Improving Birth, the largest U.S. consumer advocacy organization for better maternity care, commends the editors of the Annals of Internal Medicine for their publication yesterday of an essay and editorial addressing “the dark side” of medicine and highlighting two disturbing incidents involving women receiving reproductive health care provided by obstetricians/gynecologists. What these articles touch on is something women’s groups and legal advocates have been working to bring to light for some time: the widespread, largely ignored problem of disrespect and abuse of women in maternity care. The leadership of Improving Birth, Human Rights in Childbirth, and other groups directly addressed this issue in a May 2015 meeting with the leadership of the national obstetricians’ membership organization (the American College of Obstetricians and Gynecologists, or ACOG).
Evidence of such mistreatment can be seen in the thousands of responses by women and others generated by Improving Birth’s “Break the Silence” campaign (photos, comments, and stories here: bit.ly/breakthesilencephoto), and detailed in the article “Improving Birth Breaks the Silence on Abuse of Women in Maternity Care” (bit.ly/nodontcut), which lists common examples like forced vaginal exams during labor (described by many as a sexual assault), administration of medication and performance of invasive procedures without informed consent, and forcible restraint of women onto their backs (see “Inappropriate use of restraints” for one woman’s story). Perhaps most common are reports from women that they were bullied and pressured into routine medical interventions. The video of a 2013 incident (bit.ly/nodontcut) shows a California obstetrician cutting a woman 12 times with scissors and berating her after she explicitly refused an episiotomy (cutting of the area between the vagina and anus). More evidence of mistreatment is listed below under “References,” including a 2015 legal brief submitted by multiple national organizations to a New York court hearing a lawsuit about a forced Cesarean urging that the court affirm pregnant women’s rights to be free from forced and coerced medical treatment, with 42 firsthand accounts from women and witnesses of the same.
Across the board, women are dismissed and ignored when they speak up about their treatment, and it is our understanding and experience that their complaints to hospitals and medical boards are often ignored and dismissed, also. If they try to hire a lawyer, they are told they have no case because they and their baby are alive. Trauma from being mistreated in maternity care is often blamed on trauma from the process of childbirth itself, and women are admonished to just to be grateful they have a healthy baby, regardless of the humiliation, bullying, or trauma they endured. For all of these reasons and more, there is no meaningful system of accountability for women when they experience disrespect and abuse.
We also understand that many care providers are traumatized themselves, in high-stress, high-pressure jobs, beginning with what the New York Times called “the bullying culture of medical school,” where their initiation by superiors may include “verbal and physical harassment,” “intimidation,” “being yelled at” and “threatened,” and even being”hit” and “pushed.”
“Respectful Care” is this year’s theme for Improving Birth’s 4th annual Rally to Improve Birth. This theme was chosen, in part, to bring attention to the problem of DISrespectful care. We warmly welcome the public and the medical profession to join us at one of our 80+ locations nationwide (find a rally here: bit.ly/findarally) this Labor Day week.
We are thrilled that the medical community is taking this seriously enough to break the silence among their own about disrespect and abuse in childbirth. The conversation that Improving Birth, Human Rights in Childbirth, and others have worked hard to bring into the mainstream must include medical professionals and organizations if we are to see lasting impact. Respectful, evidence-based care can be a reality if we all decide to make it so.
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“Break the Silence” Photo Campaign with photos, comments, and stories about trauma and violence in childbirth
Amicus Curiae brief, including 42 stories from women and witnesses, submitted by multiple national organizations in the matter of Dray vs. Staten Island Hospital, et al.(2015)
World Health Organization report on the global problem: Prevention and elimination of disrespect and abuse during facility-based childbirth (2014)
Article: Improving Birth Breaks the Silence on Abuse of Women in Maternity Care (2014) and related article from Human Rights in Childbirth about the forced episiotomy of a California woman, Forced Episiotomy: Kelly’s Story
Joint statement by advocacy organizations on the forced Cesarean case of a New York woman: Advocacy Organizations Stand Together Against Forced Procedures in Childbirth (2015)
Article from Human Rights in Childbirth about the forced Cesarean case of a New York woman: Rinat Dray is not Alone, Part 1 (2015)
Blog post by anonymous woman about being violently flipped on her back and restrained there, with the hospital and Joint Commission agreeing the treatment was acceptable: Inappropriate use of restraints (2014)
Story of a young first-time mom being bullied throughout an unmedicated birth to consent to medication to speed up labor: Because We Can: A Year of Inspiration (2013)
Article: A Healthy Baby Isn’t All That Matters (2013)