Violence in Midwifery Part 2: Obstetric Violence

Posted by Katy Bones

Midwives deal with violence on a regular basis. Whether its violence experienced by the women we serve, violence within systems of health care, violence against women by providers, or violence within the community of midwives, violence should be looked at continuously in an attempt to understand it, cope with it, and curb it.

“Obstetric violence” is a legal term defined by the Venezuelan government that has been talked about a lot in the birth community since Dr. Perez D’Gregorio published an editorial describing the Venezuelan laws on obstetric violence in the Dec. 2010 issue of the International Journal of Gynecology and Obstetrics. There are several links to some wonderful blogs and articles at the end of this entry that describe the particulars of the legislation in Venezuela. These laws emphasize the role of individual providers in perpetuating and engaging in violence by holding individuals responsible for their actions. D’Gregorio also recognizes the importance of health care systems in contributing to or preventing violence. He notes the importance of training, specifically in regards to upright deliveries, in supporting the autonomy of women and in respecting the natural process of childbirth. Additionally, he recognizes the limitations of individual providers in resource-poor settings where “environmental” reasons necessitate separating the mother and baby shortly postpartum. In itself, the idea that laws can change violent practices points to the importance of system changes as well as individual changes in eliminating practices that undermine the ability of women to get both the best care and the care of their choosing.

As I begin the intrapartum clinicals in January, I feel grateful to have this opportunity to examine obstetric violence with clarity and intentionality before starting to guide women through labor and birth. The very specific acts delineated by the Venezuelan laws offer explicit components of care that must be handled with knowledge and deep respect for the woman. Specifically, I recognize the importance of learning to help women give birth vertically, a skill that I haven’t yet learned or been well familiarized with. I also intend to maintain consciousness of the ways that I am learning to be a midwife, to avoid violence and to gain trust in the process of childbirth that allows me to serve women in the best ways possible.

Salon.com on Obstetric Violence

Babble.com
The Unnecesarean

Orgasmicbirth.com on Obstetric Violence

Temptation

Posted by Tatiana

I'm in earshot of the siren call of the temptresses of number-bending.  Oh, the lure, the lure!  Not number bending, exactly, but we'll call it selective emphasis. I did a research project this fall about the experience of babies in labor and birth and it involved an online survey. I ended up with over 500 responses from all sorts of birth settings (I didn't only post it in natural birth cyber land, you know!) so I have this amazing spreadsheet of quantified experience. It makes me drool just thinking about it.

I can think of dozens of fascinating comparisons to make, and it's been a pleasure to get my hands dirty with collating data. I fully expected that all of that would the fruit of this experience, but I didn't anticipate that it would acquaint me with the temptation that I can now imagine faces many "real" researchers.  Sitting before a mound of numbers and running various comparisons, it is very easy to say "Hmm, that set of numbers doesn't make much of an impact, don't bother listing it." or "Gee, those numbers make a statement but if I alter the definition of such and such to include this and that it might show it even more strongly, let's see.."

It's very much my style to go about these things backwards (trying my hand at research without really knowing my nose from my elbow with it, and then embarking on getting the academic foundation for how it "should" be done.) I can't help it, I learn well this way.  And I totally disclosed that it was an informal survey, so don't yell at me! I know I'm not a real researcher. Just one little organism pushing my own boundaries and investigating curiosities with the tools on hand.

Violence in Midwifery Part I: Intimate Partner Violence

Posted by Katy

Midwives deal with violence on a regular basis. Whether its violence experienced by the women we serve, violence within systems of health care, violence against women by providers, or violence within the community of midwives, violence should be looked at continuously in an attempt to understand it, cope with it, and curb it.

I’ve been seeing a patient in antepartum clinic that has a very interesting story suggestive of intimate partner violence (IPV). IPV is both affected by pregnancy and affects the course and outcomes of pregnancy. While the statistics of prevalence are fairly unknown, about 14% of pregnant women in the US experience IPV. IPV in pregnancy is associated with low weight gain, substance abuse, premature labor and birth, persistent STIs, anemia, vaginal bleeding, and complications associated with physical trauma. IPV is an important and relevant topic for midwives to be familiar with in order to best care for women. Intimate partner violence is challenging to fit into the process of diagnosis and management which makes midwives (and all providers) shirk away from the issue rather than dealing with it appropriately. This case study served as an important opportunity for me to become more competent in screening for and supporting women experiencing IPV.

This woman, let’s call her Josefina, came to the inner city hospital clinic where I’m doing clinicals for prenatal care. The first time I saw her she had bruises on her face that she said were from play fighting with her partner. She had been testing positive for chlamydia since the beginning of her pregnancy and had already been treated once. She said that her partner had not been treated and that they were still having sex without condoms, despite previous counseling on the importance of using condoms or abstinence to prevent reinfection. She withdrew with questioning about her social situation or the sexual relationship with her partner, and would not answer questions.