—or to a regular police station.
Ways to prevent obstetric violence
No one deserves to be in situations involving humiliation, pain, and shame. A woman in labor is already vulnerable enough without having to deal with violent situations. The harm and trauma caused at the time of delivery can last for years—in fact, studies have linked postpartum depression to experiences of obstetric violence. To prevent women from facing such moments as much as possible, there are some steps to consider:
- Maintain good communication with your doctor
This is essential in any relationship, and when it comes to a medical team, there must be two-way communication: the team must keep the mother informed about everything that will be done, and the mother must share her fears and doubts—and must be heard. Many incidents of violence happen because this dialogue doesn’t exist or is very poor. - Have a companion who can make decisions for you
It is the woman’s right to have a companion at both prenatal appointments and during labor. And it doesn’t have to be a partner—it should be someone who, if the woman is unable to decide, can step in to authorize or decline certain procedures on her behalf. This person should understand their responsibility and will also serve as a witness if anything is mishandled. - Consider a humanized birth
Contrary to what many think, humanized childbirth does not necessarily mean giving birth at home, in a tub. It is more about the approach the medical team takes with the mother. In humanized birth, the focus is on the woman’s needs, giving her control and freedom to choose. Of course, the woman needs to be well-informed to decide consciously and not based on bias. In Brazil, the practice of using doulas during birth is becoming more common. The doula is a professional who supports the woman throughout her pregnancy. This can be a good way to make sure the experience is not traumatic. - Develop a birth plan
Lack of consent is one of the biggest causes of obstetric violence. In emergencies or risky situations, the medical team tends to do what they believe is best at the moment, but not always what’s best for the woman. That’s where the birth plan comes in. It’s a document drawn up with the obstetrician, where the woman makes it clear which procedures she prefers and which she wants to avoid. It may not always be possible to follow the plan exactly, but the more you can anticipate, the better for everyone.
Unfortunately, obstetric violence is real and the number of complaints proves it. According to a survey by Fiocruz, 30% of women treated in private hospitals suffer some type of obstetric violence. In the public health system, the rate rises to 45%. Therefore, this issue should be of concern to anyone who wishes to have children.
The journey of a woman from conception to delivery is long and, often, difficult. Respect and dignity for women must always be upheld—and no matter the reasons for certain procedures or actions, nothing justifies the use of violence of any kind in the care of a pregnant woman.
