Another round of activism against gender-based violence draws to a close today. The international 16 Days of Activism for No Violence Against Women and Children has completed its eighteenth annual campaign, with a growing number of voices stepping up to articulate the various ways we, as society, continue to fail women and children. Yet again, Obstetric Violence – the physical, verbal and emotional violence perpetuated against women in pregnancy and birth – is glaringly absent from the descriptions of violence our nations’ 16 days campaign hopes to address.

 

‘Birth’ and ‘abuse’, ‘maternity’ and ‘violence’, ‘labour’ and ‘neglect’ – harsh and crude juxtapositions that are difficult to comprehend. How could spaces and people meant to facilitate the beginning of life, also be spaces of fear and oppression?

 

As a movement dedicated to honouring motherhood and representing mothers from across South Africa, we are deeply saddened by the lack of urgent attention given to this issue. We speak to mothers who share their traumatic birth stories as matter of fact. We speak to women who, though they birthed years ago, speak of their experience as if it happened yesterday. A few weeks ago, we spoke to a family reeling from the loss of their baby who died after the mother was slapped and physically forced to delay pushing in labour.  Stories like the last are the ones that make the news. Behind and beyond the headlines is a less understood, insidious erosion of the autonomy and agency of labouring mothers. The phrase ‘all dignity goes out the window in labour’ has been allowed to take root.

 

The question that remains is why are we, as South Africans, so okay with women having traumatic experiences in childbirth? Here are some of our thoughts:

 

We’ve warped our understanding of the birthing process.

We spend too little time educating ourselves on birth. We leave the narrative of birth up to popular media. This has given rise to the assumption that birth is inherently traumatic, always an emergency, and medical expertise must always dictate the route of action. Do we have a frame of reference for low-risk, supportive and empowered births, where birth plans are respected and upheld by care providers and compassionate care is a given? This is not a vaginal versus surgical delivery debate – this is about respect and care and bringing the power of birth back to birthing people.

 

Our understanding of ‘healthy baby, healthy mother’ is limited.

As a developing country, we are understandably concerned with our maternal mortality rate and doing everything possible to decrease this. Whilst this is a necessity, it cannot be the only metric we’re interested in. A traumatic, unsupportive birth experience can leave a mother alive in the physical sense of the term, but emotionally and spiritually wounded. As we grow in our understanding of the importance of mental health – both for the mother and the infant, we need to place a higher value in the holistic wellbeing of the mother-baby dyad. Healthy mom means healthy baby. And ‘healthy mom’ encompasses physical, emotional, spiritual and psychological well-being.

 

Society has become complacent to the ‘lesser’ forms of obstetric violence.

The ‘pinnacle’ of the iceberg of obstetric violence are the stories that make the headlines, but for too long, we’ve minimised the effects of other forms of harm that can happen in labour, birth and post-partum. These include not communicating clearly and compassionately with the birthing mother, not asking for consent when performing intimate, often painful procedures, rough and frequent cervical checks, unexplained episiotomies, lack of privacy, restriction of movement in labour, restriction of support partners in the labour and delivery wards etc. Forcing these procedures on physically vulnerable women is never okay. Medical interventions may be required in birth, but in a country where we have such high rates of sexual trauma, we need to do better in communicating these needs to mothers and appropriately requesting informed consent.

As a country, we have fooled ourselves into believing that trauma is a necessary part of childbirth.

Here’s what we’re asking of South Africa:

 

Stand up for mothers.

We’re calling on society to stand up for and with pregnant and birthing people. If you know and/or love a mother, this issue should matter to you. Educate yourself on the needs of women in labour. Call your local health care centre and ask them about their labour and delivery policies. Help survivors of Obstetric Violence to seek justice and restitution.

 

Listen to mothers – believe them and show up for them.

Medical practitioners, listen to your clients, past and present. Ask them to consider a birth plan and help them to uphold it to the best of your ability. Mother-supporters, ask mothers how they’re doing. Listen to their stories and don’t minimise their experiences. The research does not lie: having an empathetic companion in the room during labour and delivery has a significant positive effect on the health outcomes of mothers and babies. So, if you can, offer to be that person.[1] You don’t need a medical qualification, just compassion and time.[1]

 

Decision-makers, pay more attention to the details.

None of the above will mean anything if you do not use your considerable power to allow it to happen. Trust the voices of mothers and mother-supporters and recruit them as allies in your work to bring healthy babies into the world and into the arms of healthy mothers. Birth should not be the seen as the exclusive province of the medical world. There are plenty of supportive people who can and should be in the rooms in which care protocols are designed, helping healthcare professionals: let them in.  Whilst the broad policy proposals are useful, they will only make an impact in women’s lived experiences if they are informed by our stories. Ask women about their experiences in ways that deliver honest answers and work with them to fix what is broken. Moreover, there are small, practical changes that you can make today, without waiting for policy or budget changes. (For example, allowing every mother to have a partner of her choice with her during labour; ensuring that every multi-bed labour ward has functioning privacy curtains etc.)

 

As Embrace, we want to reassure our community – and put society on notice – that we will be working towards eradicating obstetric violence. We will not rest until respected and empowered birth is a given for any person giving birth in South Africa.

 

If you would like to join us, get in touch with in the comments below or at info@embrace.org.za.

 

  1. Bohren  MA, Hofmeyr  GJ, Sakala  C, Fukuzawa  RK, Cuthbert  A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6.

 

Image credit: Noa Snir

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