Tuesday, July 5

A network of activists, lawyers and midwives to break the silence of obstetric violence

They all thought it had only happened to them and did not know why. It was the feeling that the small group of women had that twenty years ago started an e-mail list to talk about negative experiences they had had during the pregnancy and delivery of their children. From different parts of Spain, more and more testimonies were giving name to a silenced and systematic experience around the world: obstetric violence. The list grew and reached 1,000 subscribers in a short time. Today it is a pioneering Spanish association called El Parto es Nuestro, with local groups in more than twenty Spanish cities conceived as a space for support and listening among women, also for counseling.

Together with lawyers, midwives, activists and other groups and collectives, the association forms a map of initiatives at the national level whose work in recent years has also begun to bear legislative fruit: recently the Ministry of Equality has announced that it will include violence in the law obstetric as a type of violence against women; a step that organizations celebrate and trust that it will serve to put an end to this type of practice, which has physical and emotional consequences for them, and even for their babies.

The most common experiences that women narrate, explains Virginia Murialdo, anthropologist and activist of El Parto es Nuestro, are episiotomies (cutting of skin, muscles, nerves and fasciae that surround the vagina) unjustified and without consent during childbirth, administration excessive drug use, the growing tendency to cesarean sections or the so-called ‘Kristeller maneuver’, advised against by the World Health Organization, which consists of exerting pressure on the abdomen to try to lower the baby into the birth canal. Beyond specific practices, “there are also humiliating and abusive attitudes and comments,” says Murialdo, as well as “actions that do not respect the privacy” of women, from vaginal examinations without consent in front of students to the impossibility of choosing the right birthing position or macho comments that, for example, intimidate those who decide not to undergo epidural anesthesia.

Their stories are not isolated cases. Obstetric violence is a reality that the United Nations described in 2019 as a “generalized phenomenon” and that the WHO considers “A violation of women’s rights.” However, their experiences have often been silenced, many are afraid to speak out for fear of stigma and shame or downplay it. “There are many women who have normalized what has happened to them, so the first step is to break the silence and make it visible,” says Murialdo.

Complaints at the United Nations

Precisely, the Spanish lawyer Francisca Fernández Guillén has come to the UN to defend the cases of four women from different parts of Spain who suffered obstetric violence and whose complaints were not accepted by the Spanish courts. Fernández Guillén has been a lawyer specializing in obstetric violence for 18 years. Since its inception until now, it has observed “a good evolution” in which there have been important sentences that have served to pave the way for the end of impunity for this type of violence. “I am getting good sentences in court. Before it was much more difficult to recognize, for example, the need for informed consent to perform an episiotomy or induce labor ”, he assures.

However, there is still resistance to medically and judicially recognize the harm that many women suffer from this type of practice. In 2018, this lawyer brought four complaints of obstetric violence to the UN Human Rights Commission. One of them was the case of S., a woman who gave birth in the hospital in Cruces (Vizcaya) in 2012. “She has behaved very badly”, “she does not deserve that girl”, “she would have to take away the girl, because you’ve been very bad. ” These are some of the phrases that S. heard from the midwife who treated her, who also performed an undesired episiotomy despite the woman’s opposition. Since she was admitted to the hospital, they did not let her drink, they forced her to lie on her back and did not move, and they did not allow her father to accompany her at all times. The episiotomy caused urinary incontinence and “severe” repercussions on her sexual life and as a couple.

Finally, in 2020 the Commission condemned Spain for obstetric violence suffered by one of the women whose complaints Francisca Fernández Guillén had channeled. In its opinion, it assured that the woman was subjected to various interventions, such as the induction of her labor, “without apparent justification” and classified the events as gender violence. For the lawyer, that the Spanish law now includes this concept will be a dead letter if there is not a true commitment to comply with the respected delivery protocols and norms that already advise against many of these practices and that require women to be informed.

A humane and safe delivery

From the Women’s Institute of the Ministry of Equality, which corresponds to the reform process of the Abortion Law, they assure that “it is under way”, but still “has yet to make an important journey of dialogue, consultations and participation, for what is premature to determine concrete questions “. What sources from the agency highlight are several axes regarding the inclusion of obstetric violence in the norm: it plans to deepen the awareness and training of health professionals, “modernize” the current protocols and provide pregnant women with “all the necessary information on their rights “, as well as” prevent, detect and punish conduct that violates them. ”

The change is also happening within many hospitals. Soledad Carreguí has ​​been a midwife for more than 20 years at the La Plana university hospital, in Castellón. Since its inception until now, many things have changed thanks to the concerns of a group of professionals who began to consider the “excessive medicalization” of childbirth and to seek new practices that would humanize them and that were in line with the new medical evidence.

“Many clinical practices were questioned at a scientific level but due to the hospital routine itself they are difficult to change,” explains the midwife. The hospital already has a normal delivery protocol in which they share what they have learned: “We promote the mobility of women while they are dilating, we respect that they can give birth in the position that is most comfortable for them, we allow them to eat and drink, to be able to accompanied by the person they wish, who is not given a peripheral route to administer medication if it is not necessary, we avoid administering oxytocin or performing episiotomies and inductions to labor in an unjustified way, and we adapt the indication of caesarean sections to each case ”. In short, Carreguí says, it is a matter of “not working on a whim or by closed and rigid hospital protocols, but by putting women and their needs at the center and individualizing each case.” And he concludes: “A humanized delivery is absolutely compatible with a safe delivery.”

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