What’s in a name: inciting blame and fear, or instilling courage?

This is a post about the term Obstetric Violence.

It isn’t about doctors.

It isn’t about midwives.

It’s about both.

BUT, it’s really about childbearing women.

Before you read on, please watch this film (WARNING - it is very distressing).

I use this clip in some of the talks I give in UK and internationally, on compassionate, respectful maternity care. I ask delegates if they have witnessed any of the practices they see. There is usually a full show of hands.

One of the questions I ask is - 'Why do you think the maternity care workers in the film look so unhappy?' And then there's usually a lengthy debate...

I could write a whole blog post on the film itself. 

What is Obstetric Violence?

It appears the concept gained momentum in Brazil during the 1990's. From there, other countries are highlighting the problem, and in England there is research planned to explore how the law can be used to  'meaningfully address obstetric violence'. 

Earlier this year (April 2017), a clear message went out on social media from Europe:  World Health Day: Time to speak up about postpartum depression. Within the text there is a very clear definition of OV: 

'Obstetric violence may be defined as the appropriation of women’s body and reproductive processes during birth by health professionals which is expressed by dehumanising treatment, the medicalisation of natural processes including excessive use of c-sections, resulting in a loss of autonomy and ability to decide freely about their bodies and sexuality, negatively impacting their quality of life. It is a reality in Europe which remains under reported, under researched and largely unaddressed within health systems'. 

So, there are two issues. One is the word 'obstetric' being potentially misinterpreted as 'that done by an obstetrician', and the other is that recently it was suggested to conference delegates in England that the term should not be used, as it could instil fear into childbearing women.  If then, we change the phrase to 'Maternity Violence', which has been suggested more than once, could we then address the problem? We know that this phenomena is closely linked to the Disrespect and Abuse agenda, so should it not receive the same attention? 

I’ve had a long-standing interest in the language we use in maternity services, and nearly always mention it in the talks and workshops I deliver.  The list of words-not-to-use extends on almost a daily basis, with an overarching aim to improve the care we give, to maximize the potential for women to feel empowered yet supported, cared for, yet in control.

But recently I’ve been in a quandary, as I try to understand the implications of NOT saying a particular word or phrase for the above reasons – yet the consequences are potentially damaging. 

Obstetric Violence.

So I asked an open question on Twitter:

There was a mixed response, and some incredibly useful comments. Obstetricians understandibly feel they are being named and singled out as the perpetrators in the title. It should be noted that the term Obstetric Violence is used mainly in a global context, and 'ostetrica' is the name for a midwife in Italy. Others, usually women who feel they are victims, don't ponder on the detail of the term; their comments are about the fact that it's happening. 

Take a look at some of the tweets here, in my Stellar story (swipe the pages) 

Why do I care?

I remember being a young student midwife in the 1970's, seeing uncomfortable situations, and not knowing what to do about it.  The first time I saw a woman having a difficult vaginal examination which was distressing for her, she was crying, and the carer continued, eyes directed somewhere above the woman’s, as if there was a solution in mid-air.  Even though the woman had someone giving her a reassuring ‘it’s OK’, the event was highly disturbing for me. I remember feeling sick, as tears tried to burst forth like a raging sea behind a poorly constructed dam.  But I looked at others in the room, and they seemed calm, and unperturbed by the unfolding scene. So I thought that’s what I had to do – try hard to detach from the emotion, but I couldn’t.  These uncomfortable situations continued to occur throughout my career. Sometimes I was able to intervene, to act as a true advocate – but sometimes I wasn’t able, perplexed by the fine-line between urgency, authority, uncertainly, experience and fear.

In those days, I’d never heard of the term Tokophobia. Nor Obstetric Violence. I wasn’t aware of human rights, and ‘consent’ as a process was hit and miss. Like with other aspects of my life and career, when I read about topics that helped me to rationalize my broad experiences, it helped me to comprehend certain dilemmas. 

Now I am more aware. As I witness, write and read about maternity care around the world, my eyes are increasingly widening, and the dam is even weaker.  I understand the complexities, the varying context of abuse, and the implications. It's what drives me to influence change. In our book, The Roar Behind the Silence: why kindness, compassion and respect matter in maternity care, there are chapters on the topic.   Birthrights, the The White Ribbon Alliance and World Health Organisation are amongst the organisations highlighting and tackling disrespect and abuse within maternity services globally.

Elizabeth's story is portrayed in Voicing the silence - an animation exploring the maternity care experiences of women who were sexually abused in childhood. In my experience of listening to women following self-declared birth trauma, these reactions could be from any woman. We should treat ALL women with this in mind. 

4th April 2017, posted on Twitter.

The following message came through to me just a few weeks ago, from another person.

We know that most maternity care workers want to provide exemplary services, yet we know about the systemic problems within health care organisations that potentially influence the care women receive. We also know that in both resource rich and resource poor countries, women are choosing to give birth without medical assistance because they are afraid.  I could go on.

So, does OV incite fear, or place blame on one set of professionals? I believe we need to keep an open dialogue about this issue, whatever name is used, to enable women to understand their bodily autonomy, and human rights. 

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