What is Obstetric Violence?

What is Obstetric Violence?

Obstetric Violence at a Glance

‘Obstetric violence’ is a term used to encompass the variety of abuses perpetrated by obstetrical professionals, including doctors, nurses, midwives, administrators and technicians, upon pregnant, labouring, and postpartum mothers, as well as upon their unborn and newly born children.

Some of these abuses are physically violent, while others are verbal, social or circumstantial. Elements of obstetric violence which are not in themselves physically violent still contribute to an atmosphere of coercion, which erodes meaningful consent to physical actions by medical personnel, and thus contributes to physical violence. In Canada and many other nations, there exists a drastically unbalanced and poorly-mitigated power disparity between medical professionals and the families for whom they are expected to provide compassionate, dignified care.

Many examples of obstetric violence constitute indictable offenses when held to the standards of justice expressed in the Canadian Criminal Code. Assault, assault with a weapon, sexual assault, aggravated sexual assault, multiple perpetrator sexual assault (gang rape), forcible confinement, harassment, criminal negligence, forgery, obstruction of justice, and even torture can be found within the realm of obstetric violence.

Examples of Obstetric Violence

Physically violent elements of obstetric violence include:

  • Genital touching, genital penetration using hands or objects, cervical examination, genital cutting, or any other manipulation of external or internal sex organs, without consent. (eg)
  • Refusal to cease genital penetration or manipulation when ordered or asked. (eg)
  • The opportunistic or strategic use of a consensual examination (cervical exam, abdominal palpation) to force an additional action, manipulation, treatment or procedure without consent. (eg)
  • Attempted or successful induction or manipulation of labour without consent, by manual stretching of the cervix, manual separation of the amniotic sac from the uterine wall, manual breaking of the amniotic sac to spill the waters, deliberate abdominal impact, or use of pitocin. (eg)
  • Performance of cervical examinations or other medical actions for training purposes without informing the patient of the true purpose and obtaining the patient’s explicit, voluntary consent to having her body used in such a way.
  • Physical restraint using hands, straps, IV lines, spinal anesthesia, or continual fetal heart rate monitor without consent. (eg)
  • The opportunistic use or deliberate application of physical pain to forcibly elicit ‘consent’ to a medical action. (eg)
  • Denying a labouring mother access to food and/or water. (eg)
  • Tricking a mother into subjection to any medical action. (eg)
  • Manual breaking of the amniotic sac (breaking the waters) without consent. (eg)
  • Manual removal of the placenta without consent. (eg)
  • Use of needles including epidural, spinal anesthesia and intravenous lines without consent.
  • Application of gas and/or related apparatus without consent. (eg)
  • Withholding of desired pain relief for labour like epidural or gas.
  • Withholding of pain relief for painful medical procedures like cutting flesh, stitching flesh, or manually removing the placenta. (eg)
  • Withholding needed or desired medical treatment.
  • Tactical intimidation in which medical workers storm into a hospital room and pantomime a dire emergency to enforce compliance by bewildering and frightening a mother.
  • Requiring that a mother give birth in any particular position, especially the lithotomy position.
  • Forced episiotomy, whether performed without attaining explicit and voluntary consent, or in violation of explicitly withheld consent. (eg)
  • Pulling violently and/or unnecessarily on a newborn during birth.
  • Failing to support a newborn in an optimal position to facilitate drainage of amniotic fluid from the lungs for a sufficient amount of time.
  • Use of suctioning to remove amniotic fluid from a newborn’s lungs when not medically indicated and/or in an overly aggressive manner.
  • Routine immediate severing of the umbilical before the placenta has naturally detached from the uterine wall, especially if the newborn has not yet begun to breathe independently. (eg)
  • Forced physical separation of mother and newborn.
  • Grabbing/pinching of breasts/nipples to facilitate breastfeeding without consent. (eg)
  • Routine manual retraction of an infant boy’s foreskin.
  • Routine infant circumcision.

Physically nonviolent but coercive elements of obstetric violence include:

  • Assigning a “due date” or “estimated date of delivery” in place of a neutral “forty week date,” verbally or in medical documentation.
  • Charging a fee (often $100) to cancel a scheduled checkup or treatment.
  • Forcing an expecting mother to leave her chaperone outside before she may have access to an ultrasound examination.
  • Refusing to let an expecting mother look at the output screen at any point during an ultrasound examination.
  • Pathologizing a mother’s fears, suspicions or resistance by informally diagnosing her with “white coat syndrome.”
  • Framing medical advice in terms of what a mother “has to” or is “allowed” to do, or what staff will “let” her do, instead of using phrasing like “recommend” and “advise.”
  • Justifying a medical action by referring to institutional policy rather than to the individual’s directly evidenced medical indication or diagnosis.
  • Justifying a medical action by referring to incomplete or generalized statistical trends rather than to the individual’s directly evidenced medical indication or diagnosis (conflating correlation with causation).
  • Weaponizing paperwork by demanding that a labouring woman sign Refusal of Care (ROC) or other forms in order to be allowed to decline unwanted treatments.
  • Threats of discharge from hospital for asking questions, disobeying orders, or declining unwanted treatments, including demands that a labouring woman sign an Against Medical Advice (AMA) form. (eg)
  • Denying a labouring woman access to any of the forms that she is being unlawfully required to sign before she may decline unwanted treatment.
  • Hiding from a patient any of her medical test results or other medical data, either by omission, by telling lies, by physically blocking her view, by verbally denying her access, or by linguistic obfuscation.
  • Deliberately using needlessly complex or confusing language and jargon to intellectually intimidate and confuse, and thereby dominate, a mother.
  • Forging medical data by writing falsehoods in a patient’s medical record (eg), or by tampering with equipment, including Electronic Fetal Monitors, their readings and their printout functions.
  • Accusing a pregnant or labouring woman of choosing to recklessly endanger her child, as this implies that the accuser may step in and override the woman’s choices, or use other authorities like child protection or police to do so.
  • Blaming, shaming or showing hostility toward a mother for her pregnancy’s complications or for consequences of actions performed by medical staff.
  • Pitting a mother against her unborn child, and even tactically subjugating a mother her to child as self-assigned representatives of the child in order to dominate the mother
  • Using the threatening phrase, “All that matters is a healthy baby,” the diverting phrase “At least you have a healthy baby,” or similar.
  • Pitting a mother against her unborn child by describing the unborn child as a “parasite,” however cleverly scientific the analogy may seem.
  • Justifying any non-consensual action upon an expecting mother’s body by asserting the legal falsehood that the doctor has “two patients.”
  • Engaging in language, behaviour or advice which in any way suggests that the unborn child is the ‘true’ patient and its encasement inside the expecting mother’s womb is an affliction upon that ‘true’ patient, which must be treated or cured.
  • Responding to a patient’s corrections with hostility, condescension, or argumentativeness.
  • Responding to a patient’s questions, requests or demands with the silent treatment.
  • Responding to a patient’s complaints with minimizing or dismissive language, informal diagnoses, jokes or sarcasm.
  • Using demeaning, condescending ‘pet names’ for a mother, like “honey” or “sweetie.”
  • Making jokes about a mother’s sexuality, sex organs, pregnancy and/or sexual relationships, especially if those jokes are at the mother’s expense or the expense of any of her loved ones.
  • Failing to acknowledge that an act of obstetric violence is sexual abuse or sexual assault simply because it is not perceived to be motivated by sexual gratification or carnal desire.
  • Behaving in any of the above ways toward a mother’s advocate(s).
  • Separating or attempting to separate a mother from her advocate(s) in any way.
  • Misrepresenting traumatic abuse and assault during birth as “traumatic birth,” to imply that the victim’s own body, rather than the attending staff, caused the trauma (victim blaming).

Obstetric Violence is Sexual Violence

A 2015 Issue Brief on the subject of Sexual Violence Against Women in Canada, commissioned by the Federal-Provincial-Territorial Senior Officials for the Status of Women, employed the World Health Organization’s definition of sexual violence: “Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting.” Clearly this includes obstetric violence, and yet the issue of medical violence relating to pregnancy is not discussed in the Brief. [source]

Obstetric Violence is Violence Against Women

A 2015 Issue Brief Sexual Violence Against Women in Canada, commissioned by the Federal-Provincial-Territorial Senior Officials for the Status of Women, employed the World Health Organization’s definition of violence against women: “[Violence against women is] any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” Clearly this includes obstetric violence, and yet the issue of medical violence relating to pregnancy is not discussed in the Brief. [source]

Obstetric Violence is Violence Against Children

[To be completed at a later date.]

Obstetric Violence Definitions Worldwide

In Venezuela, where ‘obstetric violence’ is a legal term, it is defined as: “The appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and [of] the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.” [source]

[To be completed at a later date.]

Page last updated April 19, 2020