We don’t remember when we were born — let alone the circumstances and the scene that day. They’re not really stories we sit around a fire or kitchen table listening to, especially if the experience itself was negative: if the person giving birth had negative interactions with the medical personnel, if their wishes and feelings as they were giving birth were ignored or ridiculed, if they were subjected to interventions they didn’t agree to, if their lives changed dramatically as a result of what happened.

In medicine, obstetrics is the specialty that focuses on pregnancy and childbirth (it’s often summarised as OB in front of GYN to indicate a gynaecologist who also focuses on childbirth). The term comes from the Modern Latin obstetricus, “pertaining to a midwife,” which has the root word obstetrix, “midwife,” or literally “one who stands opposite.” When we talk about obstetric violence, we refer to violence connected to pregnancy and childbirth.

Obstetric violence is often associated with the idea of birth trauma, i.e. with an event that traumatises you when you give birth. But it is important to distinguish between the two. Trauma can happen even with the right support system, if you lose your baby, for example. Obstetric violence has to do with the systemic context. “In the same way that domestic violence is not defined as marriage or relationship trauma, we should not use ‘birth trauma’ to describe abusive acts. To do so risks failing to identify the true nature of the problem and allowing it to continue unabated,” writes Gemma McKenzie, a PhD Candidate at King’s College London, in the Obstetric Violence Blog.

Why is it important to talk about a term first used in 1827 when Dr James Blundell, an English obstetrician, referred to the problem of ‘obstetric violence’ in a lecture? Because if we don’t talk about what could go wrong, about the rights that we have when we are pregnant, about what represents good care and what represents abuse, then it’s hard for us to be able to advocate for ourselves, when we can, or to ask for better conditions. Even a superstar like US tennis champion Serena Williams almost lost her life after giving birth because a nurse didn’t trust her after she explained she was having trouble breathing (and her case shows just how much structural racism also plays a role).

The consequences of obstetric violence have not been documented much. But it can affect a person’s sense of self-worth and willingness to seek medical help when in need. We can blame ourselves for not being strong or resilient enough if we don’t like how we were treated, or if we don’t speak the language of the country we’re giving birth in. It also affects how we relate to our newborn children. Anecdotally, a friend in Italy told me the midwives at the hospital removed the child from her after a C-section and told her her breasts were not big enough for breastfeeding. (Yes, big, you read that right. Just to get this straight, breast size has nothing to do with whether you can breastfeed or not.) She found it hard to get close to her child for the first few weeks. But she luckily got the support of other midwives once she was at home. When they realised how much she was struggling, the midwives suggested a “rebirthing” ritual that simulated her birth experience and helped her reset her relationship with her child. She also decided not to report the accident because she wanted to get on with life — and she was not ready to face the scepticism or lack of support she may find in a legal setting.

In 2019, then UN Special Rapporteur on Violence against Women Dubravka Šimonović published a special report looking at the mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence. This is notable because this report marked the first time that the UN tackled the issue of violence systematically, pointing at the states’ failure to prioritise women’s healthcare in their budgets, and at discrimination and gender stereotypes as root causes of a structural issue. The same year, a study led by the World Health Organization (WHO) concluded that around 42% of women they surveyed said they had experienced physical or verbal abuse or discrimination during childbirth in health centres. The report followed 2,016 women in Ghana, Guinea, Nigeria and Myanmar during labour and interviewed 2,672 women after childbirth.

Four years earlier, the WHO had issued a statement with a strongly worded list of how those in labour have suffered. Just reading it out loud gives you a sense of the plethora of things which can go wrong: “outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilisation), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay.”

We have had international recognition of the issue of obstetric violence over this last decade thanks to the testimonies of women and to the work of organisations that pushed for change. In 2007, Venezuela was the first country to adopt a pioneering law that criminalised obstetric violence. More countries in Latin America followed suit: Argentina, Panama, Mexico, Suriname, Bolivia, and Brazil adopted a wide range of laws that criminalised obstetric violence and/or encouraged the humanisation of childbirth.

The laws exist, but women continue to report many abuses. In Venezuela, birthing conditions at the moment are considered “hell-like” because of the country’s economic collapse, as this report by OpenDemocracy explains. Moreover, several studies have recognised that “adolescents, unmarried women, women of low socio-economic status, women from ethnic minorities, migrant women and women living with HIV are particularly likely to experience disrespectful and abusive treatment.” In Brazil, for example, there is evidence of how structural racism in healthcare affects Black women when they give birth. Or think of the story from Kenya I shared in last week’s newsletter, where discrimination seemed to play a big factor when it came to mistreatment at health facilities.

Social media campaigns against obstetric violence have happened in FranceItalySpain and beyond, with some activists working for the legal recognition of the problem. It is not a new phenomenon — it is just becoming less silenced and more recognised.

Most of the research and the UN reports focus on pregnant women. However, it is far from my intention to exclude the experiences of trans and non-binary people from the overall issue of obstetric violence. On the contrary, they are at an even greater risk: that of being misunderstood and not seen by healthcare practitioners, and not only around their reproductive rights. I think this issue is worth a whole different story in and of itself. And if you have any interesting resources on the subject, I’d love for you to share.

What about you? I know that some of you members have shared your experiences of difficult birth situations, or those of partners and loved ones. I truly hope you haven’t had such an experience yourself. But if you have, and feel like sharing, I’d love to hear from you in our cosy, member-only comment section. And if you have not experienced anything yourself, had you heard of the term obstetric violence before? Do you find it helpful to frame the conversation? Please hit reply or leave a comment below this story.

What I’ve been reading

A man doesn’t cry, a man is strong and aggressive, a man doesn’t ask for help. Indeed, if you want to make a man miserable, box him in with these traditional ideas of masculinity. We need to reimagine masculinity, says US author Andrew Reiner, who teaches men’s studies. I find the premise of his Psyche Guide on How to be a Man very helpful; it contains a step-by-step process that starts by asking important questions, such as: What feelings should men be able to feel and show without judgment?

What I’ve been listening to

The Spermageddon is coming! This episode of the Am I Normal? podcast made me laugh even though it is about the rather serious subject of fertility. British journalist Mona Chalabi looks at the data available on declining fertility rates and puts male fertility under the spotlight. She explains how, historically, the responsibility has mainly fallen on women when a couple couldn’t conceive. Yet hardly any data, comparatively, has been gathered on men’s fertility compared to women’s. She interviews Joe Osmundson, a microbiologist and writer who is very worried about his declining fertility — and who goes on to freeze his sperm. She also talks to her mother, an Iraqi-born OB-GYN who compares attitudes towards fertility in Iraq and in the UK. Finally, I love that Chalabi talks of “wombers” and “spermers”. Thanks to Boryana, a friend and a member of this community, for the recommendation.

What I’ve been watching

This BBC report about a new organisation in Kenya helping deaf mothers take care of their mental health, and their children too. Catherine, a mother who suffered from postpartum depression after giving birth to her daughter in 2020, says she felt incapable of taking care of her daughter and of understanding what she wanted, or noticing when she was unhappy and crying. Data show that 30% of mothers in the African continent suffer from postpartum depression, more than the international average of 17%. Studies have shown that high-income countries tend to have lower rates of postpartum depression, and that poverty and unemployment play a huge factor. Talking Hands, Listening Eyes, an organisation in Kenya, tries to tackle the topic of a mother’s self-worth, offers support through therapy, and helps them take care of themselves, and their babies too.

Who’s been inspiring me

British member of parliament Stella Creasy was denied the right to bring her 13-week-old baby to parliament even though she has no legal right to maternity leave. She went public with the parliament’s ban on babies and has written a compelling editorial on why family-friendly rules are important, for everyone. This is not the first politician who has taken a child to parliament, and reactions have often been vocal. This BBC article has a list of women politicians who took their babies to work, and here is a male politician too.

What members have been saying

Following last week’s newsletter on why my son Lorenzo calls aeroplanes dragons, I asked members if they’d adopted words from books they read. Wies wrote: “We’ve adopted the Dutch word ‘drollenland’ from a short story. Roughly translated poo-land. The story is about a boy on the toilet, where does the poo go? And we are frequently talking about poo and pee since we are potty training. Perhaps not the nicest topic but a very common one with a 3 year old.” What about you? Share your own examples.

With love and care,
Irene

📣 Nabeelah Shabbir, a member of this community and a friend, edited and improved this week’s newsletter with lots of love, logging in from Slovenia. Thanks, Nabeelah! (If there are mistakes, they are my fault, not hers!)

Photo credits and alt-text: 🇸🇮 Janko Ferlič on Unsplash, baby’s feet.

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