By Hermine Hayes-Klein
Like most people, I always thought childbirth was like the images I grew up seeing in the media. Women gave birth on their backs in hospital beds; doctors delivered babies, lifted them up by their feet, and smacked their bottoms to elicit a lusty cry. Newborns were lined up in rows in hospital nurseries, to be viewed by family members through a big window. I didn’t know that these practices stemmed from a time when women gave birth under general anesthesia, and their newborns were too drugged to take their first breath without a shock, like a slap, to make them gasp.
I didn’t know that the practices I thought were “normal childbirth” had very little basis in evidence and often worked against the basic physiological needs of mother and baby mammals in childbirth. I didn’t know that childbirth could be much better, and much worse, than mainstream images of medical delivery. I only started learning the truth about childbirth when I started listening to women’s stories about the circumstances in which they gave birth. The women who experience empowered, orgasmic births need to tell those stories, in order for people to understand what’s possible when women are really supported in labor and birth. Just as important, women need to share their stories of disempowered births, in order to expose the existence of disrespect and abuse in maternity care and the impact that it has on women and babies.
If you ask women to tell you about the day they gave birth to their babies, you discover that many women have two layers to their birth story. The first layer is the story that they tell everybody: “Yes, I was induced; I had a c-section; the baby ended up in the NICU, but the doctors had reasons for all of that. What’s important is that the baby was born and is healthy.” This is the story that makes everybody nod, the story that affirms the cultural agreement that what happens in childbirth isn’t important, as long as mother and baby come out alive. But if you keep listening, if you ask women to tell you everything that happened from when they went into labor, they tell you a story about a very important day in their lives. Usually, they cry. Women often cry when they tell their birth stories, whether the memory is joyful or painful; we hold these memories in our emotional bodies.
When women share a memory of being disrespected and abused while they were birthing their babies, their eyes hold a pain that runs deep. Many mothers tell of days and months in which their relationship with their newborn, and ability to care for him or her, were affected by their trauma. They tell of trying to talk about it with friends and family, and being reminded that the baby is healthy and encouraged to put the birth behind them. Most women do, and settle into the first-layer birth story that glosses over the details and emphasizes the outcome. But more and more, around the world, women are going public with their real birth stories. Women are finding the courage to stand up and share personal experiences with obstetric violence, and to demand accountability and recognition of their rights in maternity care.
The only way that maternity care will improve is if women let their voices be heard. Many human rights violations in childbirth involve dehumanized care, and public health data has a limited ability to illuminate dehumanized care. The national U.S. survey Listening to Mothers III found that many women reported being pressured into interventions and receiving interventions without consent. The significance of those numbers can only be understood through the details of women’s experiences with pressure, coercion, and non-consented treatment in childbirth. Disrespect and abuse are widespread enough in maternity care that these experiences have now been named: Obstetric violence. Birth rape. Women around the world are reporting that these words best describe the healthcare they received while they were giving birth to their baby.
As women share their personal experiences in childbirth with each other, they are recognizing their political significance and organizing to demand change. In the summer of 2014, the U.S. consumer group Improving Birth launched the #breakthesilence social media campaign on obstetric violence. Later that year, Human Rights in Childbirth submitted an amicus curiae brief in the pending New York lawsuit that Rinat Dray brought over violent forced c-section that she received with her third baby. The brief presented 42 full stories written by American women who had experienced a violation of their right to autonomy in childbirth, and wove quotes from those stories into an argument about why the right to informed consent and refusal needs to be enforced in U.S. maternity care. One of the women who shared her story for the Dray brief launched an awareness raising art project that used quotes from the #breakthesilence campaign in some of the works.
Last year, a California woman whose non-consented episiotomy was caught on her birth video put that video on youtube in order to show people what “obstetric violence” looks like in reality. Everywhere “Kelly” turned for acknowledgment that what happened to her was not OK, she was dismissed or told that there was nothing to be done about it. The same courage that fueled Kelly to speak up for herself while her baby was crowning and her doctor and mother were yelling at her, fueled Kelly to call lawyer after lawyer to ask if one would help her stand up for her healthcare rights, and to file that suit by herself when no lawyer would invest in her case.
Kelly issued this statement for a recent article about her case: “I want people to know that everyone has rights around their body and rights to information about procedures. I got that option taken away from me. If this happened to me, it can happen to you. It can happen to your daughter. My video and I and Improving Birth are sending a message to all OBs and nurses who treat women like this — like they have no rights, like they aren’t human beings… I also want people to understand my purpose and my reason for this is about changing the system where women can be treated like this and have no recourse, have no one protect them and no one take responsibility afterwards.”
In Alabama, mother-of-4 Caroline Malatesta is demanding accountability from the hospital whose nurses, against her protests, forcibly twisted her from her hands and knees onto her back while her baby was crowning, causing damage to her pelvis that left her with severe, chronic pain. Like Kelly and Rinat, Caroline is asking the legal system to declare authoritatively that violence against women’s bodies is unacceptable in any situation—including childbirth.
The women who share their stories of obstetric violence and demand accountability for disrespect and abuse do so, like Kelly, because they want to make sure that what happened to them doesn’t happen to other women. Their stories, together, have the power to make that change. HRiC Italy leaders Elena Skoko and Alessandra Battisti have organized conferences and other opportunities for Italian health ministers and policy makers to hear women’s stories of disrespect and abuse in Italian maternity care. “The health ministers are shocked when they hear these stories,” says Elena. “They say, ‘We did not know that these problems existed in Italy,’ and want to find solutions to ensure respectful maternity care.” Last Fall, the International Federation of Gynecology and Obstetrics (FIGO) issued a road map to respectful maternity care, with official FIGO guidelines for “Mother-baby friendly birthing facilities.” FIGO’s guidelines, a joint initiative with the International Confederation of Midwives, the White Ribbon Alliance, the International Pediatric Association, and the World Health Organization, and drawing on work by the International MotherBaby Childbirth Initiative, state:
“FIGO believes that every woman has the right to a positive birth experience and to compassionate care from knowledgeable, skilled providers who recognize that each woman, family and newborn is unique and deserving of individualized dignified care. The published evidence of violations of women’s human rights during childbirth is shocking and distressing, but can also serve as an impetus for action.” [Italics mine.]
Stories about human rights violations during childbirth are hard to tell, and can be hard to hear. But if women have the courage to tell their stories, then those who hear them can understand the problems, and start to find solutions. Consumer activists and community organizers can create ways for women to share their stories, from surveys to social media campaigns, in order to illuminate what women are experiencing at the local level. Survey tools are being used by scholars and activists across Eastern Europe to illuminate women’s experiences and the prevalence of non-evidence based standards of care. The Portuguese Association for the Rights of Women in Pregnancy and Childbirth, a consumer group, recently collected 3800 birth stories in a survey there, and will use these stories in advocacy efforts to give voice to the realities faced by birthing women.
As women tell the true stories of what happened on the day they gave birth, they are breaking a silence held in place by the force of taboo. They are describing injuries to their bodies that weren’t caused by “childbirth,” but by the people they hired to support them through birth. They are talking about their private parts, both physical and emotional. But the most powerful taboo that women are breaking, when they tell their true birth story, is the taboo against saying that childbirth matters. If you listen to women’s stories closely enough, you’ll find out that it does matter. Women matter. Around the world, women are standing up together, to demand maternity care systems that treat women as if they matter, and are deserving of respect and kindness, while they are giving birth.