Obstetrical Violence

from Wikipedia, the free encyclopedia

Violence in obstetrics has been a priority issue for WHO since 2014 . Many women have violent and abusive experiences during childbirth. The WHO uses a term of violence that includes physical and psychological violence. Abuse, neglect and disregard during childbirth endanger the human right to dignity and protection from discrimination. The WHO therefore calls for increased dialogue, research and advocacy. For this purpose, five measures have been formulated that must be taken to end violence in obstetrics:

  1. More extensive support to governments and development partners in research and action against disregard and abuse
  2. Initiation, support and maintenance of programs for the improvement of health care for mothers. A special focus must be the respectful care as an essential component of a high quality care.
  3. Emphasizing the right of women to dignified, respectful health care throughout pregnancy and childbirth
  4. Data collection on appreciative and disparaging care practices, liability systems and meaningful professional support is required
  5. Involve all stakeholders, including women, in efforts to improve the quality of care and to prevent disparaging and abusive practices

There are only estimates by sociologist Christina Mundlos, but no official statistics on how many women giving birth are affected by obstetric violence. This is due on the one hand to a lack of data collection and on the other hand to the taboo that arises from experiences of violence.

Violent Practices in Obstetrics

Violent practices in obstetrics can be found in the form of physical and psychological violence. There is no uniform definition of violent practices in obstetrics because this topic is not adequately addressed in the scientific literature. What is essential here is the subjective feeling of those affected. Whether or not the practice is experienced as violent depends heavily on the circumstances. The following factors can determine the subjective perception of violence:

  • Degree of dependence
  • Degree of helplessness
  • Understandability of the processes
  • Intention and attitude of the supervisors
  • Levels of violence
  • Biographical priorities
  • solidification

Experiences of violence in obstetrics are not infrequently experienced as sexual violence:

“As much as gynecology has been keen to convince us since the field was first created that its field has nothing to do with sexuality - it has. At the center of gynecology, and thus obstetrics as a sub-area, is the individual woman with her body and soul. Obstetric medicine and obstetrics care for a sexual being, the pregnant woman. Obstetrics focuses on the sex and reproductive organs of women, the associated seat of their sexuality. Care in this area, even if the focus is often placed on the allegedly asexual child, remains an accompaniment linked to sexuality and thus sensitivity and intimacy. "

Often abuses during childbirth are referred to as rape by both those affected and the obstetricians present. The term birth rape has been used in English for a long time. In Germany, sociologist Christina Mundlos spoke out in favor of using the term on her blog in 2018.

Specifically, violent practices can take the following forms:

Physical violence

  • Hold tight
  • Buckle up the legs
  • no free choice of the birth position (e.g. supine position on the birthing bed)
  • rough treatment (e.g. placing catheter unnecessarily painful, unnecessarily rough / painful examinations)
  • examinations that are not medically indicated (e.g. repeatedly feeling for the cervix if this is not wanted / necessary)
  • Perform a perineal incision without consent or medical necessity
  • to have a caesarean section without consent or without medical necessity
  • Caesarean section without adequate anesthesia
  • Carry out other medical interventions (medication , induction of labor, Kristeller handle , catheter insertion, cervical dilatation, ovipolar detachment, opening of the amniotic sac, sterilization) without consent or medical necessity .
  • unnecessarily frequent vaginal examinations (also of unnecessarily many people)
  • unnecessarily large incisions (e.g. for perineal cuts)
  • too tight / tight sewing of a perineal cut or tear (so-called Husband Stitch)
  • pulling out / tearing of the placenta
  • Incorrectly performed Kristeller handle (with elbows, wrapped in sheets, with knees on the stomach, with the entire body on the stomach, etc.)
  • Beats, slaps, pinches
  • Forced to lie still in labor

Psychological violence

  • Shout at
  • Exercising verbal violence
  • Insults, insults
  • Laugh at
  • lack of information, misinformation
  • Applying pressure, extortion, threats
  • Leaving the woman giving birth alone during childbirth (unless she expressly wants to)
  • Ignoring the woman giving birth, her wishes and questions
  • leave no (real) freedom of choice in medical interventions
  • Abuse of power
  • coercion
  • Disrespectful or undignified handling of wishes or the privacy of the childbearing woman
  • irreverent handling of placenta, umbilical cord or stillborn children
  • Sexualized violence in the form of language, jokes
  • No eating / drinking or moving
  • arbitrariness

frequency

Studies show that verbal and physical violence often occurs around childbirth. According to estimates by sociologist and author of the book " Violence During Childbirth" Christina Mundlos , at least 40 to 50 percent of all women experience psychological or physical violence during childbirth.

Global day of action against violence in obstetrics

The global day of action "Roses Revolution" is directed against violence in obstetrics and is celebrated annually on November 25th. The “Roses Revolution” campaign was launched on November 4, 2013 at the 3rd Human Rights in Childbirth Conference in Blankenberge, Belgium, based on an idea by Jesusa Ricoy. The aim is to draw attention to violent and abusive experiences during the birth process. Affected women are encouraged to place roses and, if necessary, a personal letter in front of the hospitals or district rooms in which they have experienced violence. In 2016, 22% of German clinics were given roses. In addition to gestures, violent practices in the course of childbirth also trigger dismay among midwives (especially midwifery students), as it is not uncommon for them to involuntarily witness acts of violence. It is not for nothing that one of the WHO demands in this context is the quality assurance of the institutionalized birth process with the participation of all those affected (clinic director, doctors, midwives, women giving birth, etc.).

So far there has been no significant reaction from politics in German-speaking countries.

Textbook and media

After the sociologist Christina Mundlos published the first specialist book on the subject in 2015, there was a media response in Germany and an initial rethink among the obstetrical staff. The German Midwives Association dedicated itself to the topic at its federal delegates' conference in 2015 and invited Mundlos as a speaker. Since then, midwifery associations, doula birth attendants and gynecologists have been trained in workshops by Mundlos on sensitization and de-escalation. At least the number of perineal cuts has fallen from 24% to around 19% since the book was published. The media also put the issue of childbirth violence in the context of the #MeToo debate. The "small and large border crossings that women experience because of their womanhood" are "currently discussed more urgently than they have been in a long time". When it comes to the question of what is socially acceptable, society is now at a similar turning point on obstetric violence as it did in the 1980s on marital rape.

help and support

Awareness at the institutional level is not yet developed and changes are only happening on a small scale. Individual birthing centers and clinics have high, self-imposed standards, which, however, are not adopted across the board. Women giving birth can find out in advance about common practices at the chosen delivery site. A birth plan , which is discussed with the hospital staff, can also act as a preventative against unintentional interventions in the intimate sphere of the giving birth woman. An even more legally binding form is the Justiziable Patient Will, as it was presented at the beginning of 2019 by the sociologist and doula Christina Mundlos and the bond analyst Doris Lenhard. As a further preventive measure, engaging a doula and working through previous traumatic experiences can be recommended.

Midwifery associations and trauma therapists offer help in coping with stressful birth experiences. Healthcare professionals are often not yet ready for the topic. But there are some psychologists and alternative practitioners in Germany, Austria and Switzerland who specialize in birth trauma and who have been put together by Christina Mundlos in a list of contact points .

literature

documentation

Individual evidence

  1. ↑ a b Prevention and elimination of disrespect and abuse during childbirth. Retrieved March 5, 2017 (UK English).
  2. ↑ a b Against violence in obstetrics. (No longer available online.) Archived from the original on February 28, 2017 ; Retrieved March 5, 2017 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.geburtsallianz.at
  3. ↑ Irin Carmon: What Is "Birth Rape"? Retrieved February 10, 2019 (American English).
  4. ↑ Christina Mundlos: Birt Rape - rape in the delivery room. November 22, 2018, accessed February 11, 2019 .
  5. ↑ a b Christina Mundlos: Violence during childbirth . Tectum, Marburg 2015, ISBN 978-3-8288-3575-7 , pp. 216 .
  6. ↑ a b Initiative for just obstetrics in Germany - violence in obstetrics. Retrieved March 5, 2017 .
  7. ↑ Jennifer Litters: When fully conscious, cut open the stomachCesarean section without anesthesia - why does that happen again and again? In: focus.de. May 22, 2015, accessed June 14, 2020 .
  8. ^ S. Miller, A. Lalonde: The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO's mother-baby friendly birthing facilities initiative . In: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics . tape 131 , no. 1 , October 2015, p. S49-52 , doi : 10.1016 / j.ijgo.2015.02.005 , PMID 26433506 (English).
  9. ↑ Christina Mundlos: Violence during childbirth. The everyday scandal . Tectum, Marburg 2015, ISBN 978-3-8288-3575-7 , pp. 216 .
  10. ↑ Roses Revolution - for non-violent obstetrics. Retrieved March 5, 2017 .
  11. ↑ SQG - Cross-Sector Quality in Health Care | AQUA Institute. Retrieved February 10, 2019 .
  12. ↑ Meredith Haaf: Don't touch me! In: sueddeutsche.de. May 5, 2018. Retrieved May 12, 2018 .
  13. ↑ Kristina Kiauka, in conversation with Pia Müller: Violence in obstetrics: “Girls, don't be like that”. In: SWR aktuell. November 26, 2017. Retrieved May 12, 2018 .
  14. ↑ Write a birth plan . In: BabyCenter . ( babycenter.de [accessed on March 5, 2017]).
  15. ↑ Christina Mundlos: Justiziable patient decree instead of a birth plan - a powerful instrument for self-determination. January 25, 2019, accessed February 11, 2019 .
  16. ↑ Christina Mundlos: 10 tips for a non-violent birth. January 26, 2019, accessed February 11, 2019 .
  17. ↑ Christina Mundlos: 33 Signs of Birth Trauma . February 7, 2019, accessed February 11, 2019 .