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December 9, 2022

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Having a baby can be an empowering experience when women are treated with kindness and respect.

However, some women are left feeling traumatised by how they were treated. When women receive disrespectful and abusive care from health providers during pregnancy, labour and birth, or after the baby is born, it’s called obstetric violence. This includes verbal, physical and emotional abuse, threats or coercion by health providers.

Our study, published today in journal Violence Against Women, is the first to look at Australian women’s experiences of obstetric violence. Of the 8,804 women we surveyed, more than one in ten (11.6%) indicated they had, or may have, experienced obstetric violence.

Respondents who elaborated told us this ranged from disrespectful, abusive and coercive comments (42%) to physical abuse (7%) and vaginal examinations without consent (17%).

‘Dehumanised’, ‘powerless’ and ‘violated’

Birth

Our data comes from the Birth Experience Study, a survey asking Australian women about their birth experiences over the past five years.

We asked participants if they experienced obstetric violence and they were able to leave comments if they wanted to.

Like all surveys, women who are more educated and have English as their first language tend to respond the most. To reduce this bias, we translated the survey into seven other languages.

Some 626 women left comments describing feeling dehumanised, powerless and violated. Some experienced psychological and emotional abuse, while others were threatened and yelled at.

More alarming were the experiences of physical assault, such as forcible restraint or being held down.

Some women felt the experience was like a sexual assault. This was mainly associated with rough vaginal examinations or procedures the women didn’t consent to.

As one woman from New South Wales explained:

I was told by the doctor who just appeared in the room that he would need to do a vacuum delivery and an episiotomy, and I felt him cut me as he was speaking before [using] a numbing needle, it wasn’t during a contraction and I hadn’t had a chance to consent yet.

Another woman from Queensland told us:

I felt dehumanised because A) nobody told me the procedure was optional or gave me choice to opt out. B) I was very clearly highly distressed and they didn’t pause or stop the procedure to check my consent. C) there were three people I didn’t know standing and looking at my exposed naked body. D) the midwife had joked about the procedure.

What is the law in Australia?

Birth delivery suite

Australia doesn’t have a National Human Rights Act or legislation addressing obstetric violence.

The Australian Capital Territory, Victoria and Queensland have their own state/territory human rights acts. This protects against “cruel, inhuman or degrading treatment” and requires clinicians get the “person’s full, free and informed consent” before performing any medical treatment.

However, across Australia, consent is always required before any medical treatment or examination, except where the woman is incapacitated or unconscious. The provider must explain the proposed treatment in a way that is balanced, truthful, timely, and free of harassment and coercion. And she can change her mind at any time.

Clinical guidelines don’t trump the right to bodily integrity. If guidelines suggest a vaginal examination, they need to be explained, including the reasons for the treatment and the alternatives. Then the woman has to be given an opportunity to accept or decline.

Yet our study detailed many instances of treatments or examinations with either no consent, no informed consent, or despite their refusal.

Midwives and obstetric doctors are expected to practise ethically and respect their patients’ right to refuse consent or withdraw consent.

Patients can make complaints about doctors or midwives, however there are a variety of different methods dependent on state/territory which can make the process confusing and overwhelming.

How do we eliminate obstetric violence?

All women deserve respectful maternity care, free from harm and abuse. To prevent obstetric violence, we first need to recognise it exists.

The next steps need to involve getting the main professional colleges for obstetricians and midwives, consumer organisations, universities that train health providers, health departments and governments to work together to change policies and improve education.

The International Confederation of Midwives and UN Population Fund created a RESPECT toolkit to facilitate workshops for health care providers on respectful maternity care to support their strategy to create zero tolerance for disrespect and abuse. Programs such as this could be implemented across Australia.

In Queensland, Human Rights in Childbirth and Maternity Consumer Network have just commenced consent training for maternity health professionals. Again, similar programs could be rolled out nationally.

Alongside education, we need legislation recognising obstetric violence as a human rights violation. This would mean women are aware of their rights and have access to legal support if needed. It would also prompt governments and health services to develop quality improvement systems, including repercussions for clinicians who commit obstetric violence. The Conversation

Hazel Keedle, Lecturer of Midwifery, Western Sydney University; Bashi Hazard, Lawyer, PhD Candidate, University of Sydney, and Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • I guess I was lucky and had wonderfully supportive nurses and Doctors for all 3 of my births. I sis have one older nurse who was a little short with me because I was heading home in under 24 hours. She thought I was crazy and was putting my child at risk.

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  • With my first child I experienced something like this after having a traumatic birth and been told oh come on get up and have a shower now your not sick your only had a baby hurry up

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  • naively did not realize this.

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  • I don’t remember having any issues but feel for when who do. It shouldn’t be still happening.

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  • This is sad. We can give all the training to medical staff at any stage of their learning, but ultimately it comes down to the personality of the medical staff. If they are caring people, it will show.

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  • So sorry to the women that these things have happened to, so terrible.

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  • I felt violated with the Midwife who was so aggressive in trying to get my baby to latch on to breastfeed, we were both so distressed and it did traumatise me. I questioned her behaviour and ended up with another midwife.


    • Well done, as tough as it is, people have to be challenged. I did the same and challenged.

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  • This breaks my heart. I hope these obstetricians have been or will be reprimanded. Its a stressful time and you don’t need any abuse during labour.

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  • I don’t have a negative experience during birth, but do have a negative experience when I miscarried. Reality is that interrelational skills are very important when providing quality care

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  • I had to be extremely firm and have a loud voice and be heard.

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  • I found that the midwives and female nurses were actually worse than the male doctors.

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  • I have to count myself lucky that I had a relatively smooth child birth, I know what things might have been required at the time (forceps, vacuum delivery, episiotomy, etc), I dont recall being asked if they could do the episiotomy at the time, I had a lot of drugs in my system and was violently ill every contraction due to the pain but I do recall saying just do what needs to be done to get bubs out safely. My after birth care was wonderful and just an amazingly supportive experience, which i believe everyone should have the right to expect.

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  • So sad that in this day and age we are still having to push for women’s rights around birthing; if there’s one area we should all put our judgements aside and stand together, this is that area.

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  • This is shocking! Child birth is already such an extreme event without the added trauma of this. I am so thankful that I had the more beautiful care team around me for my entire pregnancy and birth. I don’t think I could have gotten through without them! All women deserve the most positive experience possible when welcoming their precious babe into the world.

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  • I never had any problem with the doctor and staff when my boys were born. Mine was due to a miscarriage at 16 weeks. The doctor said it was my fault because I kept working. I told him what I did in my job, making beds and hanging out sheets but he said it was fine. He literally told me I killed my baby and didn’t deserve to have any.

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  • After reading this article it bought back some memories from my daughters birth and how the doctor dismissed my concerns or questions during labour and I felt really powerless. Thankfully someone must have said something as he came in and eventually apologised for not answering my questions before I was rushed to theatre. I feel for every woman who has experienced disrespectful behaviour.

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  • As a Midwife this breaks me to read, our job is to advocate for women. To be their voice when they can’t do it themselves and ensure they have true informed consent on everything, true informed consent/choice means to have no coercion at all- I remember years ago a Dr telling me to go back in that room (birth suite 4) and tell that woman her baby will die if she doesn’t (agree to dr decision), I looked at tht Dr and said “you are not allowed in my room”, the woman ended up having an unassisted normal birth.
    We need to empower women, women already don’t trust their bodies will do what they are designed to do and come with anxiety that halt labour processing as it should.
    If there is anything I can say to any woman doubting their body’s ability to give birth is … please trust the process and listen to your body, your body is design to grow life, give birth and then feed your baby… you got this

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  • I found the staff to be mostly amazing. However I was quite traumatised by a couple of the nurses in the special care nursery. I was so vulnerable after the prem birth of our first daughter. I felt very powerless.

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  • Speechless from reading this but I’ve had a good experience so far

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  • This is terrible to read. I was so lucky. All for of my births were amazing and the staff were all wonderful.

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