Understanding Obstetric Violence
This blog post contains graphic and potentially triggering content about violations, violence, assault, and sexual assault during childbirth.
It’s hard to believe violence would happen during childbirth because a pregnant person’s body is already inherently not entirely their own. To combine the pain of childbirth with unwarranted trauma is sickening. Moreover, like many forms of reproductive injustice, threats and assault toward people in labor are not taken seriously enough to produce much research about the matter. We also have yet to reach a safe space culturally for these survivors of assault to tell their stories and be truly heard. With this in mind, this blog post aims to introduce the (minimal) information about this form of violence to readers who might have never heard about it, or want to learn more.
When a person prepares to deliver their baby, they can find themselves completely vulnerable, with little control over their bodies or the unbearable pain of labor in general. In most cases, the only thing a pregnant person can do is trust the resources around them, which typically means medical professionals who are trained in obstetrics and gynecology, or midwives. But what happens when that trust is broken, and the pregnant person is taken advantage of or assaulted during labor?
An outpouring of stories has surfaced that detail the horrifying obstetric violations patients have faced during childbirth from their healthcare providers (doctors, nurses, and sometimes midwives). For instance, a patient in labor in Germany did not speak the language, so she couldn’t communicate that she wasn’t given enough anesthesia during her Cesarean section. Another story from Russia explains the painful process of getting overly-aggressive pelvic exams followed by a 16-hour wait with other people in labor all sharing one room. The patient was then forced to have an induced labor and was stitched up without anaesthetic. A third patient post-labor was yelled at by an overworked nurse for their inability to produce breast milk, causing the baby to cry in the middle of the night. The worst imaginable stories have been shared around the world. Each country has its own history regarding childbirth violence, but I will mostly focus on the United States.
In no way is this blog post intended to generalize the work of healthcare providers as something to question. From the research I’ve done thus far, this labor violence is not a common experience. However, even one case of birth-room violence indicates that the system is broken, and points to questions of agency, voice, and autonomy in birthing situations.
Most stories of violence told by victims occur in medical facilities and happen less often at home. Judith Walzer Leavitt wrote a book called Brought to Bed that describes the medicalization of birth, experienced generally as the transition from home births to hospital births. Leavitt explains how the transition to medical facilities for childbirth contributed to the rise of violence during childbirth. Although, abuse during childbirth was already widespread among American enslaved people. Slave owners and doctors during this transition had something in common: they were all white men with white supremacist, elitist, misogynist belief systems. Although the book mostly focuses on US enslavement, the rise of stories involving violence experienced during childbirth has grown similarly worldwide.
The current issues in medical facilities that people in labor face are even more complex because of the massive growth in gynecological research. An article from the U.S. National Library of Medicine describes every method previously used that violates people in labor. If you want to read the full study, click here. This is a summary of the various ways people in labor are mistreated and abused:
Non-confidential care: patients are entitled to confidential care from their healthcare providers, so this violation is disclosing a patient’s medical information without their consent or showing the patient’s body to others.
Non-consented care: any physical care provided without the consent of the patient. This can include not properly explaining a procedure before performing it, hysterectomies, episiotomies, vaginal examinations, sterilization, and Cesarean deliveries.
Abandonment of care: leaving a patient unattended when in need of care, delivering baby unattended, not providing care when the patient asks for help/pain relief.
Non-dignified care and discrimination: the lack of dignity and respect for a patient by being threatened, yelled at, laughed at, insulted, or scolded by healthcare providers.
Physical abuse: healthcare providers hitting, slapping, pinching, beating, kicking, performing procedures without anesthesia, sexually assaulting, or raping labor patients.
Detention in facilities: detention for failure to pay hospital bills or unpaid bribes.
Art by Noa Snir for Quartz
Although this study was done in the United States, violence during labor is reported globally. In 2015, a research team studied mistreatment during childbirth across 34 countries and found that countries with the worst systemic sexism and the lowest reproductive autonomy had more cases of mistreatment during childbirth than other countries. People in labor with fewer resources are more at risk of facing violence; class status, marital status, immigration status, age, race, gender, and sexual orientation are several examples of factors that can contribute to being targets of violence. Additionally, people who go into labor while in jail or prison have reported being ignored, abandoned, handcuffed during labor, and abused by prison guards while being escorted to medical facilities.
It’s no surprise that violence toward people in labor has deep historical roots. Since the first Central and West Africans were kidnapped and forced into American enslavement in 1619, enslaved people have been giving birth under the violent control of their slaveholders. The vast majority of slaveholders were white men, the only exception being freed slaves. They exercised control over the bodies of enslaved people, including during their pregnancy and labor. Marie Jenkins Schwartz wrote a book called Birthing a Slave that provides a detailed history of the common experience for enslaved pregnant people/people in labor. The book includes stories of harrowing physical, emotional, and sexual abuse.
Unsurprisingly, if you were a white person in labor, the experience was quite different. White Americans were much less likely to receive mistreatment during labor. That being said, there are still stories of violence since before 1619 through 2019 that show how much people in labor have suffered over many centuries of violence during childbirth.
In the 19th century, gynecologists targeted poor and powerless people in labor to practice their medical experiments without the patient’s consent. Deirdre Cooper Owens wrote a book called Medical Bondage that explains the origins of gynecology and how this medical field used race, gender, and class as tools to target certain demographics for their medical experiments. The experiments included ovariectomies (surgical removal of one or both ovaries), Caesarean sections, and obstetric fistula repairs. Gynecologists circulated eugenicist myths to the general public, including the idea that black people who forcibly received these procedures tolerated the pain better than white people.
Some of these practices and beliefs were held in the United States through the late 20th century. Although people in labor slowly received better treatment over generations of new labor practices, the systemic racism and classism are still dominating factors in who will potentially face mistreatment during labor.
Given that people in labor with fewer resources are targeted with abuse, a person with privilege––a white, wealthy, hetero, cisgender woman ––is more likely to have a positive childbirth experience. In other words, fair treatment during childbirth is a global privilege! Unless a pregnant person has the monetary resources to pay for the exact treatment plan they want, medical professionals decide how a person’s childbirth will go.
Childbirth stories are typically told to children as “one of the most special days of our lives,” or “all of the pain was worth it for our baby.” Meanwhile, these victims of obstetric and gynecological violence have a completely different and nightmare-like experience that barely receives attention, if any. These victims report postpartum depression and PTSD that might stick with them for life, among other side effects.
So, where should we go from here? I don’t have a great answer, other than to suggest educating yourself beyond this blog post with the resources I included or through your own research. As reproductive justice advocates, we can all try to facilitate conversations by raising awareness about birth-room violence, and to support victims if they share their story with you.
Sources
Blog post image: The Disturbing Trend of Obstetric Violence
PLOS Medicine journal article: The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review
U.S. National Library of Medicine Study: Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned
U.S. National Library of Medicine Article: Abuse in Hospital-Based Birth Settings?
Op-Ed from The Guardian: Mothers are being abused during childbirth. We need our own #MeToo.
Dierdre Cooper Owens: Medical Bondage
Marie Jenkins Schwartz: Birthing a Slave
Judith Walzer Leavitt: Brought to Bed