​Most people will have never heard of it, some may have experienced it but not had a name to call it, some may think it’s just a crock of shit and that women (in general) should just be grateful that they are alive and have a healthy baby (assuming that the one who experienced Obstetric Violence actually did have a healthy baby which I do know for a fact isn’t always the case).

So what is it?

According the MidwivesVictoria1 blog maintained for the Midwives in Private Practice (MiPP) collective Obstetric violence is “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 times 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."

The World Health Organisation2 defines Obstetric Violence as “disrespectful, abusive or neglectful treatment during childbirth in facilities” and “included outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay.”

In addition Obstetric Violence also includes committing acts against the birthing person, including but not limited to medical intervention (both physical and via IV), without valid informed consent and verbal permission (after obtaining valid informed consent) to do so.

Obstetric Violence can also include holding a baby’s head inside the birth canal, performing a routine episiotomy without informed consent and against the birthing persons wishes, performing a caesarean against the birthing persons wishes (even if it puts the unborn baby at risk – the birthing person has the legal and human right to accept and/or refuse any and all medical treatment regardless of if it’s during childbirth or not), stitching up a perineal/vaginal/rectal/vulval tear without valid informed consent, denying a birthing persons request for specific procedures (hysterectomy or other sterilisation, delayed cord clamping, genetic testing for a known genetic disease within the family etc) and/or rejection of intervention (refusing ergometrine/syntocinon injection for delivery of the placenta, refusing a canula/IV, refusing internal examinations, refusing to be confined to the bed, refusing to use continuous fetal monitoring/CFM etc), giving the birthing person IV or intramuscular medication without valid informed consent, bullying/coercing/scaring/manipulating a birthing person into interventions that the birthing person otherwise would not have consented to (this also goes against the Human Rights laws and Australian law – Australia is also a cosignatory of the Human Rights laws meaning that they apply here and anything going against those laws is a violation of the Human Rights laws).

For some of these things it can be argued that they are lifesaving procedures – and while many of them can be for many women I am not talking about them right now (although some of them have involved violations of human rights too). The issue I am writing about here is to do with Obstetric Violence. Violence perpetrated against a birthing person that is either verbal or physical or even a combination of both.

If we take away the hospital/medical setting -  the gloves, the gowns, the masks, the lights and equipment, and transpose these abuses into any other setting, eg the cinema, the shopping center/mall, the car park, a private home, basically anywhere else except for in a hospital or other medical facility – everyone would be in an uproar, the perpetrator would be charged with assault, with physical abuse, with domestic violence or just simply for perpetrating violence against another person.
The media would be all over it, the general public would be screaming (well maybe not screaming exactly but at least calling loudly) for justice, if it just happened to be a native Australian who experienced it there would be a giant uproar and picketers would be barricading Parliament House demanding reforms and justice and changes to the law.
If it was a celebrity who experienced it there would be stories in every magazine, it would be known pretty much all over the world what had happened, and the court case would be all over the news.

But it is in a hospital setting, and because of that it’s “accepted”, it’s treated as “normal”. The birthing people who go through such a horrible experience are left to deal with on their own with very little support and sometimes even no support at all.

They don’t get any justice.

If they lodge a complaint with the hospital they may or may not get an insincere apology designed to cover the hospitals arse, the perpetrator may or may not get a slap on the wrist and will then most likely go straight back to doing the exact same thing to other birthing women.
If they lodge a complaint with the relevant regulatory authority they might see the perpetrator investigated, or they not see anything done at all.
If they contact the police they are normally told that “there’s nothing we can do”.
If they contact a lawyer they’re told “we can’t help you”.

Obstetric Violence is being perpetrated against birthing people every single day in hospitals everywhere and the victims have no recourse.

They get no justice for what was done to them.

They may get an insincere apology.

They get minimal help – and what little help they do get is usually limited to seeing a psychologist or counsellor to treat PTSD and/or depression caused by their experience.

Those who are creating awareness of Obstetric Violence, who are trying to bring into the public’s knowledge and sight so that something can be done, are usually those who have personally experienced it or who have personally witnessed it.

The victims of Obstetric Violence, those who have already experienced it, those who are experiencing it right now and those who will experience it in future, all need our help. We need something to be done right now.

OBSTETRIC VIOLENCE NEEDS TO BE STOPPED.
 
 
 
 
References:
1 - http://midwivesvictoria.blogspot.com.au/2014/03/definition-of-obstetric.html
2 - http://apps.who.int/iris/bitstream/handle/10665/134588/WHO_RHR_14.23_eng.pdf?sequence=1

Today I took part in a discussion about obstetric violence and the doulas role when witnessing obstetric violence. It was very interesting and also sad, frustrating and made me a bit angry reading the personal experiences of going through obstetric violence from some of my fellow doulas, as well as the first hand witness accounts from those who has seen it done to their clients.
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Obstetric abuse is not new to me; I have been through it myself and know many others who have also been through it. Seeing it discussed openly and respectfully with suggestions of things that we (doulas) can do to help any of our clients who may be on the receiving end of it and hearing about the different ways that obstetric violence can be presented was very helpful and I know that I will be taking away much of what I have read and using it to help any of my future clients who may experience obstetric violence (I bloody well hope that none of them do!)

The biggest issue discussed was about many of those who experience obstetric violence AND have a doula supporting them while it is happening – specifically about the client blaming the doula for not stopping what happened and what we, as doulas who may be witness to this awful practice in the future, could potentially do to not only stop it from happening but also to potentially prevent it from happening at all. The one thing that I noticed most about this part of the discussion (and from a documentary that discussed women’s experiences of obstetric violence) was that the doula was often blamed for not stopping it, not preventing it, not fixing the problem.

Having personally experienced "birth rape" during the birth of my youngest child - I didn't have a doula during that birth and I did blame my husband for a LONG time afterwards (and still have some residual anger towards him that I have not yet been able to release, it has been nearly 6 years now and the long term negative effects of that experience still affect me to this day - I have forgiven my husband however, and I have no doubt at all that had I had a doula I would have blamed him/her for not protecting me instead of my husband) for not doing anything to stop what was being done to me (in his defence he truthfully had no idea what was going on and was focused on our baby who wasn't breathing yet and needed resuscitation). I blamed the person that I trusted the most during the most vulnerable moment of my life for not protecting ME, for not SAVING ME, for not ripping that fucking obstetric registrar away from me and ripping his damn head off. I still blamed the registrar for his actions, but most of my blame went to the person who was supposed to be my protector.

We as women who have experienced obstetric abuse still blame our care provider for what happened - that's obvious - but we also blame the person that we trusted most to protect us, either our partner, a family member/friend  or our doula (if we have one), because in our eyes they DID NOT protect us and they were supposed to.

Blame, choosing one person to blame for what happened, is (unfortunately for us) normal and is part of the grieving process, it's awful for us who are on the receiving end. And we are grieving after what happened to us – we are grieving for what should have been, grieving for the pain we have experienced that we shouldn’t have had to experience, grieving for everything that should have been perfect and right and instead went so very very fucking wrong.

WE the doulas become the scapegoats instead of the other support person (if there was one) just because of our presence in that room, WE become the ones who SHOULD have done more, SHOULD have been better, SHOULD have been able to FIX whatever was happening, SHOULD SHOULD SHOULD have done SOMETHING, ANYTHING to stop what was happening from happening in the first place. WE doulas are the ones who are trusted to protect our client, to keep our client safe, to tell our client what is happening and when. WE doulas are often expected to do more and be more than we actually are – like that old blog post about airy fairy doulas full of unicorns and rainbows from way back in 2014.

All that we as doulas are physically able to do in the birthing room is to tell our clients what is happening, speak up (out loud so that everyone present is aware of what we are saying) and ask our clients if they are ok with what is happening or if they wish for it to be stopped.

We cannot control what their care providers do.

We cannot physically stop their care providers without risking being charged with assault ourselves and as a result leaving our client alone, vulnerable and still in the hands of that care provider (here in Queensland, Australia we are now not "allowed" to even raise our voice in anger or frustration at a care providers actions, regardless of if we are in our role as a doula, as a patient or as the support person/advocate of a family member, without risking being potentially charged with abuse against that care provider ~ carries the risk of spending up to 14 years in jail if we are charged), we can do what we can within the limits of the current system wherever we are but we alone cannot change it, we can only create awareness and make sure that our clients know all of their options.

The harsh reality is that there isn't all that much that we doulas are able to do in the moment and we cannot stop all of it from happening. All we can do is support our client, inform them and their other support people, tell our clients if we see that something is being done without their consent and remind them that they can say NO and STOP and can kick their care provider out of their room if they don't stop what they are doing.

After the birth we can register complaints with the hospital and the relevant medical authority as witnesses of what occurred and we can provide a witness statement that our client can use for what we saw happen. We can support our client physically and mentally/emotionally and we can find suitable resources for our client so that our client can hopefully begin the process of healing, if not physically then at least mentally/emotionally.

It kills me inside that I cannot do more. I wish I could do more. I wish that I could save every single woman from experiencing anything like what I went through – I know that I can’t but the wish is still there – and all I want, more than anything else in this world, is to see those care providers who practice obstetric violence be appropriately punished for their actions and for all of the damage, pain and heartbreak that they have left in their wakes.

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Just a little end note:

-  If you or someone you know has experienced obstetric violence please lodge a complaint against the person who perpetrated that violence with both the hospital that it occurred in and also with the relevant regulatory authority for that persons profession.
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- If you or someone you know has experienced obstetric violence and is struggling mentally/emotionally please encourage them to seek help from a maternal mental health counsellor/psychologist with experience in treating complex PTSD caused by obstetric violence/birth trauma.