​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

Recently I saw a question on a pregnancy and parenting page asking about being induced at 37 weeks for a “Big Baby” (estimated to be around 9ish pounds/4-4.5kg by 40 weeks). This particular mum-to-be didn’t feel comfortable with being induced then, and did say that, but was seeking advice and support that it was the right thing to do.
I did what I usually do, I advised of the risks, the benefits, that the estimated weight was not “Big” at all and many women birth babies even bigger than that vaginally and after spontaneous labour with no issues at all, and reassured the mum-to-be to follow her heart – in that if it didn’t feel right then tell her doctor that she didn’t want to be induced and would wait until baby decided to arrive on his/her own.

This kind of question is becoming more and more common these days, women being told they are having “Big Babies” estimated to be between 9 and 10pd (which isn’t “big” as such, it is just another variation of normal size) and will be induced between 37 and 38 weeks gestation because of that. These women are apparently not being given any choice in the matter, they are being told it WILL happen, that they NEED to be induced as if they don’t their baby will get stuck (shoulder dystocia) and die because it is too big to be born vaginally.

For the record, this is not evidence based medical practice, this is fear mongering and scare tactics and outright lying by medical professionals in order to get an expectant mother to do what THEY want her to do. A 9-10pd baby is not big, 11+ pounds is “big”. 9-13pd babies are born all around the world all the time without any issues when the mother is able to move around in whatever way she finds comfortable and as a result assist the baby in manoeuvring through the birth canal. In these cases there is no respect for a mother’s decision making, no allowing the woman’s body to do what it was made to do, preventing the natural physiological process of birth from occurring when the time is truly right and making women around the world afraid of a natural body process. To add to this a small baby is just as likely to get stuck as a larger baby if baby’s position and mothers position while birthing are not ideal. There are ways to prevent it and to reduce the chances of it happening, and early induction is not one of them and has a higher chance of shoulder dystocia by preventing the mother from adopting natural birthing positions due to the CTG monitoring and in many cases an epidural as well when the induced contractions become too much for the mother to bare and increasing the chances of baby being malpositioned when artificial rupture of the membranes (amniotic sac) is done as part of the standard practice of induction, traumatic physical and emotional intervention with the use of ventouse (vacuum), episiotomy, forceps and physical pressure on the mothers abdomen, and fetal distress from the induction itself resulting in either the above mentioned interventions or an emergency cesarean occurring.

But what I've mentioned just above is not what prompted this blog post. What prompted this is the lack of up to date knowledge in obstetricians and other mothers who were “fans” of this particular page and answered this particular question.
These “fans” were promoting induction at 37 weeks with no major risk factors or true need, stating that it was “term” and “baby would be fine”. This information is incorrect, not only have the WHO and ACoG, within the last 12 months, updated their guidelines of when “term”, “full term” and “post dates” are, but an induction at 37 weeks for no reason other than an ultrasound weight estimate (proven to be inaccurate in the majority of cases) shows that baby is measuring larger than average. The new guidelines state that “term” is now from 39 weeks to 39+6 weeks after recent research showing that a lot of important brain development occurs in-utero between 37 and 39 weeks and babies who stay in longer have less physical issues than babies born before 39 weeks gestations (eg feeding issues, regulating of body temperature issues etc), “full term” is now from 40 weeks to 42 weeks gestation, and “post dates” is now from 42+1 weeks onwards.

What does this mean for pregnancy and birth and going past 41 weeks gestation? Well frankly it means that every woman should now have a much higher chance of being able to go into labour naturally when their baby and body are really ready without the need to be induced, whether it is at 37 weeks that their baby decides that he or she is ready, or at 43 weeks, AS LONG AS all obstetricians and doctors follow the ACoG and WHO guidelines, which unfortunately for all of us women is not the case. Sadly most obstetricians and doctors do not follow these guidelines, they follow their own guidelines and the hospitals outdated policies on “management” of pregnancy and labour. And “management” it is, they are “managing” us like animals, inducing when they want, cutting us open when they want, giving us medication when they want, telling us what we can and can’t do, scaring us and putting the fear of death into us, only telling us what they want us to know and not what we need to know, essentially taking away our basic human rights and preventing us from making our own truly informed choices and decisions by not providing all of the information and only telling us what they want us to hear.
There are of course exceptions to this, there are some wonderful and truly amazing obstetricians and doctors out there who treat women with respect and dignity that they deserve and do everything that they can to inform women of ALL of the risks and benefits, accept a woman’s choices without trying to change her mind, support her unconditionally in those choices and go out of their way to try and give the woman the birth that she desires. They are few and far between, a dozen or so in every state, a few hundred or so in every country out of a hundred thousand or more obstetricians and doctors around the world that are trained in high risk pregnancy and birth.

“So what?” You might say, “They are trained in pregnancy and birth, they know what they are doing.” Yes, they are trained, in “HIGH RISK” pregnancy and birth, the types of pregnancies that might be dangerous for mum and/or baby. They are NOT trained in natural physiological childbirth, they are not trained in the kind of birth that does not need drugs to make it start, that does not need intervention or constant monitoring, that does not result in a mother on her back in a bed unable or "not allowed" to get up and move around and physically help her baby to get into a better position for birth, they are not trained in allowing a woman’s body to do what it was made to do and treat every woman the same as if they have the same risks as every other woman. Every woman, every body and every baby are different with different risks and different needs, we do not all fit into same mold (eg not everyone has a 12 hour or less labour just as not every woman has a very long 55+ hour labour), but obstetricians and doctors are trained to fit everyone into the same mold with the same risks regardless our own individual risk factors, body shapes, histories, abilities and needs.

How can we change this? How can we make pregnancy and birth an individual thing again? How can we make obstetricians treat us with the respect and dignity that we deserve? How can we make them respect our decisions and choices without trying to scare us or bully us into what they want us to do? The answer is that every woman and every man must make the decision to stand up for themselves and their partner, to say NO, to make obstetricians and doctors understand that it is NOT a medical professionals or hospitals decision to make on when a baby comes into the world, to make obstetricians and doctors stop scaring women with generalised risks and outright lies, to make the maternity system in whatever country you live in stop and listen and change its policies for the benefit of ALL women, to make pregnancy and birth about the woman once again and not about the medical side of things. Women everywhere need to take their bodies back, to make sure that everyone knows that SHE makes the decisions regarding HER body and HER baby, and that hospitals, obstetricians and doctors are NOT the ones to make the decisions. Even in a life or death situation the mother has the right to decide what is to be done and should be given the chance to do so, even if there is only a minute available for her to make that decision that will affect her and her family for the rest of their lives, she should be the one to decide, not someone else who doesn’t have to live with the consequences.

So there you have it. We live in a medicalised world that is slowly trying to remove all natural bodily autonomy from women, that is trying to stop women from being able to choose if she has an induction or cesarean or waits until her baby and body decide that it is the right time, a world where women are being scared and bullied into inductions and cesareans instead of being given the right information and support to make a truly informed decision over their bodies and method of birth, a world where women are ridiculed for their decisions, denied good care, denied the right support that they need and are traumatised on a regular basis when they are in the most vulnerable state and position.

Can you imagine a world where women are supported personally in a way that fits their individual needs and wants and are empowered in the process? Can you see a world where a woman is able to choose whenever she wants if she has a home birth, an unassisted birth, a hospital birth, an induction or a cesarean without being judged, ridiculed or traumatised in the process? Where she is truly informed about the risks and benefits of every procedure instead of only informed that  the medical professional feels is all she needs to know? Where she can birth however she wants without being lied to or scared by medical professionals? Where she can trust those who are caring for her and supporting her to give her the power to make her own decisions regardless of where she lives, her body shape, her previous history, or what she looks like? I can, I can see that world, our world can become that world. If we all worked together to make changes, if we all supported one another in our individual decisions regardless of what they are, we can create that world and make it ours.

Jenna Edgley
Student Birth Doula
Placenta Encapsulator
FOOTPRINTS & RAINBOWS

How does Birth Trauma Occur? According to http://www.birthtraumaassociation.org.uk/what_is_trauma.htm birth trauma can be caused by any of the following:

• Lengthy labour or short and very painful labour
• Induction
• Poor pain relief
• Feelings of loss of control
• High levels of medical intervention
• Traumatic or emergency deliveries, e.g. emergency caesarean section
• Impersonal treatment or problems with the staff attitudes
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth
• Birth of a damaged baby (a disability resulting from damage that occurs during delivery either from the birth itself or damage given by a medical professional)
• Baby’s stay in SCBU/NICU
• Poor postnatal care
• Previous trauma (for example, in childhood, with a previous birth, prior sexual abuse or domestic violence)

Birth Trauma is a real thing that affects many women all over the world. it isn't something that can just be swept under the rug or fobbed off as post natal depression or the feelings of an ungrateful new mother with a healthy or sick baby. In fact one of the worst things that you can say is "At least you have a healthy baby" because that can in many cases just make the mother feel worse, and can make her feel even more guilty than she may already feel for having those feelings.

Another article that mentions Birth Trauma is http://www.whole-woman.com/index.php/a-birth/87-what-is-birth-trauma. Their description of the reasons for Birth Trauma are as follows:

Trauma can result from different things - birthrape, a precipitous birth, caesarean surgery, experiences of intense pain and fear, or experiences of powerlessness. It can also result from birthing stillborn babies, or experiencing inconsiderate treatment from caregivers, during a time where women are vulnerable.

http://www.essentialbaby.com.au/birth/birth-stories/the-truth-about-birth-trauma-20081013-4zm2.html lists Birth Trauma as "a normal reaction to events in labour and birth that you perceive as being scary, out-of-control, helpless, or painful. Birth trauma can result from pregnancy, birth or even during the postnatal period. The response may be one of intense fear, helplessness or horror. Sometimes the events trigger memories of earlier trauma that remain unresolved."
Essential Baby has an in depth explanation of Birth Trauma as well as potential signs that may indicate that you have Birth Trauma.

Birth Trauma isn't something that will just go away and be swept under the rug, it is something that needs more awareness and prompt treatment through therapy (and may require taking antidepressants or anti-anxiety medication to assist in overcoming the trauma), because as one Birth Trauma mother (yes I have experienced Birth Trauma myself) to all the other Birth Trauma mothers out there, we deserve to be heard to to be understood and to be able to find a way for our Trauma to be healed or at least resolved within ourselves.

I hope this post has been a little bit enlightening, please do take a look at the 3 links provided.

P.S. And here are some more links for you to browse if this subject pertains to you or interests you.

http://www.solaceformothers.org/what_birth_trauma.html
http://www.joyousbirth.info/birthtrauma.html - * * Birth Trauma Section Trigger Warning * *  - *rape, medical procedures described and depicted*
http://birthtraumatruths.wordpress.com/
http://en.wikipedia.org/wiki/Birth_trauma
http://www.osteodoc.com/birthtrauma.htm



Jenna
Student Birth Doula
FOOTPRINTS & RAINBOWS Birth Doula Services

It has taken me a while to finish compiling this list of links, between a post-op infection behind my belly button (I had my gallbladder removed almost 6 weeks ago) and now pharyngitis (a throat infection) while looking after 3 children under 4 years old while my husband works I just haven't had the chance to do it before now.

So without further ado here are the links relating to vaginal birth after birth trauma - mostly after birth trauma resulting from cesarean, but there are some that are also relevant to vaginal delivery after a traumatic vaginal delivery.

Vaginal Birth after Traumatic Caesarean Birth Links

1. http://www.bellybelly.com.au/post-natal/emotional-scars-caesarean-birth - article on various types of emotional trauma.

2. http://en.wikipedia.org/wiki/Caesarean_section - small section/paragraph under “Risks For The Mother”.

3. http://www.pregnancy.com.au/birth-choices/vbac/index.shtml - links to resources and information.

4. http://www.pregnancy.com.au/birth-choices/vbac/vbac-articles/vaginal-birth-after-caesarean.shtml - following on from the previous link.

5. http://birthtraumatruths.wordpress.com/2010/11/06/women-suffering-from-birth-trauma-are-not-just-being-selfish/  -traumatic birth after cesarean, includes stories from both sides, those happy to have a c-section and those who were/are traumatized by it.

6. http://www.womenshealthcaretopics.com/VaginalBirthvsCesareanSection.html - VBAC pros and cons.

7. http://www.midwiferytoday.com/articles/healing_trauma.asp - PTSD, PPD and trauma article.

8. http://www.midwiferytoday.com/articles/emotional_impact.asp - The emotional impact of c-sections.

9. http://www.mumslounge.com.au/lifestyle/pregnancy/1349-ask-the-childbirth-educator-vaginal-birth-after-caesarean-vbac.html - good information on having a successful VBAC.

10. http://www.canaustralia.net/ - Cesarean Awareness Network Australia, another good source of information.

11. http://consumerjusticegroup.com/birth-injuries/vbac/ - interesting article on VBAC, but seems to have a slightly pro-cesarean slant to it by mentioning more of the risks of VBAC and glossing over many of the risks of having a repeat cesarean.

12. http://www.bellybelly.com.au/birth/vbac-birth-tips-advice-from-VBAC-mums - another BB article with answers from VBAC mums to questions asked by Kelly.

13. http://healyourearlyimprints.com/blog/?p=70 – good article on cesarean trauma and the interventions that lead up to it.

14. http://www.vbac.com/emotional-healing-after-a-cesarean/ - good article help for dealing with the trauma of an unwanted cesarean prior to having a VBAC.

15. http://www.birthtalk.org/BirthingAgainFAQs.html - good questions and answers.

16. http://health.ninemsn.com.au/pregnancy/labourandbirth/695308/vaginal-birth-after-caesarean - awesome article on VBAC! Also has links to some websites that I have already listed plus others.

17. http://www.vbac.com/support-groups/ - already listed one link, but this one is for the support groups.

18. http://www.solaceformothers.org/mothers-forum.html - birth trauma support community.

19. http://melbournedoula.blogspot.com.au/2008/06/birth-review-tool-for-de-briefing-after.html - A great post-birth debriefing tool.

*PS - Regarding link #19, I will be passing this link on to future clients and printing off copies for clients that will be in their "Birth Packs" that they will receive when they hire me (these packs will be separate from the introductory packs handed out during the first meeting).