In the seventh post of the Birth Trauma takeover, Julia Drewnowicz continues to elucidate a central theme in this series: the failure to name obstetric violence.
I first experienced what I consider to be reproductive or gynaecological violence at the age of nineteen; such experience all too often paves the way to obstetric violence in later life. I was excited to be switching my choice of contraception from the pill to the coil, feeling grateful that I was able to have an autonomous choice at all, when I knew that so many women and girls around the world did not. This gratitude quickly subsided. With my barely-adult feet in stirrups, a stranger’s gloved fingers poked around inside of me and, for the first time, I was introduced to medical equipment that, for lack of a better term, made me feel like a farm animal. A plastic speculum opened me up, and a tenaculum – forceps with sharp hooks – pierced my cervix and pulled it steady while the IUD was inserted. I could not talk or move through the pain, so even if my doctor was willing to give me extra pain relief, aside from the two Ibuprofens I was advised to take prior to the procedure and the dab of anaesthetic cream I received during, I would not have been able to ask for it. This was in no way a solitary, unlucky occurrence; the lack of adequate pain relief during IUD insertion is a persistent issue in gynaecology (see Georgia Moot, 2023). The period-like cramps I was told I would experience after the insertion were not period-like at all. In my tiny, fluorescently lit university halls ensuite, I laid curled up in a foetal position on the grey linoleum floor for hours – a cruel mockery of my mother’s womb – experiencing cramping so severe I felt like I was giving birth.
At first, rather subconsciously, this shaped my academic interests in women’s reproductive health in literature.
The Inquiry’s failings to name obstetric violence
Five years later, during the first year of my PhD, the Report was published. It prides itself on being ‘the first national enquiry in the UK parliament to investigate the reasons for birth trauma and to develop policy recommendations to reduce the rate of birth trauma’ (APPG, 2024). I was pleased, both personally and academically, that Members of Parliament (MPs) seemed to be taking female reproductive health seriously, recognising the physical and mental pain endured by women and birthing people. But as this reflection on the report will show, as well as those written by my fellow attendees of The Birth Trauma Inquiry Response Events, the Report, while well-meaning, is disappointing in some aspects.
For a report that places so much emphasis on the truly harrowing birthing experiences of women in the UK, I was surprised to find that ‘lack of kindness’ is the phrasing the APPG utilised when referring to the obstetric violence that women who volunteered their traumatic birth stories for the report endured. It is clear to me that ‘lack of kindness’ is in no way sufficient to substitute ‘obstetric violence’, a term that the report employs only in reference to other countries, demonstrated within the fifth chapter: ‘what we can learn from other countries’ (see Hand and Nelson reflection in this collection for exploration of the Report’s use of ‘lack of kindness’). Within this section of the report, obstetric violence is defined as ‘abusive behaviour or forced intervention on the part of a maternity professional’(p. 31). The issue with this definition, and in fact with any definition of obstetric violence, arises from the slipperiness of the term, its intrinsic resistance to be easily defined in a straightforward, universal manner. Violence in and of itself is not universal, and this is doubly true when it concerns obstetrics and gynaecology.
The history of violence within obstetrics
It is especially violent, I argue, to ignore the history of obstetrics in the UK. It would be a misrepresentation of the field to generalise the germination of the violence as stemming purely from the shift of control of female midwives to male physicians. People had traumatic births, births that led to deaths, before ‘medical men’ arrived at the birthing room during the seventeenth century. Yet, mortality rates for birthing women and the violence they experienced at the hands of medical men, as explored by Jean Donnison (1993), is pertinent to note when discussing midwifery and obstetrics today.
During the nineteenth century, female midwives were being increasingly ousted from the birthing room, despite being medical professionals working within obstetrics in their own right. They were being ousted in favour of male physicians, surgeons who began their history of delivering children by negligently going straight from the autopsy table to the birthing table sans hand washing. This, of course, increased the risk of death for both the parent and the child. It was particularly apparent that, from the late nineteenth century onwards, these surgeons often utilised women’s health as a mere tool for career and monetary advancement. Hilary Marland, an academic focusing on maternal studies, for example, states that in the late nineteenth century, ‘pregnancy and birth were conceptualised as routes full of danger and obstacles. This was not particularly new, but what was new was the emphasis on careful monitoring, ‘expert’ guidance and the possibilities of medical intervention’ (pp. 24-5, 2004).
By ignoring the history of obstetric violence, the Report does little to mitigate what concerned pregnant women in the nineteenth century. In Jane Ellen Panton’s late nineteenth-century advice book to young parents, she describes her own pregnancy as having to ‘be borne in absolute silence… we have to add secrecy, and have to conceal everything and appear as usual, when we really long only to creep away in silence and die’ (p. 15, 1896). This is disturbingly echoic of the stories relayed by the women and birthing people interviewed for the Report , and, indeed, of my own experience during my IUD insertion (a year later, it was yanked out of me with no anaesthetic or other form of pain relief whatsoever).
Obstetric violence then and now
The more an obstetrical procedure is externally controlled by medical professionals, the less legal risk it poses to those medical professionals if something goes wrong. Now, as in the nineteenth-century, Jessica Cox summarises the approach to obstetrics and gynaecology as moving increasingly to a more hands-on practice: ‘[a]s the field became increasingly the domain of the medical man, so too did many of the interventions and procedures that often accompanied childbirth’’ (p. 180, 2023). Medical exams and operations on the female reproductive system ‘whether by hand or an instrument… posed a risk of infection, whilst the use of instruments, particularly forceps, could cause significant physical damage to both mother and child’ (Ibid.). Similarly, the Report describes that ‘[w]omen frequently felt they were subjected to interventions they had not consented to, and many felt they had not been given enough information to make decisions during birth’ (p. 8). In an especially visceral account, Rachael, one of the women interviewed, described being treated as “a birthing vessel” and “a slab of meat.” She added: “It was so impersonal.” (p. 24).
It is the inclusion of these harrowing, yet all too familiar, accounts within the Report that disappoints the most. There is no contextualisation for these traumatic occurrences, no situating them within the wider history of obstetric violence. Despite the Report’s inclusion of the legal background of obstetric violence as a recognisable harm (though it does not include the Latin American origins of obstetric violence as legal terminology), utilising previous research conducted in other European countries and Australia, nowhere in the Report is obstetric violence explicitly connected to the UK, and the report does not include the Latin American origins of obstetric violence as legal terminology (Williams, Jerez, Klein, et al, 2018).
Herein lies the hidden violence of the Inquiry. When the Report has the correct language for the specific branch of violence that the women interviewed for the Report endured and it purposely does not use it, the progress that the Report hopes to make for the obstetric field is undermined.
About the Author
Julia Drewnowicz (@motherstrange_ on Twitter/X) is a PhD candidate in English Literature at the University of Bristol, focusing on presentations of transgressive pregnancy and childbirth in Gothic and occult fiction.
References
Cox, Jessica, Confinement: The Hidden History of Maternal Bodies in Nineteenth-Century Britain. Cheltenham: The History Press, 2023.
Donnison, Jean, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth. London: Historical Publications Ltd., 1993.
Moot, Georgia, “Why is Pain Relief Not Offered for IUD Insertion?” accessed 30 October, 2024. https://www.service95.com/why-is-pain-relief-not-offered-for-iud-insertion/
Panton, Jane Ellen, The Way They Should Go: Hints to Young Parents. London: Downey & Co., 1896.
The All-Party Parliamentary Group on Birth Trauma. “Birth Trauma Inquiry – Listen to Mums: Ending the Postcode Lottery on Perinatal Care.” The All-Party Parliamentary Group on Birth Trauma, 2024).
Williams, C. R., Jerez C., Klein K., et al, “Obstetric violence: a Latin American legal response to mistreatment during childbirth.” An International Journal of Obstetrics & Gynaecology 125, 10 (2018): 1208-1211.
