The United States has the worst maternal mortality rate in the developed world. It is the only wealthy nation in which childbirth and pregnancy-related deaths have risen over the past 20 years. Most childbirth-related deaths are preventable.
Public anecdotes about people dying in childbirth often feature doctors who ignore obvious signs of distress. In one famous case, Kira Johnson slowly bled to death after a cesarean section. She and her husband had sought help from medical staff, only to be told that she “was not a priority right now.” Several hours later, she died.
Childbirth advocates claim another problem fuels the maternal mortality epidemic: a refusal to listen to and honor the needs of birthing people. Mistreatment of birthing people is common. According to the Giving Voice to Mothers study, around one in six pregnant people experience mistreatment during childbirth. These experiences can lead to lasting psychological trauma as well as physical harm.
What Is Obstetric Violence?
Obstetric violence is maltreatment by doctors and other health care providers during pregnancy or birth. It’s important to note that any health care provider can commit obstetric violence. Nurses, midwives, nursing assistants, anesthesiologists, and other birth workers may play a role in trauma; the abuse is not limited to obstetricians.
Some examples of obstetric violence include:
- Denying a laboring person care or pain relief within a reasonable time frame when they request it.
- Dismissing a person’s pregnancy or birth-related complications as unimportant.
- Using demeaning, threatening, or abusive language when a person is giving birth.
- Physically or sexually assaulting a birthing person.
One of the most prevalent forms of obstetric violence involves performing medical procedures on laboring people without their consent. Most birth workers (87%) have witnessed a care provider perform a medical procedure without giving the birthing parent a choice or time to consider the options. Over half of birth workers say they have seen a care provider perform a medical procedure explicitly against the patient’s wishes.
One procedure which is commonly performed without consent is an episiotomy, which is a cut into the vagina or perineum (the tissue between the anus and vulva). Corrinna Edwards, a midwife, childbirth advocate, and the founder of the Bellies to Babies Foundation emphasizes that this procedure is rarely medically necessary. Furthermore, its use can be both physically and emotionally traumatic. “Skilled providers should only perform a handful of episiotomies in a 30- or 40-year career, since the only accepted indication is to expedite the birth when a delay would compromise the baby. Physician-led care still has high rates of episiotomy for controversial indications, even when a baby isn’t at risk. It is an easier repair for the provider than a natural tear, although a natural tear heals better and produces less trauma for the mother.”
In 2013, a shocking video went public of a doctor cutting Kimberly Turbin’s vagina 12 times despite her vocal pleas to stop. Turbin ultimately settled a lawsuit with the doctor, and the doctor was forced to surrender his medical license. However, birth activists say that these sorts of coercive procedures are common and that without video evidence, Turbin’s suffering might have gone unheard.
Marginalization and Obstetric Violence
Research consistently shows minority groups (particularly black parents) are more likely to experience obstetric violence. In a 2014 survey of labor and delivery nurses, doulas, and other birth workers, around 30% reported hearing a care provider use racist language in the delivery room. Even wealthy celebrities such as Serena Williams have had their lives put at risk by medical staff who dismissed or ignored their medical complaints.
Incarcerated people are also more likely to experience obstetric violence. Several states still allow jails and prisons to shackle pregnant inmates, even when they are in labor. These practices can cause intense psychological trauma. They may also lead to birth complications, such as when a laboring person falls while shackled.
Obstetric violence can directly contribute to maternal mortality, especially for people of color. Nationwide, black people are up to four times more likely than white people to die of pregnancy and birth-related complications.
“Black families aren’t being valued during the birthing journey, and socioeconomic status isn’t the issue,” explains Desiree Butler, a birth doula and racial justice activist from Atlanta, Georgia. “Doctors can prevent maternal mortality by listening to birthing families and respecting their autonomy.”
Mental Health Consequences
Obstetric violence is a form of trauma. Like other traumas, it can change the way the brain behaves and processes information. The specific effects vary from person to person, but they may include:
- Shame and anger about physical trauma. For example, a person who sustains pelvic floor damage that prevents pleasurable sex may feel both angry and ashamed. They may struggle to discuss their injury with other people.
- Depression. Trauma is closely linked to depression. The postpartum period is a vulnerable time for many people recovering from birth. Trauma intensifies this vulnerability. Research consistently links birth trauma to an increased risk of postpartum depression.
- Relationship problems. People who experience birth trauma may have relationship challenges, especially if they feel unsupported by partners or other loved ones who do not take the trauma seriously or who did not intervene to stop obstetric violence.
- Parenthood struggles. Trauma can make it difficult to bond with the baby. Physical injuries related to obstetric violence may make new parenthood extremely difficult, compounding bonding difficulties.
Much like other forms of gendered violence, survivors can encounter victim blaming. They may face shame from people who tell them they should be happy to have a healthy baby. Some survivors may worry that they deserved the abuse or that caring about having a good birth experience makes them selfish. This stigma can prevent individuals from sharing their stories and seeking support.
The Right to Consent
“Childbirth does not eliminate the right to informed consent and informed refusal in any state, although state standards for consent and refusal vary. Legally, a person giving birth has a right to decline medical procedures, even those her doctor thinks are medically necessary. Touching her or performing procedures without her consent may be an assault or battery,” says Jeff Filipovits, an Atlanta civil rights lawyer who advocates for pregnant people. “The problem is that punishing rights violations after the fact is legally tricky, and many lawyers are reluctant to take these cases.”
Cristen Pascucci says that though obstetric violence is technically illegal, it usually goes unpunished. Pascucci is the founder of Birth Monopoly, an organization that provides training to expectant parents about their childbirth rights and advocates for birthing policy change.
“What’s difficult about preventing obstetric violence and the trauma that results is that both are so normalized and culturally accepted,” Pascucci explains. “That normalization is part of the reason it’s almost impossible to hold anyone accountable. I’ve had lawyers say, ‘Well, I don’t see how this is a case; the same thing happened to my wife and we never thought about suing.’ And sure, much of it is not actionable—like being disrespectful or passive aggressive toward your patient—but much of it does fall under what we could consider malpractice or battery in any other context. There’s this awful circle of silence and acceptance that makes this abuse virtually invisible.”
Birthing people concerned about maternal mortality and obstetric violence should carefully research their providers and choose ones who understand the importance of informed consent. Providers who use language indicating that a patient “has to” or “must” do something a doctor says are more likely to violate a patient’s bodily autonomy. Asking a doctor ahead of time how they respond when a patient says no or asks for more information may give pregnant people time to switch to better providers.
Therapy after Obstetric Violence
Therapy can help with the aftermath of obstetric violence by providing a shame-free place to discuss birth experiences. In therapy, an obstetric violence survivor can expect:
- Strategies for managing flashbacks.
- Emotional support if they choose to pursue legal action.
- Psychoeducation that supports a deeper understanding of trauma and its aftermath, including how trauma can affect bonding with the baby.
- Support to bond with the baby.
- Validation that obstetric violence is real and that the survivor did not cause the abuse.
- Family support. Some people who give birth feel unsupported by families who think they should be grateful to have a healthy baby. A therapist can educate families about the pain of birth trauma and work with families to develop strategies for supporting an abuse survivor.
Therapy may be especially helpful to abuse survivors who hope to have another child and who need support to advocate for themselves with new providers.
There is no “right” way to respond to obstetric violence. While reporting doctors and pursuing legal action may stop future abuse, it can also re-traumatize survivors. It is important for survivors to work with their family or therapist to decide how best to proceed.
Some resources that may help in the aftermath of obstetric abuse include:
- Birth Monopoly tracks obstetric abuse, offers resources to survivors, and educates families about their rights during and after childbirth.
- ImprovingBirth.org connects survivors to recovery resources, advocates for legislative change, and publicizes cases of obstetric violence.
- National Advocates for Pregnant Women provided legal advocacy and know-your-rights training to pregnant people and their allies.
- Black Mamas Matter advocates for an end to all forms of racialized violence against mothers, including maternal mortality and obstetric violence.
Additionally, a lawyer who specializes in issues related to childbirth abuse may be able to advise a person about their specific rights. Every case is different, so people interested in fighting abusive providers should consult an attorney. They may be able to sue the provider, file a medical board complaint, and in rare cases, pursue criminal charges.
GoodTherapy.org can help trauma survivors find therapists who specialize in obstetric violence, trauma recovery, postpartum depression, and other common challenges of new parenthood. Begin your search here.
Disclosure: Jeff Filipovits is the author’s spouse.
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