End Obstetric Violence – Promote Respectful Care at Birth
With a growing focus on improving maternal and infant health around the world to achieve the Millennium Development Goals, and the new commitments for women’s and children’s health and other initiatives against poverty, hunger and disease. The more we look to identify solutions to achieve optimal MotherBaby care, another disturbing yet important area of women’s health disparities and gender in-equality has come into focus.
In a special edition of the International Journal of Gynecology and Obstetrics Volume 111, Issue 3, Pages 201-202 (December 2010) Rogelio Pérez D’Gregorio writes an editorial entitled: “Obstetric violence: A new legal term introduced in Venezuela” Venezuela has recognized “obstetric violence” as a legal term. The term appeared in March 2007 when the “Organic Law on the Right of Women to a Life Free of Violence” was published in Venezuela’s “Gaceta Official” (Official Gazette) . The law addresses the high incidence of violence against women in Venezuela –a significant problem that is perpetrated worldwide. The forms of violence are described, including obstetric violence, which is defined as: “…the appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.”
It continues: “the appropriation of the body and reproductive processes of women by health personnel” is contrary to good obstetric practice, whereby medication should only be used when it is indicated, the natural processes should be respected, and instrumental or surgical procedures should be performed only when the indication follows evidence-based medicine.” What a powerful statement this is as obstetrics is the field of medicine with the largest gap between what research allows us to understand is the best available techniques and treatment and current practices. Obstetrics often fails to implement the things we know offer benefits (i.e. freedom of movement, continuous support )and instead include practices that research lists as harmful or unlikely to be beneficial. I have long wondered why this has been allowed to continue, as no other field of medicine would people stand for outdated and harmful practices. This is the only time we are caring for two people, mother and child, shouldn’t we all want to do what is best for them?
The article continues to quote the law, Chapter VI concerns offences, and Article 51 establishes that: “The following acts implemented by health personnel are considered
obstetric violence: (1) Untimely and ineffective attention of obstetric emergencies; (2) Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available; (3) Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breast-feeding immediately after birth; (4) Altering the natural process of low-risk delivery by using acceleration techniques, without obtaining voluntary, expressed and informed consent of the woman; (5) Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman.” It goes on to say: “In such cases, the court shall impose upon the person or persons responsible, a fine …”
The author states that to implement the evidence medical providers will need to have training in upright births and the importance of mother-infant bonding. I would add that they need to experience normal physiologic, undisturbed births. We must also look at the short and long-term effect that birth has on the mother’s emotional well-being. I am thankful we are providing access to care to many more women around the world, but now it’s time to improve the quality of care women receive. It’s not just about surviving birth; it’s about thriving after! Not suffering the consequences of violence and abuse – turning a day that has the potential to be transformative, sacred, blissful and ecstatic into a traumatic event. Childbirth Connection’s – Listening to Mother’s survey in the U.S identified 18% of women had symptoms of post-traumatic stress syndrome after childbirth. PTSD is often associated/caused by natural disaster and war; this is a tragedy that women experience this after childbirth in America. I applaud Venezuela and in addition USAID who is also shining a light and doing research on this global issue as well as, the While Ribbon Alliance and Amnesty International . USAID recently supported research on “manifestations of disrespect and abuse in facility-based childbirth, contributors to the problem, the negative impact on skilled care utilization, and approaches to tackle this human rights, ethical and quality-of-care problem”. The White Ribbon Alliance says “members in many countries have also identified this issue as central to addressing quality of care and improving maternal health.” The WRA is working on actions to Promote Respectful Care at Birth.
It is time to Stand up and Deliver! Have a Voice in all decisions – informed consent or informed refusal -with the information needed to make decisions for yourself and your baby.
One resource you can download, support and use to transform care in your community and start a MotherBaby Network is The International MotherBaby Childbirth Initiative, IMBCI, is a quality care, evidence based, human rights initiative to create optimal models of MotherBaby Maternity Care that is currently in the demonstration phase of testing the initiative globally. Step 1 of the Ten Steps of the IMBCI (available in 14 languages) states:
Treat every woman with respect and dignity, fully informing and involving her in decision making about care for herself and her baby in language that she understands, and providing her the right to informed consent and refusal.
In closing, I would like to add my voice to what both Maureen Corry and Marsden Wagner share in our film Orgasmic Birth: The Best-Kept Secret: we have good, highly skilled, doctors, midwives, nurses working within a broken system. We all need to work together to effect change on a systemic level to end birth violence and improve care and outcomes for women and babies.
Let your voice be heard to bring respect and dignity to all women around the world.