Although disrespect and abuse in childbirth is recognized as a global problem (see the World Health Organization’s 2014 report), there is a culture of silence around this issue in the United States. Discussion around this “women’s issue” is usually limited to private settings and personal conversations. Among women, birth professionals, and birth advocates, stories abound–the co-worker told she had “no choice” about being induced because of hospital policy, the sister-in-law forced onto her back to push, the friend who yelled, “Stop!” at a vaginal exam but was penetrated anyway–but they are told quietly. For many reasons, they are not publicized and they are not believed. Perhaps they are not publicized because they are not believed… and then they are not believed, because if all these stories were true, surely they would they be publicized, right?
Over the past months, we’ve had the opportunity to speak directly with some leading national doctors at the American College of Obstetricians and Gynecologists (ACOG) about this issue. It is our impression that they are truly unaware of the reality of how too many women are treated in their maternity care. In fact, one prominent doctor said exactly that about forced interventions: “That’s just not reality.”
We know, and you know, that disrespect and abuse are reality in many places, and now it’s time to “prove it.” Real research on this topic is overdue, and we’ve got a plan in the works about that part, but in the meantime, we want to hear from YOU. Please read our Action Alerts below, as well as the letter we sent to ACOG leadership shortly before our 2015 Rally to Improve Birth. (Yes, they did respond to our letter very nicely, but again, it was clear they do not understand the scope or severity of the problem.)
ACTION ALERT #1: If you have experienced (as a pregnant or laboring person) or witnessed (as a professional, partner, or loved one) disrespect and/or abuse in facility-based childbirth, we will be inviting you soon to share your story in brief. Make sure you are subscribed to our email list here so we can let you know when and where to participate!
ACTION ALERT #2: We’re asking our rally coordinators around the country to send a copy of the letter below to their state ACOG representatives, local hospitals, and state medical boards, and you are welcome to do so, as well! Please cc: (carbon copy) us at admin_at_ib.env.by when you send your letter. We suggest you include a short introduction in your email, including, if applicable, a very brief statement about why this is meaningful to you or how disrespect or abuse in childbirth has affected you personally, or someone you love.
Click here for a list of ACOG representatives and email addresses.
Click here for a sample email introduction message.
September 4, 2015
Hal Lawrence, III, MD, Executive Vice President & CEO
Mark DeFrancesco, MD, President
Thomas Gellhaus, MD, President-Elect
American College of Obstetricians and Gynecologists
P.O. Box 70620
Washington, DC 20024-9998
Dear Dr. Lawrence, Dr. DeFrancesco, and Dr. Gellhaus:
We write on behalf of the thousands of women and families represented by Improving Birth, the national consumer movement to improve maternity care in the U.S. As you may recall, Improving Birth represented pregnant and birthing women in a meeting with ACOG leadership this past May. During that meeting, we were pleased to hear of your objectives regarding recognizing women as the decision-makers in their maternity care, as well as ACOG’s move toward more collaborative relationships among the various maternal health care providers. It is exciting to see that we share these common goals.
On the heels of the anonymous essay published recently in the Annals of Internal Medicine about abuse of women receiving reproductive health care from obstetrician/gynecologists, we are writing today to touch back on an extremely important topic we discussed at our May meeting: an alarming–and alarmingly frequent–stream of consumer feedback to Improving Birth about instances of disrespect, misinformation, and abuse at the hands of maternity care providers. We are deeply concerned by the daily reports we hear from women about failures of physicians and hospitals to provide informed consent and to honor informed refusal, as well as the use of coercive and bullying tactics to gain consent for procedures declined by the mother. In just the last four years, several organizations have sprung up to address these issues–Improving Birth, Human Rights in Childbirth, and the Birth Rights Bar Association–all of whom have endorsed, on behalf of U.S. women, the World Health Organization’s statement Prevention and elimination of disrespect and abuse during facility-based childbirth.
These reports from women are critical to public health not least because they shed light upon the statistics that are so concerning to us all at a population level— high and variable Cesarean rates, low and variable VBAC rates, and the continued popularity of episiotomy in some facilities, among other measures. The presumption that women are willingly accepting greater health risks by consenting to unnecessary or contra-indicated procedures makes sense only when we recognize the fact that too many women are not being given full and accurate information, and often, they are not even given a choice in their care. We can confirm that both of these things are happening around the country, and they are resulting in emotional and physical trauma and other negative maternal health impacts. Further, many consumers report that experience with or awareness of subpar and/or abusive hospital maternity care was an important factor in their subsequent decision to give birth outside of hospitals, whether or not out-of-hospital birth was integrated into the overall health care community.
Unfortunately, there does not seem to be any effective or meaningful system of accountability regarding such mistreatment in maternity care. Our volunteers around the country and the women who contact us regularly report that complaints made to hospitals are routinely ignored or justified as mere communication lapses, while responses from state licensing boards are glacially slow and investigations, if they are conducted, take place behind closed doors. Litigation is a last resort, but is a blunt and slow-moving tool, inaccessible for most women, although the existence of groups like Human Rights in Childbirth and the Birth Rights Bar Association network means we have been able to steer several women to attorneys recently. In sum, no one is in charge of protecting women in their maternity care, and women are losing trust in the industry.
In light of this lack of oversight or regulation, we are appealing to you to join us as allies, to help spur corrective action. ACOG’s excellent ethics committee opinions on informed consent and use of force against women in maternity care are explicit regarding pregnant women’s rights with respect to care providers. We ask that ACOG honor the women its members serve by joining us to address and eliminate all such unethical conduct among its members.
Building on last year’s viral “Break the Silence” campaign about mistreatment of women in their maternity care (bit.ly/breakthesilencephoto), this year’s national Rally to Improve Birth features the theme of “Respectful Care.” In all U.S. rally locations this Labor Day week, we will be addressing the media and the public about the need for more respectful maternity care, including, importantly, making women’s rights to informed consent and informed refusal a reality in all aspects of their reproductive health care.
We hope these public demonstrations will help move the conversation forward, and we would like to extend an invitation to your organization and members to be a part of the conversation that is happening around the country. Women want to trust their doctors, but doctors must be worthy of that trust. How can we work together to ensure that happens?
Thank you for your attention to this issue, and we look forward to hearing from you soon to talk about how consumers and physicians can collaborate to make maternity care safer for women. We know there is so much we can achieve together.
Dawn Thompson, President, Board of Directors
Cristen Pascucci, Vice President, Board of Directors
Heather Thompson, PhD, Secretary, Board of Directors
Mandi Hardy Hillman, PhD, Member, Board of Directors
cc: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine
Hermine Hayes Klein, Founder, Human Rights in Childbirth
Indra Lusero, President, Birth Rights Bar Association