Often this violence is no longer recognised by those who practice it, nor by those who suffer it.
Traumatic childbirth can stay with a woman for the rest of her life and have significant psychological, emotional, physical and social impacts.
Trauma can be viewed on a sliding scale and how it is received in and through the body can be dependent on one's experiences of life, values and boundaries.
How it is experienced in pregnancy, birth and postpartum is also dependent on the care providers a woman has access to and the environments in which she surrounds herself - the most significant environment being the space of birth.
Developing a caring, supportive relationship with a chosen health care provider is critical for women to be able to effectively communicate their feelings and preferences, and for their choices to be respected throughout their pregnancy and ultimately in the birthing room. Education around birth is also fundamental but most importantly, the confidence to speak up and voice concerns or curiosities is vital.
Currently, the standard and consistency of medical care provided to women during their motherhood continuum is not effective. When women see multiple midwives and/or birth specialists throughout their pregnancy and do not receive continuity of care, they are more likely to have negative experiences during childbirth, impacting on into postpartum.
Within maternity care models, there is a continuing theme emerging of women feeling a 'lack of control' and right to consent along with an inconsistency of support. The care women receive during childbirth varies around the world with one in six women (June 2019) reportedly subjected to at least one form of obstetric violence during pregnancy and/or birth.
Obstetric violence (OV) refers to professional deficiencies in maternity care and is a specific type of violation of women’s rights in medical practice during health care related to the child birth processes. Labouring mothers may be subjected to different forms of OV including non-dignified care, non-consented care, non-confidential care, inadequate treatment, neglected and/or discriminated care.
Obstetric violence can manifest in different forms, including verbal, physical, and emotional abuse, as well as inadvisable clinical practices.
From midwives to sophisticated caesarean techniques, childbirth has gone from being part of human nature and essentially female to becoming a procedure whose decision-making is exclusively the health professional’s responsibility. With this, the woman is no longer the protagonist but the object of interventional and medical procedures.
The advance in science concerning specialist medical techniques has undoubtedly, when used appropriately, contributed to the reduction of risks for both the birthing mother and the newborn. On the other hand, the same procedures can increase maternal-foetal mortality when applied indiscriminately without proven efficacy. Thus, a scenario of violation of rights arises in maternity wards, legitimised by medical knowledge, which leads to the pathologization of childbirth.
The fact is that these interventionist conducts and procedures, routinely adopted without concrete need, are often not perceived by the main subject involved: the woman. And for this reason, obstetric violence becomes an invisible reality.
The process of hospitalisation of childbirth was essential to improve medical knowledge and to reduce maternal and neonatal mortality rates. However, as far as one can recognise the benefits of the institutionalisation of childbirth, one must also admit that this change has led to the establishment of the medicalisation of the female body. It seems we are now living in a time where this process does not reach its primary objective of reducing risks since it creates other negative impacts on women’s experience during childbirth, such as verbal violence, imprudence, negligence, humiliation, threats, loneliness, fear, and unnecessary interventions.
Obstetric violence can further be characterised by all acts or conduct that are carried out without the explicit and informed consent of the woman, causing death, physical, psychological, or sexual harm to her or the unborn child, to injure her right to choose and the right to physical and mental integrity. Thus, obstetric violence is multifaceted and can be expressed through the woman’s body (physical), her mental health (psychological), or her intimacy and modesty (sexual), in addition to conduct that hinder access to her rights.
The report Violencia Obstetrica: un Enfoque de Derechos Humanos (2015), published by the Grupo de Información en Reproducción Elegida, points out two modalities of obstetric violence: physical and psychological. Physical violence expresses itself through invasive practices and the indiscriminate use of medication, as well as the disrespect for the time and possibilities of biological childbirth. Psychological violence, on the other hand, includes harsh and inhumane treatment, discrimination, and humiliation when care or attention is requested during an obstetric procedure.
Many women do not recognise some behaviours and procedures as violations of their rights, and if they do, they are afraid to report them because they see themselves as vulnerable to the health professional.
The experiences women go through during pregnancy and childbirth represent unique moments in their lives and, as such, should be seen as natural, biological, and human. In this way, seeing the woman as a subject in the professional-patient relationship is to respect and understand her individuality, valuing the attention to her needs and well-being. It is to give her the tools to claim and protect her rights. Because obstetric violence is a routine, it is more than necessary to discuss this issue and provide the women themselves with mechanisms to be aware of it, denounce it, stop it, and change this reality.
Alongside this awareness, it is important that we illuminate the voices of women who are sharing their traumatic birthing stories to gain understanding and raise awareness in the community on aspects of birth trauma connected to OV.