Imagine going into labor. You arrive at the hospital or birth center expecting to deliver your baby in the comfort and care of friendly doctors and nurses. In a clean bed. With privacy and respectful treatment and support. And good medical care. Unfortunately, this is not the reality for some women around the world. ‘Obstetric violence’ is a term that is used to describe care provided to women during labor and delivery that is forced, coerced, not voluntary, and without consent. Obstetric violence is a combination of “institutional violence and violence against women” experienced during pregnancy and delivery.
Obstetric violence can occur in any setting (private versus public centers) and in any part of the world. The occurrence of obstetric violence has been documented throughout countries in Central and South America as well as the United States. Low income women and women who are ethnic minorities may be more likely to experience obstetric violence. Obstetric violence can take the form of denying treatment, physical violence, detainment in a facility, use of forced or unnecessary medical procedures, ignoring a woman’s pain or needs, humiliation, and discrimination. One author elaborated, describing obstetric violence as failure to provide any sense of modesty for a women during labor and delivery, subjecting women to unfriendly settings, and separating mother and child immediately after delivery. In cases of obstetric violence reported outside of the United States, women have been forced to deliver their babies outside the hospital or on concrete floors, physically assaulted by medical staff, physically and verbally abused, and forced into having a Cesarean delivery. In the United States, obstetric violence takes the form of detainment in cases of pregnant and drug-addicted mothers, forced medical procedures such as Cesarean section or episiotomy, and forced oxytocin use to accelerate labor.
The World Health Organization (WHO) recognizes obstetric violence is a concern for women all over the world. WHO classifies obstetric violence into three categories: abuse, coercion, and disrespect. Abuse can include forced Cesarean sections, forced episiotomies, procedures performed without consent, sexual violation, or physical restraint. Coercion can include legal interventions, restricted access to vaginal delivery after Cesarean (VBAC), child welfare interventions, or pressuring/manipulation. Disrespect includes insulting comments, ignoring, and humiliation from providers.
Obstetric violence is is a type of violence that is easy to overlook because there is little discussion about the issue. Women often do not discuss instances of violence during their labor and delivery due to stigma, lack of support, or lack of understanding around what has happened to them. Legal and medical legislation also support protection of the fetus, even if this is at the cost of the mother’s health or autonomy. Cultural beliefs such as mothers sacrificing their needs for their child’s further create an environment where obstetric violence is not acknowledged. In the United States, obstetric violence is attributed to increasing economic pressure for providers and hospitals to conduct certain procedures during labor and delivery, increasing use of technology and interventions during childbirth, and increasing fear of liability and malpractice among providers leading to excessive tests and interventions.
Obstetric violence is important to address for the health of women and their babies. This type of violence and abuse can interfere with mother and newborn bonding, cause physical or emotional harm in mothers, increase maternal complications, and discourage mothers from seeking further care. Public awareness has been limited and very few studies exist to define the incidence of obstetric violence in the United States, but the topic is becoming more and more commonly discussed in the United States. Future studies, legal cases, legislation, and formation of advocacy groups can help to shed more light on this epidemic of maternal abuse and violence. The World Health Organization has provided tips for prevention and elimination of obstetric violence throughout the world: enhance government support, provide greater social support, research incidence and impact of interventions, incorporate into human rights issues, train and hold healthcare providers accountable, and engage women in their communities. Latin American countries such as Venezuela, Brazil, and Argentina have already made strides to address obstetric violence in their own countries.
