And We Wonder Why Victims Don’t Come Forward

Just 12 hours ago, President Donald Trump posted the following statement on Twitter, his preferred forum of communication:

 

Donald Trump is referring to the alleged sexual assault that took place approximately three decades ago, where Christine Blasey Ford was victimized by Brett Kavanaugh, President Trump’s Supreme Court nominee.

President Trump, who has no training in the fields of medicine, sociology, psychology, or psychiatry, seems to feel strongly enough about his understanding of the female reaction to sexual assault to make inflammatory, victim blaming statements on a public forum. SHEESH I WONDER WHY VICTIMS ARE SO AFRAID TO COME FORWARD!

As a survivor of sexual assault, and I choose to write sexual assault rather than “rape” most of the time because that word seems to make my bones cringe every time I associate it with myself, I cannot imagine the strength it takes to come forward not only to the entire nation, but to the entire world. While I chose not to press charges or draw attention to myself out of fear and self-blame, I applaud all women who feel the strength and empowerment to come forward; I don’t care how many decades later it is. They give me strength to speak my truth. They empower me to be proud of the woman I’ve become.

Coming forward is much more complex than most people can comprehend. Victims weigh all consequences in their minds when the question of who to tell hangs in the balance. Will my dad look at me differently? Will they find out I was drinking? Will people call me a slut even though I said no? Will he tell everyone at school what I look like underneath my clothes? Will this affect my career? Sometimes staying silent and suffering alone seems a lot easier when the questions begin to run through our minds.

In short, there was a time in my life when these comments filled me with anger. And while it still ignites a passion deep within me to defend whichever victim they are blaming today, it saddens me more than anything. We are in the year 2018, and not only can people still not keep their hands to themselves, they also seem to think that revealing an intimate, violent act should be as simple as ordering food off grubhub. The victim blaming has to stop, whether its questioning the validity of an accusation due to delayed reporting or interrogating victims about their prior sexual behaviors. When you take your teenager shopping, do you blame them for breaking a fragile vase with a sign that says “do not touch” underneath of it? Or do you blame the vase for being too fragile?

                                                                                                                                            Carol Stojinski 

                                                                                                                                             DUCOM 2019

Understanding Obstetric Violence and Providing Respectful Maternal Care

WHO statement (2015): "Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care."

Even as a budding OB-GYN, I had not heard of the term "obstetric violence" until a few weeks ago. I happened to come across an article from Broadly/Vice that claimed, "There Is a Hidden Epidemic of Doctors Abusing Women in Labor, Doulas Say." Although my gut reaction told me that the article was likely clickbait, I was intrigued. The article went on to describe some cases of highly inappropriate behavior by OB-GYNs, while the majority of the claims of abuse stemmed from an unwillingness to cooperate with patients’ birth plans, episiotomies without explicit consent, excessive exams, coerced C-sections, and other procedures that the patients felt were not necessary and not properly consented for.

While a few of these cases were undoubtedly inappropriate and appalling, I saw the majority of them as highlighting an extremely common problem in medicine: a lack of communication between patient and provider. From the perspective of the OB-GYN, these actions were necessary to secure the well being of both the mother and the fetus, and sometimes these decisions must be made quickly to avoid a tragic result, which providers unfortunately know from first-hand experience. From the perspective of the patient however, these actions were frightening, painful, and their necessity was not thoroughly explained, nor were alternatives or proper consents provided.

There are currently no laws in the U.S. that directly address obstetric violence; most legal cases have relied rather on malpractice law. Several countries in South America, including Venezuela and Argentina do have laws that directly define obstetric violence and confirm pregnant patients’ rights to violence-free healthcare. Whether these laws are effective in preventing obstetric violence or bringing justice to these patients is still uncertain. While not directly addressing the issue as "obstetric violence," ACOG did release a committee opinion (#664) in 2016 that does address the ethical dilemma of trying to reconcile the pregnant patient’s autonomy with the need to maintain the well being of the fetus. While the situation can obviously be very distressing to the healthcare team, ACOG strongly recommends against coercion and confirms the capable patient’s right to refuse medical and surgical treatment, even when it can be life-saving for herself or the fetus. All attempts to counsel the patient and elicit their reasoning and knowledge should be made so that the patient can make an informed decision.

The World Health Organization also released a statement that confirmed a woman’s right to respectful healthcare during childbirth and beyond. The statement called for greater support for research and programs that can help foster respectful healthcare for women, developing policies that emphasize women’s right to respectful healthcare, and initiating a multi-disciplinary effort to educate health systems about women’s rights and holding such health systems accountable for not meeting such standards.


Obstetric violence is still a large, loosely defined umbrella term that applies to a wide range of disrespectful, inappropriate, and potentially dangerous experiences that women undergo during childbirth. More research and education are clearly needed on this topic, and health systems need to adopt actions and attitudes that better reflect women’s rights to autonomy and respectful healthcare. Ultimately however, better communication between provider and patient can help mitigate many of these issues, as well as a commitment to providing conscientious care.

                                                                                                                        Chelsea Nemeth  DUCOM 2019