This post is a companion piece to my article, Domestic Violence During Pregnancy, and was previously published as a sidebar in Citizens for Midwifery News and later in International Doula.

Abuse of pregnant women in the medical setting

 By Susan Hodges, founder and past President of Citizens for Midwifery

Have you or someone you know experienced rude, abusive or violent treatment at the hands of obstetricians or other hospital staff? Abusive behavior, in or out of the hospital, can include threats, coercion, yelling, belittling, lying, omission of information, lack of informed consent, misrepresentation (of medical situation, of interventions, of reasons they “need” you to do something or not do something), and so on. For example, nurses yelling at a woman to push is abusive, even if the nurses don’t intend to be abusive. An OB lying to a woman that her baby is “too big” (something that neither he/she nor anyone else can predict), telling her she “needs” intervention, and then not providing complete information about the risks and benefits of the intervention, is abusive behavior. Unwanted and unnecessary surgery (such as episiotomy or an avoidable cesarean section) is no less violence against a woman than hitting or strangling – most of us have just not thought about it in that way. The fact that most women are persuaded that they “needed” the intervention, that it was because their body was somehow defective, is another aspect of the abuse (blaming the victim).

While the situation is different from domestic violence in some ways, it is also similar. Abuse in the medical setting is also about power and control, the pregnant or laboring woman is often blamed for her situation, and verbal and emotional abuse can be similar. Because we are taught to “trust your doctor”, and in fact there is an explicit assumption of trust in the “fiduciary relationship” between the woman and her doctor who is an “expert”, most of us do not think about the possibility of abuse, and many of us stay with the OB or feel we have no choice about our health care providers or settings, especially when we are in labor. Also, the doctors and staff generally are not even aware that their behavior or actions are abusive.

Forty years ago, domestic violence happened, but was hidden and accepted. A lot of women had to do a great deal of work to come up with the language and the legal strategies, and to educate women, law enforcement, judges, mental health workers, and many others to get us to the point where we are today, where at least the problem has a name and at least some of the time women can fight back with the law on their side.

It is extremely difficult to deal with an abusive OB (and it might be hidden abuse, manipulation, etc.) in the middle of labor, just as is very difficult to effectively deal with an abusive spouse in the middle of the abuse. The childbirth community is only just now beginning to recognize that women are being abused in many ways in the present system of maternity care.  We don’t really have special words for it yet. We do have some legal underpinnings to fight at least some of it, but we are in the very early stages. It will take recognition of the problem on a larger scale and by women who are not being abused by OBs to bring this issue to public attention, create language for it, and use legal tools to end it. We have a lot of work to do.

Have you experienced abuse? At the least you can file a complaint. See “Unhappy With Your Maternity Care? File a Complaint!” at http://cfmidwifery.org/Resources/item.aspx?ID=1

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Related post: Birth Violence