Obstetric violence: the law that remains pending

According to a study of obstetric violence In Chile, 79.3% of women report having suffered this type of violence. Leidys is one of them. He arrived at the hospital Port of Montt with six centimeters dilated. Despite her insistence, they did not allow her husband to accompany her until she reached nine centimeters. She suffered a long and painful labor as her baby did not descend properly. Despite her pleas, the doctors didn’t seem to listen, they wouldn’t let her get up, and over time Leidys’ pain increased. “When I saw the doctor, I started crying, grabbed his hand and said, ‘Please help me, give me a C-section.’ I’m in a lot of pain, I can’t take it anymore, I won’t be able to give birth to him.’ Ignoring her request, the doctor ordered the labor to continue and to be given oxytocin to speed up the process, even though Leidys begged them not to do so as it would only make her suffer more. Once again, she was not heard.

After several hours, the doctor decided to use forceps. “When he inserted the forceps to remove the baby, the pain was horrible, the worst of my life, and the scream I let out was heartbreaking. I think the whole hospital heard me, even though I didn’t know myself. But my baby didn’t come out, so the doctor took out the forceps and said “it failed, let’s do an emergency C-section”.

The process became complicated and resulted in severe bleeding during which Leidys’ hemoglobin levels dropped significantly. A few days after giving birth, she started experiencing abdominal pain and bloating. After being taken back to the hospital, she was diagnosed with postpartum endometritis, caused by an unknown mass causing inflammation in the uterus. After ruling out a possible tumor, they gave her antibiotics and sent her home. 20 days later, Leidys expelled gauze vaginally.

On the way to the hospital, the doctor was extremely “dismissive,” as the woman describes it. They denied it was a hoax, offered no supervision beyond hospitalization, and she was eventually escorted out by a guard. “I wasn’t expecting this treatment, I came away upset, scared and nervous, so we requested a consultation with a private gynecologist. I brought him what I had expelled and just by looking at it he told me it was gauze and therefore the cause of my postpartum endometritis.

The situation was further complicated when the hospital attempted to deny the existence of the gauze and refused to take legal responsibility for it. Leidys’ recovery was complicated and painful, affecting her ability to care for and her relationship with her baby. Additionally, she had difficulty breastfeeding and suffered emotionally due to medical neglect and lack of support. Leidys denounces the lack of empathy and respect for her wishes and needs before, during and after childbirth, which has generated an atmosphere of discomfort and distrust towards medical personnel. “I wish they would have been honest with me and explained the situation to me. If they had, I would never have reported it because I would have understood that as human beings they can make mistakes, but they lied to me,” he says.

The midwife and founder of Alma de Mamá, Pascale Pagola, defines obstetric violence as the appropriation of women’s bodies by health personnel, through practices that result from the medicalization and pathologization of their reproductive processes. “ Childbirth is considered a disease that carries a potential risk, which results in a loss of autonomy for women and a significant reduction in their quality of life,” she says.

Some of these practices are the abuse of cesarean sections, oxytocin and episiotomies, as well as lack of respect for the pregnant woman, not listening to her needs or minimizing her pain. Leire Fernández, perinatal clinical psychologist and coordinator of the Perinatal Mental Health Unit at the University of Desarrollo, explains that These practices can have negative consequences such as anxiety, depression, insecurity and difficulties in the mother-baby bond.

This is why, in recent years, various civil society groups have fought to create laws that defend women against this violence. “There is no law in Chile that addresses the concept of obstetric violence, there is no definition in Chilean legislation, but there are isolated concepts, such as the Dominga Law and the Mila Law, which seek the support for women,” he says. Fabiola Yáñez, coordinator of the Adriana Law project. The latter, initially conceived as legislation in favor of respected childbirth, is distinguished by its desire for revolution and has evolved to address gynecological and obstetric violence separately. However, it has been dormant in Congress for several years and next week its discussions will resume within the Health Committee.

The midwife, Pascale Pagola, reflects that This bill is very important for healthcare workers. “It makes us question ourselves, makes us think, makes us look at what is happening and not only near us, but also throughout Chile, South America and the whole world” . Although he affirms that after the promulgation of these laws, the medical environment has seen improvements in its technical and human aspects, certain indicators cannot be left aside.

Although there are women like Leidys who share their experiences, many prefer to remain in the shadows, causing this practice to remain silent. Leire Fernández, also a member of Alma de Mamá, explains that there are different reasons to remain silent. In the first place, There may be a lack of identification of the action as violent because many practices are normalized and families do not need to know that they are not normal.

Second, when the woman sees her baby healthy, she minimizes the importance and seriousness of the violence suffered. Phrases like “What are you complaining about if your baby is alive?” or “Now enjoy your baby, you don’t have to think about it”, can reduce the woman’s emotional symptoms, not because she does not find support or understanding. Finally, there may be insecurity because it is not clear whether an action was violent or not. For this reason, the specialist recommends socializing to clarify doubts, since often they are unknown and the environment also does not have much information because the system itself hides them.

“Compared to countries like England, where they encourage you to speak, they encourage you to ask if your birth had certain complications or generated intense emotions for you, you can go and ask for your story. Here, we are very far from these cultures. Here it’s covered, it’s silent. It doesn’t help to talk about and make these behaviors visible,” criticizes the psychologist.

Fabiola Yañez also explains that in terms of complaints and claims, the process is complex and can be intimidating for victims, especially when it comes to filing a complaint against the same healthcare provider, “you have to go complain to his own.” A violent person who goes beyond the limits,” he denounces.

Pascale Pagola proposes that to generate change, the provision of prenatal information and education is essential both to women, so that they can be free to express their wishes and preferences during childbirth, and to teams health. Although these are highly criticized, they are also neglected by their own systems because they are overworked and have few hours of rest.

Childbirth is a physiological process in which a woman needs to feel safe and be in a space of trust, recognizes psychologist Leire Fernández. This is the most vulnerable moment of the woman, if this connection does not exist the process can be inhibited, which is why the medical team must always have an attitude of care, openness and calm towards the female.

Furthermore, the specialist emphasizes the importance of being able to look at the system from the outside in order to connect and empathize with these situations. “Behavior as simple as asking can give me the key to being able to support this woman or to be able to follow the right path with her. On the other hand, if I am disconnected, if I am in a hurry, if I run around tight schedules, I will carry out, often unintentionally, practices that threaten this woman or this baby.

“The woman has something that the professional will never have, and that is the knowledge of her body, of what she feels about her baby and the instinct that also develops. On the other hand, the medical team also has technical knowledge about childbirth, about the presence of difficulties in the mother or the baby, which the mother is not obliged to have,” explains the psychologist. “If they work together, they form the perfect team to make everything go as smoothly as possible. The fact that there are complications during childbirth should not generate damage or psychological consequences if attention has been paid to the mother, her decisions and her will. Add.

Fabiola comments that the process of childbirth, which is natural and has occurred for thousands of years, has been significantly altered and changed over the last 60 or 70 years. While childbirth once occurred primarily naturally, the use of medical interventions such as cesarean section and oxytocin to aid the process has now become common. “What the Adriana bill aims to bring out the best of both worlds, biology, which allows us to exist, and the medical apparatus, which allows us to anticipate problems,” explains Fabiola, and thus guarantee care adequate, respectful and focused on the needs of pregnant women.