Everyone Deserves Safe and Respectful Maternity Care

Violence and abuse have no place in prenatal health care or the delivery room, and yet obstetric violence occurs far too often.

‍By: Yalinie Kulandaivelu (Mommy Monitor’s Youth Subcommittee)

Originally published here: Mommy Monitor’s Blog

The care people receive during pregnancy and childbirth should be safe and respectful. While this statement may seem like it should be obvious, far too often women receiving prenatal care or giving birth experience abuse during their interactions with care team (specifically clinical care). This is known as obstetric violence, which is a form of gender-based violence.

Obstetric violence is defined as neglect, physical abuse, lack of respect, discrimination, and non-consented or non-confidential care during prenatal care and childbirth. Obstetric violence occurs when healthcare providers violate the trust between them and the women they treat. Examples of care providers committing obstetric violence include: not seeking patient consent for interventions or procedures prior to completing them, forcing C-sections, neglecting care or calls for care, and being verbally abusive towards patients. Violence during childbirth itself has many adverse consequences for both the mother and infant, which includes causing maternal post-traumatic stress disorder and furthering the distrust of healthcare providers, as well as increasing the risk of miscarriage or premature delivery and thereby compromising the safety of mom and baby.

Similar to other forms of gender-based violence, obstetric violence is compounded by racism. Rates of obstetric violence are highest among Black women, and this neglect contributes to higher rates of pregnancy-related complications and dying from pregnancy-related complications. For Indigenous women, this neglect is due in part to a lack of access to culturally safe care and healthcare providers. Black women at the highest levels of income and resources are not immune — notable examples include Serena Williams and Beyoncé who still experienced life-threatening perinatal conditions as a result of this neglect.

The reasons that obstetric violence persist are complex. Obstetric violence has a history rooted in slavery, colonialism, racism, and discrimination. Black women’s bodies have been experimented on without their consent, used to perpetuate slavery, and have had sterilizations forced upon them, among other acts of violence. Furthermore, Black women’s expertise in midwifery was exploited for centuries, until they were pushed out of the very profession they led. For centuries, obstetrics and gynecology have been rooted in violence against Black women, as inhumane experimentation on Black women’s bodies was used to move the field forward. These effects reverberate today, as Black women are still weary of placing their trust in institutions and fields built upon the violence and oppression of Black women.

Another part of the problem is that for many first-time mothers, there is anxiety and uncertainty about what is considered “normal” for prenatal care. The nature of childbirth and exams often prevents us from seeing what is happening. The urgency of childbirth and the fear that may accompany the process facilitates the normalizing of obstetric violence. Alongside the uncertainty, there is a normalization of the process, with the focus on the healthy baby is all that matters — not the trauma of mothers and the risk to infants.

Finally, in Canada, incidents of obstetric violence are difficult to track. There are no national mechanisms for tracking of incidents, and Ontario and Quebec — the two largest provinces — do not track obstetric violence at all. Being unable to adequately describe a problem contributes to the cycle of normalizing trauma and its long-term impacts.

Given that maternal mortality among Black women remains high today and remains high in countries around the world, we should think about whether sufficient progress has been made to improve the care and circumstances of pregnancy and childbirth. If the history of violence, racism, and oppression in obstetrics and gynecology are not addressed in solutions today, there is no true progress we can speak of.

However, there are a few steps that we can take to prevent obstetric violence and keep our communities safe.

• When choosing healthcare providers, ask about their approach to informed consent early on to ensure it aligns with your expectations.
• Review the patient bill of rights at your birthing hospital and understand their informed consent and pregnancy and birth encounter approaches.
• Document stories and incidents.
• Support and validate the stories of others experiencing obstetric violence.
• Educate yourself on birth justice courses and tools. (See below)
• Share and talk about experiences with others.

Birth Justice Resources for Parents and Parents-to-Be:

• Mommy Monitor Birth Justice Workshops
• Mommy Monitor Obstetric Violence Form
• Mommy Monitor Birth Justice Podcast
• Birth Monopoly
• Improving Birth
• The Obstetric Justice Project
• Black Women Birthing Justice
• OHCHR — Mommy Monitor Report on Mistreatment/Violence & Racism against Black Women during Childbirth in Canada
• The Birth Rights Bar Association (Legal Support for parents seeking justice in the US)

Many of the solutions proposed here target parents planning to get pregnant or who are pregnant, unfortunately, few solutions target the root of the problem — the perpetrators of obstetric violence. If change is to happen at all, there needs to be a fundamental shift in the way healthcare providers and institutions care for patients. Healthcare providers will need regular training in patient-centred care, informed consent and choice, trauma-informed care, culturally sensitive care, and patient autonomy, all of which should be informed by anti-oppression and anti-racist frameworks. Hospitals and birth centres need to examine their protocols and policies using anti-oppression frameworks and with the involvement of communities who use their services. Mechanisms for reporting obstetric violence must be created and publicly available, with the ultimate aim being that there is a zero-tolerance policy for any form of obstetric violence.

For far too long, obstetric violence has been overlooked and Black women’s experiences have been minimized and silenced. However, by involving communities in redesigning care and changing the way healthcare providers are trained we can begin to take steps to improve maternal health care.