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
