What is Obstetric Violence and what can be done to prevent it?
Obstetric violence encompasses a wide spectrum of behaviors and practices that compromise the dignity and autonomy of the patient:
Physical and Psychological Abuse: This includes verbal insults, physical force, or threatening behavior by healthcare providers.
Non-Consented Procedures: Performing medical interventions (such as episiotomies, inductions, or pelvic exams) without the patient’s explicit, informed consent.
Structural and Institutional Violence: The prioritizing of institutional convenience or medical protocols over the individual needs and rights of the patient. This may involve the normalization of abusive practices as “routine care”.
Neglect or Non-Dignified Care: A lack of privacy, abandonment by providers during labor, or the denial of a chosen birth companion or free movement.
Clinical Significance
Major health organizations, including the World Health Organization (WHO), prioritize the elimination of “mistreatment during childbirth” (a term often used interchangeably with obstetric violence in research). It is recognized as both a public health issue and a violation of reproductive rights. A significant issue is the the growing backlash of pregnant people avoiding seeking medical care during pregnancy, birth and/or postpartum.
Impact on Health
Experiencing obstetric violence can lead to severe and lasting consequences for the patient and their family, including:
Mental Health Issues: Increased risk for Postpartum Depression (PPD) and Post-Traumatic Stress Disorder (PTSD).
Maternal Mortality Rates: Contributes to higher maternal mortality by reinforcing biases such as racism, ableism, and weight stigma, delaying timely care, and increasing the use of unnecessary interventions that elevate the likelihood of surgical births and related complications.
Future Care Disruption: A decreased likelihood of seeking postnatal health services for the mother or child in the future.
Physical and Social Effects: Impact on breastfeeding success and lowered self-esteem.
What research and policies are being done to prevent it?
Current medical research is shifting toward Respectful Maternity Care (RMC) as a solution. RMC focuses on improved provider communication, informed consent, and protecting the patient’s right to a safe and dignified birth experience. Many researchers emphasize that addressing obstetric violence requires fixing structural issues, such as under-resourcing, hospital policy and inadequate training, rather than just blaming individual providers.
What YOU Can do to avoid obstetric violence
1. Choose the Right Care Model: Prioritize Your Dignity from the Start
The model of care you choose significantly impacts your likelihood of experiencing respectful, dignified maternity care:
Midwifery-Led Continuity of Care (MLCC): This model, where you see the same midwife or team throughout pregnancy and birth, is strongly associated with higher levels of patient autonomy, self-determination, and preservation of dignity through personalized, relationship-based care.
Reduced Interventions: MLCC models often result in fewer medically unnecessary procedures such as elective C-sections or labor induction, reducing exposure to situations where dignity can be compromised through coercion or lack of consent.
Therapeutic Alliance: Building a trusting, long-term relationship with a provider helps ensure your individual needs, values, and dignity are consistently recognized and respected.
2. Utilize Continuous Labor Support: Protect Dignity in Vulnerable Moments
One of the most effective ways to mitigate the risk of mistreatment is having a dedicated support person who helps safeguard your dignity:
Birth Companions: Continuous support from a companion such as a partner or a professional doula is associated with higher maternal satisfaction, fewer interventions, and greater protection of your emotional and physical dignity during labor.
Advocacy and Navigation: Birth companions play a critical role in maintaining your dignity by ensuring your voice is heard, your boundaries are respected, and your preferences are honored, especially when you may not be able to advocate for yourself.
3. Collaborate on a Birth Plan: Center Your Dignity in Decision-Making
A birth plan is more than a list of preferences; it is a tool for asserting your dignity through Shared Decision-Making (SDM):
Communication Tool: Develop your plan collaboratively with your provider during prenatal visits. Use it to clearly express your values, cultural needs, and expectations for respectful, dignified care.
Protective Factor: Establishing clear expectations helps safeguard your dignity and can reveal red flags if your provider dismisses your preferences or frames options as something that is not allowed, rather than engaging in respectful dialogue.
4. Enhance Health Literacy and Self-Advocacy: Claim Your Right to Dignified Care
Empowering yourself through information strengthens your ability to demand and maintain dignity in your care:
Shared Decision-Making (SDM): The gold standard for respectful care, SDM ensures that your dignity is upheld by involving you as an equal partner in all decisions about your body and your birth.
Health Literacy: Patients with higher health literacy often feel more confident asserting their rights, asking questions, and ensuring their dignity is not overlooked or dismissed.
Informed Consent: You have the right to give or withhold explicit consent for any medical procedure. Respect for dignity means no intervention should occur without your fully informed, voluntary agreement, including routine exams.
5. Evaluate the Birth Facility: Choose Environments that Institutionalize Dignity
Institutions vary in their commitment to Respectful Maternity Care (RMC), which is fundamentally rooted in dignity. Consider asking:
Facility Policies: Does the hospital support your right to continuous companionship, recognizing its role in preserving dignity and emotional safety?
Staff Training: Does the facility train staff in interpersonal communication, ethics, trauma-informed care, and dignity-centered practices?
Intervention Rates: Facilities with very high rates of elective interventions may reflect systems where efficiency or routine overrides individualized, dignified care
Your bottom line is:
Avoiding obstetric violence is not just about reducing harm. It is about actively seeking, expecting, and insisting on care that protects your dignity at every stage, in relationships, decisions, environments, and interventions… and that will inherently be less likely to be harmful.
