The phrase, “The baby is the candy and the mom is the wrapper,” has been stuck in my head since I read it in an NPR article.
It’s the perfect descriptor of maternal care in this country. Because, after all, once the candy is out of the wrapper, you don’t really need it anymore, right?
It was evident when I was told to “stop screaming” while giving birth. (I wasn’t being belligerent. I was shouting as one does when a human is being expelled from her body without pain medication.)
It was evident when doctors dismissed my postpartum fevers as “just hormones.” It was evident in the care of my friend who, during her six week postpartum check up, said her doctor “didn’t even check anything.”
If you haven’t experienced any of these subtle or not so subtle ways healthcare officials demean and dismiss pregnant and postpartum women, just look at social media. On Facebook, there are well over 40 birth trauma support groups with tens of thousands of women all over the world. Women who have been screamed at, ignored, and subjected to unwanted procedures and exams during pregnancy and birth, who are experiencing depression, anxiety, and PTSD – only to be told, “but you have a healthy baby, so what’s the problem?”
Obstetric violence — subjecting pregnant and postpartum women to unwanted procedures and exams — has been happening for decades, but most of those in the medical community who care for mothers have been brushing the idea under the rug. Until now. The International Federation of Medical Student Associations (IFMSA) is resolving to make change and calling on healthcare providers who care for pregnant women and moms to do the same.
The IFMSA recently released a paper on humanized birth, reaffirming its commitment to the defense of women’s right and gender equality. Here’s more about it and how we think it could impact the future of care.
Obstetric Violence in the U.S.
While there are multiple definitions of obstetric violence worldwide, in the United States, a common form of this practice is the forced c-section. In order to get women to undergo the procedure, many physicians use threats of legal action or complaints to child protective services.
And women who are subjected to these forced procedures often have no recourse. Consider this:
“While U.S. laws state unpermitted touching even for medical procedures as battery, no provision has been made in regards to pregnant women. Despite several lawsuits filed against physicians, most rule in their favor keeping the fact that ‘physicians know best’ as paramount,” the IFMSA writes.
Being able to refuse treatment is a hallmark of medical care, but that doesn’t apply to women in labor. (It’s all about the “candy,” or baby. Don’t forget.)
No wonder women in labor are afraid of the c-section. Not only is it major surgery, it’s often thrust upon you when you’re most vulnerable and have little or no decision in the matter. It’s a power play your medical team can pull at any time, especially if their shift is ending or you’ve used up your allotted laboring time.
I had an unnecessary c-section with my first child, but as a first time mother, I didn’t know any better. And when I hear friends’ birth stories that ended the same way, I wonder if any of the procedures would have happened if any of us would have done our research.
During my second pregnancy, I went in for my 8 week check-up and was told, “We’ll see,” about not having a repeat c-section. So, I went home and read everything there was on c-sections and VBACs, prepared to fight for a VBAC. And there’s the problem: Pregnant women shouldn’t have to show up at their appointments prepared to do battle with their healthcare providers.
In 2010, Browser and Hill found that worldwide, complications from verbal abuse, lack of privacy, lack of consent, and denial of care significantly affected maternal mortality and morbidity. But the mistreatment doesn’t stop there. They also found women experienced many other forms of mistreatment like unnecessary episiotomy, abuse of safe synthetic oxytocin levels to induce labor, and lack of safe abortion procedures.
A survey conducted in 2014 found that over half of healthcare workers who attended a birth witnessed a physician perform a procedure against a woman’s will. Two-thirds of healthcare workers reported a physician performing a procedure on a laboring woman without giving the woman enough time to consider the procedure. These findings are especially important considering the rise of unnecessary c-sections.
When faced with the induction of their labors, a quarter of mothers felt pressured to do so, and for those who had c-sections, 63% reported their doctor was the “primary decision maker” when considering the procedure.
I certainly felt pressured to induce during my first pregnancy. Even during my second, I had the cutoff time of 41 weeks because that’s all they’ll “let you go to.” Never was there a discussion why or how care could change once I hit 41 weeks.
Obstetric Violence Isn’t Limited to Labor and Delivery
Women worldwide also face obstetric violence during prenatal and postnatal care. Examples include enemas given without consent to clear out intestinal contents prior to delivery or the denial of alternative pain relief strategies.
Many of these situations are justified by the provider, because they are “allocating goodwill to the fetus.” However, in that process they are putting the mother’s life at risk. To shed more light on obstetric violence and humanize childbirth, the IFMSA is calling on governments worldwide to make policy changes to protect women and educate families and providers, as well as vowing to be more empathetic to what pregnant women have experienced at the hands of providers thus far.
The IFMSA defines humanized childbirth as “putting the woman giving birth in the center, giving her the control and authority to make all the decisions about what will happen – not the doctors or anyone else.”
“Most importantly, humanizing birth means giving women the center of will within a clinical setting and it does involve the further analysis of women empowerment within a health system instead of prioritizing technicians needs over those of our patients,” IFMSA writes.
Humanized birth encompasses these principles:
- The fulfillment and empowerment of women and their care providers
- Promoting and encouraging women to be active decision makers in their care
- The provision of care by both physicians and non-physicians working together as equals
- A high priority for community based care with the location of birth attendants and institutions in a decentralized system
“…As medical students we stand for a nondiscriminatory obstetric practice that takes into account the patient in all of its assets and fulfills not only technical evidence-based efficiency but humane health support as well.”
It’s time for the larger organizations, hospitals, providers, and nurses to be so bold as this, take a stand, and make a pledge to no longer stand by and accept these outdated practice patterns.
This is the future ImprovingBirth is working diligently for. If you have experienced a traumatic birth visit our resources page to find useful tools that can help in healing and seeking accountability.
Families will continue to suffer until this massive problem with a broken system is corrected. Your financial contributions make it possible for us to continue this crucial work of improving birth. Every dollar counts. Thank you in advance for your support.
About the Author
Casey Newman is a PR/Marketing professional with a passion for maternal and women’s issues. She enjoys spending time with her family, writing, and angrily tweeting about baseball @caseybnewman.