The Socially Accepted Violence Against Pregnant and Labouring Women

Birth Related Violence Against Women
By Samantha Thurlby-BrooksToday Amnesty International and One Billion Rising are campaigning together for women’s rights. They are encouraging everyone across the world to support the elimination of violence against women and girls. I think in the light of recent events, such as the horrific Delhi gang rape that happened in December 2012, this day is much needed.

We usually think of violence against a woman as being rape, beaten or emotionally abused, often by someone they are in a relationship with or someone else they know. Domestic violence is a serious issue and society is working together to find out what is going on behind closed doors and helping women in need. Sadly the prevalence of abuse specifically during pregnancy is rarely thought of yet 20% of pregnant women will suffer at the hands of their partner. This is unacceptable.

It is estimated that one in five women will be abused during pregnancy. As homicide during pregnancy now surpasses the previous leading causes of death (automobile accidents and falls), it is more important than ever that we know the signs and properly screen women for domestic

What I’d like to talk about here is the socially acceptable physical violence and emotional abuse pregnant and birthing women suffer. The abuse that leaves a woman feeling unworthy, incapable, doubting her abilities, fearful and physically and emotionally scarred. This is also the abuse that makes a woman feel like she deserved it, that there was something she did wrong to bring it on herself, that ‘it’s just what happens’ and brush it under the carpet to suffer in silence. It’s the socially acceptable abuse that leaves new mothers depressed and anxious or in a state of shock and numbness. Sometimes (and probably more frequently than is recorded) these women suffer post-traumatic stress disorder.

This violence I’m talking about is the way pregnant women are treated by the health profession in general and some health professionals (obstetricians and midwives). The problem is widespread because no one talks about it as being abuse and so many of the health professionals don’t even realise they are being abusive and how their words and actions affect a person. The Nocebo Effect is a term that is used when someone says something negative to a person and the person responds negatively. For instance, “your baby is measuring big” at 20 something weeks gestation sets a woman up to believe that her baby may be too big to be born vaginally. She wonders over the next few months how she would ever get a large baby out without tearing her perineum. When her healthcare provider then offers her the opportunity of an early induction or caesarean she is likely to accept.

Instead, it would be great if the healthcare provider didn’t comment on baby’s size or alternatively could say “Wonderful, your baby’s growing healthy and big. Just what we want. So long as you’re eating healthy foods this is great.” I had a client a couple of years ago who birthed an 11lb baby. She didn’t realise she was in labour because she wasn’t in much pain but, on a routine visit to her midwife, her midwife got suspicious and asked to do a vaginal exam. It turned out she was fully dilated and her waters had broken! She walked down to the labour ward and six pushes later her baby was born… no stitches, no tearing. It’s not the size of the baby that causes problems, it’s whether mum and baby are able to get into good positions and move together.

A client came to me for a postnatal massage a few months ago. She was feeling quite traumatised by her birth and the way she was treated. She had assumed that having a female private obstetrician would give her the best care available. Among some of the things that happened during her birth, the obstetrician, whilst stitching up her torn perineum, said she wasn’t surprised it happened as she [the mother] was overweight and probably sat around in cafes drinking coffee and eating cake. Besides the woman not being overweight at all this was horrendously inappropriate!

Pregnancy, birth and new motherhood is a time when a woman is at her most vulnerable. Her hormones for love and calm have increased since conception and during labour these hormones are peaking higher than any other situation can create. This love hormone, Oxytocin, is the creator of labour contractions. To feel the love and calmness of the hormone Oxytocin there needs to be an absence of the stress hormone Adrenaline. Adrenaline blocks Oxytocin. In otherwords, a woman must feel safe, confident and protected for Oxytocin to peek, giving her and her baby the safest and most empowering experience of birth.

Here are just a few facts about birth that are widely known;

  • A labouring woman must feel safe and relaxed
  • The safety of birth increases when a woman is continuously supported
  • A woman will birth her best where she feels safest; this can be a hospital, home or birth centre
  • Movement during labour reduces the experience of pain
  • Movement during labour helps baby position correctly for a safe, un-assisted vaginal birth
  • Lying on your back or semi-reclining during labour and birth is more painful, uses up more energy and is less effective than forward leaning, upright positions.
  • Forceful pushing can damage blood vessels in the mother’s eyes, create back pain and headaches
  • Forceful pushing won’t get a baby out if the baby’s shoulders are not in the pelvic brim… but moving around will
  • Foetal distress is frequently relieved if the labouring woman changes position (normally if she gets off her back)
  • Continuous Electronic Foetal Monitoring increases the caesarean rate (but is safer during an induction using synthetic oxytocin)
  • Inductions create more painful contractions
  • Bright lights and other distractions create more painful contractions
  • Hunger creates more painful contractions
  • Epidurals increase risk to mother and baby (lowers mother’s blood pressure, can create foetal distress, prevents baby from turning for birth, increases need for forceps, ventouse and caesarean)
  • IV fluid, necessary for epidurals, creates a bloated mother and baby and difficulty with feeding from bloated breasts, as well as diluting the mother’s blood which increases the chance of haemorrage
  • Hospital policies are largely there to protect the hospital against law suits

Even though we know all of these to be true, many health professionals still offer inductions without medical cause, offer epidurals as routine, require a woman birth on her back/semi-reclining with her feet in stirrups or more fashionably now with her feet pressed on the hip of a person on either side. If we know these things to be harder for the woman, but easier for the health professional, how can this not be abuse? How can forcing a woman to lie on her back, despite her saying no, saying she wants to be upright, saying that it hurts more, not be abuse and violence? This is an abuse of power, knocking a woman’s confidence and intuition that she knows her own body. How can doing an episiotomy (surgically cutting the perineum) or the perineum tearing because of this unfavourable position not be an act of violence against women?

Women who have suffered rape, sexual assault and other types of abuse (including emotional abuse) will agree that this creates the same feeling of helplessness, shame and guilt.

During labour, telling a woman that if she doesn’t birth her baby within two hours they will do a ceasarean is like telling a man that he has to have an orgasm within the next three minutes or they will cut the end of his penis…. except what they are threatening the woman with is major surgery. A woman doesn’t need to know what might happen while she’s in labour as this will disrupt her feelings of safety and the release of hormones that will improve her chances of a safe and easy birth.

These labour hormones are the same as the sex hormones. Imagine how each person would feel if the other said, during sex, “You’re not doing it right”, “Your penis isn’t big enough”, “Stay still”, “This isn’t about your pleasure”, “You’re no good at this because you’re too fat, too old, too sick, too tired”.

The health profession know this about birth. Doctors and midwives know that a woman must feel safe and confident and keep moving to have a good birth. However, when they don’t act for the whole good of the mother and baby, I believe they are putting themselves in the position of abuser. Hospital policies are not law yet they are pushed onto a healthy labouring woman as though they are.

Now, I’m not saying all obstetricians and midwives are abusers. I know many wonderful health professionals who do a truely amazing job at supporting women. But, having massaged over 2000 pregnant women and new mothers over the last seven years I have heard many, many wonderful and awful stories. A student of mine called me up recently feeling very upset about the way her midwife treated her during her birth. Upon arrival her midwife said she’d have to cancel her beauty appointment to be here, giving the labouring woman the strong feeling that her being in labour was such an incovenience. She was then set up for feeling guilty and also untrusting of her midwife and all that happened thereafter.

I’ve had many clients complain of painful vaginal exams during labour. Despite protests these women are often ignored, told to suck it up or reassured that it needs to be done and it’ll be over soon. How familiar this is to a child suffering sexual abuse from a person they know?Vaginal exams give very little useful information when done routinely. A cervix can dilate and contract very quickly or very slowly and still be part of a safe birth. The dilation of the cervix doesn’t tell us how soon a baby will be born… there are many other factors that affect this.

One midwife, during a birth I attended, carried out a vaginal exam during a contraction, despite it being more painful, and causing the woman’s waters to break (technically a surgical procedure). The midwife turned around and said that is was common for that to happen when doing a vaginal exam through a contraction. It is common for medical professionals to do these types of procedures ‘accidentally’ without the person’s consent, increasing the risks of birth and violating the person’s human rights of choice.

I have frequently heard of women being given Pethidene, an opiate based drug that strongly affects the mother and baby, without their permission. They weren’t told what it was or what the risks of it were before it being administered, with at least one woman being left on her own for the experience. The biggest fears humans have is to be abandoned in our time of need and to be held against our will. Labouring women are often subjected to both.

I could write a whole book about the stories I’ve heard, first hand, from women about their treatment through pregnancies and birth. About caesareans that weren’t necessary, about the terminology used by the medical profession (failure to progress is actually a successful protection of the baby, something I call the Lion Effect), the lack of scientific evidence for many diagnosed cases of cephalopelvic disproportion (baby too big for the pelvis), of women not being believed when they say how labour feels, that baby’s coming soon or that they are in labour at all. Of women, successful, well educated women, being called a ‘good girl’, of being ridiculed when she says she wants a natural, unmedicated birth, of being pressured into consenting to a procedure (often with the ‘your baby might die if we don’t do this’ threat for something that carries a very small risk).

So, yes, many midwives and obstetrician’s are wonderfully caring and supportive. But, there are equally as many who subject women to this socially approved low and high level abuse creating mothers who doubt themselves, go away feeling that birth was a trauma best forgotten, that they were ‘saved’ by a terrible experience, that their body’s don’t work and that other people know what’s best for them and their baby.

When we change the way pregnant women are treated, how society prepares women for birth and nurtures new mothers, when we train healthcare professionals and update hospital policies with the latest sound research… then we will be on our way to creating a society without violence.

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