​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.

Image courtesy of and Copyright FOOTPRINTS & RAINBOWS 2014

It doesn’t matter if it was an emergency caesarean or an elective caesarean, it was still a caesarean and a major abdominal surgery and it is essential that you look after yourself properly in the first 6 weeks after a caesarean, and that you look after yourself in general for the first 6 months after your caesarean.

When you’ve had a caesarean it can be hard to remember to take it easy and look after yourself properly – especially if you have older children that you need to look after.

When you had your caesarean the surgeon not only cut through the skin on your lower belly/bikini line horizontally (or possibly he did a vertical incision running up/down your belly instead of horizontally), but he or she also cut through the nerves located in the skin of your belly, either divided your lower abdominal muscles or cut through them (depending on if they were able to be stretched apart enough for the uterus to be pulled through or not), cut through the outer, middle and inner layers (including the muscle layers) of your uterus, cut through numerous blood vessels and nerve pathways, may have cut through some fluid drainage systems, cut through the tissue barriers that separate the various parts of the body (the fascia, and the peritoneum which is cut through twice during the procedure) and then stitched it all back together to make you as close to whole as possible again. The surgeon may have cut your uterus horizontally (transverse incision), or he/she may have cut it vertically (classical incision) or in a “J” or “inverted T” incision if a horizontal incision wasn’t an option at the time.

Major abdominal surgery like a caesarean takes 6 months to become 100% fully healed, and although the incisions themselves will be healed by 6 weeks post partum there is a lot of microscopic repairs that need the rest of those 6 months to be completed. If you had complications with your surgery or developed an infection in the incisions or in your uterus afterwards it can take longer than 6 months – sometimes in rare cases up to 2 years – for it to be completely healed.

During those 6 months there are many ways that you can take care of yourself. Not driving for those first 6 weeks is usually one of the first things that you are told – driving uses the abdominal and core muscles and can put strain on your incisions, you are also not covered by insurance during those first 6 weeks after a caesarean, and if you have an accident while driving during that time your incisions can reopen which can cause some serious complications.

One of the other things you are first told is that you cannot lift anything heavier than your new baby. If you have older children, for example toddlers, who like to be lifted up and held this can be difficult to do, and it is essential that you don’t lift them up in those first 6 weeks as in doing so you run the risk of your incisions reopening or causing further damage.

You need to rest as much as possible and get a good amount of quality sleep. The majority of healing a repair work within the body is done while you are sleeping, and you need quality sleep with at least 2 REM cycles (around 7-8 hours of sleep) every night in order for it to work efficiently. This can be difficult with a new baby who may wake up several times a night for a nappy change and/or a feed, so sleep whenever you can, sleep when baby is sleeping, and don’t stress about the housework, right now you need to focus on you and on healing your body, the housework can wait until later on when your partner (if you have one) is home or until the weekend. If you have older children at home it can be even more difficult to get enough sleep and sleeping when your new baby is asleep can be close to impossible. If you are in that predicament then it is time to ask for help – from family and friends that you trust who can help look after your children for an hour or two each day while you take a much needed nap - or time to send the older kids to day care one or two days a week to give you a break and time to catch up on sleep (and housework if you need to catch up on it as well).

You need to eat a healthy and well balanced diet. Your body stores many of the vitamins and minerals that it needs within it until they are needed. During pregnancy your baby takes nutrients from your body, even when you haven’t had enough of them during your daily food intake (in which case the baby takes them from your internal stores), and by the time your baby has arrived you may be running low on some essential vitamins and minerals like Vitamin D and Iron. If you choose to breastfeed these vitamins and minerals will be going into your breast milk for your baby as well, so it is essential to make sure that you are getting enough from your food (and in the case of Vitamin D, from sunlight. You produce the highest amount from exposure of the areas of skin between your lower ribs and the base of your neck, so wearing a shirt in the sun all the time while it is good for helping to prevent skin cancer it can greatly reduce the amount of Vitamin D that your body produces). Eat healthy foods with lots of carbohydrates, a reasonable amount of natural fat (you need this to help with energy) and protein. During the 6 months that it takes for abdominal surgery to fully heal ensure that you eat an increased amount of protein in your diet. Your uterus is made up of 3 layers of muscles, and the incision from the surgery did cut through part of your uterus. Muscles need protein to grow and to heal, so for those first 6 months after your caesarean make sure you eat more protein than normal to help your uterus heal well and to help reduce your risk of uterine rupture and other complications in any future pregnancies (while the risk of uterine rupture during labour is actually less than 0.5% after 1 caesarean and less than 1% after 3 cesareans it doesn’t only happen during labour, it can happen during pregnancy too, so if you strengthen your uterine muscles now, and continue a high protein diet during your next pregnancy your muscles will be stronger and your risk of rupture will be reduced).

Take care of your emotional health. This side of things can often be forgotten, and good emotional health is just as important as good physical health. If you aren’t emotionally healthy then that will affect the rest of your life and will also affect your baby and any other children you might have. If you experienced a traumatic delivery there are many people and groups who deal with that and can help you, for example in Victoria, Australia, there is now a Maternal Mental Health Service that has a section dealing specifically with Birth Trauma. There may be similar services in other states within Australia, and in other countries around the world.
If you are feeling down or just don’t feel right go and see your family doctor. If they brush off your concerns see someone else, because you may have a mild case of post partum depression (or something else might be going on) and you will need support. If you are having visuals of your child/ren or yourself being hurt (by you or someone else), combined with these feelings and are having dreams that are similar to the visuals as well go and seek help now.

Make time for you! I have mentioned this in several other blog posts, because it is very important and follows on from the above section on your emotional health.
You need to have something special that you do for yourself, without children, and without your partner, that makes you feel good and happy. Whether it’s going out to see a movie or meeting up with your friends, getting your hair done, taking up a hobby, going back to work (if that’s what makes you happy), whatever makes you happy go out and do it.
And don’t feel guilty about doing something for yourself, it makes for a happier mum, and by proxy it makes for happier kids and a happier home. Therefore by doing things for yourself as well you are making your home a much better place to live in.

Lastly, and most importantly, keep an eye on your physical health post caesarean, in particular the scar area for separation of the incision or signs of infection (more redness than is normal, puss, a foul odour, seepage that doesn’t look right etc) and your legs for signs of a blood clot (a bruise that cannot be explained that spreads quickly over a 12 hour period, and/or redness and/or pain and/or a localised area of swelling spreading in a meandering line across and/or up/down your leg). If you notice any of these things go and see your GP right away, if you notice all the symptoms of a blood clot go straight to your local Hospitals Emergency Department to get checked out.

Also keep an eye on your general physical health, if you develop a fever in the first 2 weeks post partum go and see your GP, especially if it is within 5 days of coming home from hospital. If your post partum bleeding suddenly increases and you are going through a maternity pad in an hour or less go straight to the emergency room to get checked out as it could be a sign of a post partum haemorrhage (contrary to most common knowledge in the mummy world haemorrhages can occur right up until your post partum bleeding ends anywhere between 2-10 weeks post partum). If you are having clots larger than the size of a 50 cent piece (or larger than the size of a golf ball) go and get checked out. If your post partum bleeding continues for longer than 10 weeks go and get checked out as well. If you are feeling run down then you may be overdoing things and it is time to slow down and take care of yourself for a while, because you are important and need to be healthy and in good health just as much as your baby is.

As always, feel free to share.

Jenna Edgley
Student Birth Doula
FOOTPRINTS & RAINBOWS

they b elieve thatThe Placenta.
The organ which connects the baby to the mother and provides nutrients, glucose, fluids and oxygen to the developing baby.

The Original Tree Of Life.

The cord is the "trunk" and delivers oxygen, nutrients, glucose and fluids to the developing baby.
The main  body of the placenta is the "roots, branches and leaves" all in one, and filters the mothers blood (like a kidney) and transports oxygen, glucose and nutrients to the cord.
It removes harmful substances from the blood and allows the things that baby needs to grow and thrive to pass through to the cord.
The placenta also produces hormones to maintain the pregnancy, prepare the breasts for milk production and prepare the body for the upcoming delivery.

Some women choose to have their placenta/s dried and/or encapsulated as it contains trace elements and minerals that can become low within our bodies during pregnancy, birth and while breastfeeding and these women believe that the hormone content of the placenta may assist in reducing the incidences and/or severity of post partum depression after delivery (this is currently not supported by scientific research due to a lack of research in this area). We do know thanks to recent research that the placenta is high in iron which quite often becomes low during pregnancy and it is potentially possible that consuming it, alongside an iron rich diet, may assist in bringing iron levels back up to a normal level in someone with anemia.

Visually it may not be beautiful to everyone and has often been described as "somewhat like a piece of liver" but it is an important piece of tissue and is often forgotten once baby and placenta have been delivered and it has been confirmed that there is no retained placenta in the womb.

The placenta is truly the tree of life, without it babies could not grow and develop and we should treat it with the respect and reverence that it deserves.

Jenna
Student Birth Doula
FOOTPRINTS & RAINBOWS Birth Doula Services