When I was attending primary school, it was thanks to soap operas that I learned that women experience severe physical pain during labour. I was astounded by this discovery and even years later kept wondering how bad the pain was like.
Medical professionals and scientists compare the pain a woman feels during natural childbirth with that of breaking 20 bones at a time. Sounds scary? And what if the process doesn’t go the way it should, involving a lot more suffering?
Moving borders altogether
The year 2016 appeared to be a milestone for women in Eastern Europe: their desire to be heard at last was big enough to set off meaningful social change. As with a Mexican wave in the stadiums, small – but not easy – contributions from every woman who had been in similar situations came out, having a rippling effect and as a result making a huge difference.
It all kicked off with the #IamNotAfraidToSpeak (#Янебоюсьсказать) — an online flash mob that was started by Anastasia Melnichenko. This Ukrainian social activist set an example for women from her motherland, Belarus and Russia to share personal stories of encounters with sexual violence they had experienced. The flash mob went viral resulting in thousands of women posting unpleasant memories on Facebook and Vkontakte, a popular Russian social platform. The affected ladies had previously kept silent: the issue is highly tabooed in East European society, and the blame is normally imposed on the victim. But this time the world had a chance to learn how many women had been physically and/or sexually attacked, and to offer words of support. Sadly, after the flash mob, those victims who had dared to speak out went on to be verbally abused online. Nevertheless, one mustn’t forget that the whole story had more of a positive after effect.
Another campaign, equally as important and again in the form of a flash mob, took place shortly after, in the autumn of 2016: #ViolenceInChildbirth (#Насилиевродах) on Vkontakte. It brought together women with shocking experiences of mistreatment during (as well before and after) childbirth. In an open group, there are more than 11k members now and new stories are being published daily. Each of them is full of distress, each of them proves it was enough of silent suffering.
The very fact that such disrespectful and abusive treatment still exists in the 21st century is not only discouraging from a legal point of view (as an infringement of fundamental human rights), more importantly it leads to psychological and physical trauma for both women and children — and even death.
The following story could give you a rough idea of both possible mistreating acts and their outcome. For your convenience the information in square brackets names the wrong-doing. Please refrain from reading the story in case you are currently pregnant.
She was at her 38 week when her labour was induced. Feeling severe pain she asked for spinal anesthesia, ‘they turned it down saying babies are born sick after it’. [Poor pain relief, lack of information.] The midwives were screaming at her that she did not want to help her baby and were apparently ‘helping’ multiple times altogether pushing her baby bump. [Physical abuse.] They shouted asking why she had not implanted new teeth [lack of dignity] (‘I lost mine when breastfeeding my first child’), threatened to cut her down there so badly that only a plastic surgery would be able to hide those cuts. After she heard that ‘they were going to take out the baby with forceps’ and that ‘it would be born handicapped.’ [Fear for baby’s safety.] To add another dose of distress they asked if she wanted to have a sick baby. ‘I was crying asking to help my baby, I allowed them to cut me in any manner needed, if only they could help my baby to be born,’ she writes. At the end she had bruises and stitches and more issues, as well as a long-lasting depression. After two years she is stating: ‘Childbirth again? Don’t think so. At least, I want to protect my daughters from the similar shame.’
All this is just one person’s pain. Believe it or not, the rest of the stories under the hashtag partly or fully echo it. Some of them can be summarised in a sentence one victim posted: ‘When you are pregnant everyone cares for you as for the apple of their eye. After – you are a waste.’
Childbirth violence worldwide.
If after reading this you thought ‘God, this cannot happen in developed world’ then please take a minute and think again. The Birth Trauma Association’s (TBA) website keeps records of traumatising birth experiences around the UK. The association was created to inform and help women who have Post Traumatic Stress Disorder (PTSD) or some of its symptoms. This kind of disorder is not only related to those who experienced violence in labour, it is an umbrella term for many more issues including stillbirth, poor postnatal care, birth of a disabled baby. According to TBA ‘approximately 1/3d of women have some traumatic response to birth’ and around ‘200,000 women may also feel traumatised by childbirth and develop some of the symptoms of PTSD’.
In Canada an investigation held by CBC revealed at least 13 cases of female facility birth mistreatment last year. When that was happening just across the border two women, a doula (childbirth assistant) Lindsay Askins and a photographer Cristen Pascucci were driving all across the U.S. in the framework of Exposing the Silence Project. They were meeting and interviewing mistreated ladies in order to ‘advance the recognition of women’s rights in childbirth’.
Another developed country where females still face facility based labour violence is Germany. France, Italy, Spain and many more are also in the list. One should not forget developing and undeveloped states where the way women are treated in hospitals is far from being respectful. The World Health Organization is nowadays concerned about the situation worldwide, and therefore issues statements on this topic. However, much more tangible effort to battle this evil is needed.
This is the reason why Spanish activist Jesusa Ricoy started The Roses Revolution movement in November 2013. Hundreds of people and multiple organisations endorsed her campaign, leading to the establishment of a worldwide day against obstetric violence which is now on 25 November. The rose flowers have become the embodiment of these women, and they are encouraged to leave the blossoms at the doors of hospitals where obstetric violence took place.
With numbers or percentages, even with the knowledge that violence happens, it is difficult to visualise how terrible the problem is. Roses, however, as if women in blood, is an eye striking mark left on a building, a sign of inhumane treatment.
A Professional’s opinion
Mr. Airat Zalaldinov, a Russian obstetrician-gynaecologist who has worked in both state and private hospitals, shared his informed opinion on the topic. Following more than twenty-year experience, he has noticed how considerably the attitude towards a woman’s body has changed recently in Russia. Generally speaking, obstetricians are nowadays approaching pregnant women as gently as possible. Physical mistreatment during labour, however, exists, but it rather has to do with particular individual’s attitude to the profession or some mental conditions. He thinks mistreatment in Russia does not happen often, because ‘it is legally punishable’. It may happen that no mistreatment took place: quite often ‘the obstetrician and a patient just cannot find a common language in little given time.’
Mr. Zalaldinov points out that low wages together with heavy workload and lack of staff led to professionals’ en masse ‘migration’ into private hospitals. The latter are blooming: the stories of birth mistreatment together with women’s desire to stay on a safe side have also meant that far more people resort to private maternity hospitals in Russia. Such services are quite expensive, but there are more budget-friendly options as well: making a contract with an obstetrician (here prices vary a lot) or a midwife (around 18.000 rubles – 250 Euros) at a state hospital. ‘An obstetrician in a state hospital has to handle as many patients as there are.’ In contrast, when a contract between an obstetrician and a patient within a state hospital is involved ‘the patient can count on an OB-GYN, who will always be there when the very moment comes, meanwhile the rest of the patients will be treated by an on-duty obstetrician.’
Other issues existing in state hospitals are the difficulty for relatives or a partner to be allowed contact with a woman giving birth (while psycho-emotional comfort naturally contributes to a better and quicker recovery), early umbilical cord cutting (may lead to baby’s anemia), not putting a baby onto abdomen of its mother (crucial for bacterial flora exchange and setting off the sucking reflex).
Almost every third story within #ViolenceInChildbirth mentions fundal pressure (Kristeller’s maneuver – pushing on the mother’s abdomen). Mr. Zalaldinov says it used to be an ‘aggressive obstetrics’ method for speeding up the pushing stage (when there was one OB-GYN and plenty of patients waiting). Today medical professionals strictly refuse to practice it almost everywhere. It is already forbidden in Russia and many more countries worldwide. In fact, ‘there is no ground at all to apply fundal pressure even if there are 40 women waiting for one obstetrician’, says Mr. Zalaldinov.
Episiotomy (incision of the perineum) is legally OK, but it should be used only if there is a chance tissue tearing will be bigger than the size of the cut. ‘It is no more believed that cuts recover better than when the tissue was torn itself. Moreover, the latest symposiums results tell that the less interference there is in labour the better it is for everyone.’ Nevertheless, Mr. Zalaldinov does not endorse the approach used in the Netherlands either (there C-section is only performed in emergency situations): ‘in Russia if there is a chance to save and prevent the baby from birth traumas we always do all what we can’.
It is sometimes difficult to think clearly during childbirth but there are ways to minimise your own and your baby’s risks:
1. If there is a possibility take a hospital tour before you are due to deliver.
2. Read the reviews online and ask your friends about their experiences in particular hospitals, try to find out more about obstetricians and midwives who will be assisting you.
3. Bring a friend or a partner to support you during labour.
4. Write down things you do not agree with (for example, forceps, vacuum extraction), tell these to your obstetrician as soon as you can so that they can explain what other options exist in case the situation gets complicated.
5. Use B.R.A.I.N. Before giving consent to anything, ask yourself about Benefits, Risks and Alternatives of the proposed action. Listen to your Intuition and think what will happen if Nothing is done.