2023-11-10 01:44:45
“Clean yourself up and stay in bed lying up, motionless and with your legs open and slightly bent… and don’t move!” This was the order that a midwife gave to a 38-year-old pregnant woman about to give birth in a hospital in Seville. To make matters worse, when she had the epidural, her catheter had to be reinserted into the spine several times, leaving her with cervical-dorsolumbar pain. She finally gave birth by cesarean section against her will, without having signed informed consent.
The events occurred in January 2009. After numerous legal claims, in March 2023 the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) finally held the administrative and judicial authorities responsible for what happened, expressly urging the Spanish State to protect women “from mistreatment, lack of respect and abuse during childbirth.” That is, obstetric violence.
Pursue obstetric violence
In 2007, Venezuela issued a message to the world approving the first law against obstetric violence. After her, a rosary of Latin American countries They were generating and applying analogous laws.
What has happened in the meantime in Europe? Until recently, no country had passed specific legislation, despite the high level of debate and festering between academic discussions, civil organizations and various citizen movements. This is because it is denied that there is a specific violence that can be called “obstetric”, with the bio-health class understanding that this term is offensive. But scientific research on the recurrence and severity of malpractice (often with tremendous consequences) during childbirth care is already notable. And there are already several sentences that support the sad reality of the concept in dispute.
CEDAW, considered the most important human rights treaty for women, condemned also to Spain in 2020 “for not acting diligently to protect the rights of a woman and her daughter to quality obstetric care free of violence.” The ruling forced the Spanish State to compensate a mother who was subjected to ten unnecessary vaginal exams and one induction, among other forms of violence that caused lasting physical and mental trauma.
They do not seem like anecdotal cases. It has been affirmed from the scientific community that “Spain seems to have a serious public health problem and respect for human rights in obstetric violence.” A reality that was exacerbated in the pandemicconverted into a kind of excuse to cancel fundamental rights, increasing the cesarean sections unnecessary or even leaving women give birth alone.
The only (recent) exception has been Catalonia, which, in a pioneering manner and with tremendous reluctance on the part of the medical class, has legislated obstetric violence, denouncing that it can affect the physical, mental, sexual and reproductive health of mothers, nuanced as “prevent or hinder access to truthful information, necessary for autonomous and informed decision-making.” It has even formalized a Obstetric Violence Observatory.
It is difficult to agree on the definition of obstetric violence
Define obstetric violence entails certain difficulties. It is born in certain practices and relationships in childbirth health care, understood as “dehumanized, disrespectful, hierarchical treatment, and insufficient attention in the area of childbirth,” in words from the Majorca Primary Care matron Rosa Llobera.
Talk about “violence” linked to obstetrics It is something that many medical-health professionals do not share. It is certainly necessary problematize the very definition of obstetric violence, but above all recognize its gravity and its existence.
Let’s think that concepts are tools for thinking, like states The philosophy. They represent the world, they are social categories, they allow the semantic organization of knowledge and they also impel us to act. In the case of the concept of obstetric violence, we can consider it what is called in philosophy a moral concept. densocompared to what would be an ethical concept narrow. And as a dense moral concept, when we use the concept “obstetric violence” we are not only describing something that happens, but we are assuming which is avoidable and rejectable.
It is not exclusive to Latin America
A fundamental fact about obstetric violence is where the concept originates: in Latin America, Venezuela being the first country to legislate on the matter, as we mentioned. Countries like Argentina stand out clearly in its pioneering contribution to the international debate, especially through the implementation of a Obstetric Violence Observatorywhile in Europe until recently there was no specific legislation, with the already mentioned exception of Catalonia.
and it does not obey, as has often been argued, to the fact that in “rich” countries there is no obstetric violence. Quite the contrary, Obstetric violence can occur both due to default – and lack of resources – and due to excess healthcare, and both cases often occur on all continents. The examples most notable cases of obstetric violence for excess Interventional procedures often involve the use of forceps, the Kristeller maneuver, scraping of the uterus without anesthesia, cesarean section without true medical justification, episiotomy (including suturing without anesthesia), or the administration of unnecessary medication.
Whether due to lack of means or excessive medicalization, the inadequacy in the care of a crucial universal process such as childbirth must be addressed. Being born (like dying) affects all humanityand not just to birthing mothers.
Childbirth is not just a medical act
What’s more, the human birth It cannot be reduced to a biological-physiological fact. Childbirth is by no means “just a medical act”: it is a freak complex, cultural and sociological human, radically crossed by the anthropological condition of the biocultural species that we are. It is a moment thresholdof social transformation in many senses, and which entails a impact gigantic in the life, well-being and agency of parturient women and their children.
This is how different people defend it movements genuinely rebellious and transformative, among them the association Birth is Ourswhich claims:
“The birth is ours, let it be returned to us.”
Obstetric violence should be considered a affair of ethics of public health global situation that is unavoidable to debate, given that it not only affects women mothers and their children (sufficient reason in itself), but also involves the entire human species.
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