Disrespectful maternity services – on the cusp of a breakthrough
In September 2018, the Society of Obstetricians and Gynaecologists released a news item:
In response to recent media reports, the SOGC feels it is timely to remind women of their rights related to labour and delivery and to remind health care providers of the importance of appropriate and caring behaviour during labour and delivery.
This is a welcome turn of events, as not too long ago in response to a story published by CBC that pulled the lid off Canada’s dirty little secret that women were being abused during the births of their babies, the SOGC’s CEO Jennifer Blake told the reporter that she’d never heard of any such complaints. The SOGC’s response at the time was to ensure that the public understood that they had no culpability in this human rights travesty:
We have no examining, licensing or regulatory authority over any health care provider…
And in personal communication with Birth Trauma Ontario, she encouraged birthing clients to report abusive behaviour to the hospital, health facilities and provincial regulatory authorities.
Indeed. The SOGC is NOT a disciplinary body and they have no authority over any practitioner. They are a society that is dedicated to the promotion of their industry.
The telling part to their news item comes in this sentence:
We also urge women who feel their basic human rights have been violated during these important life-events, to take action by talking to their health care provider, the hospital ombudsman, patient representative, or their local provincial or territorial college.
Traumatised and victimised individuals do not go to their abuser to tell them how they feel. Nor do they usually go to the abuser’s place of employment to talk about it. Generally speaking, they run as far away as they can get – especially if they are also feeling the need to protect a vulnerable newborn. We’ve already shared many of the reasons mothers don’t register a complaint after abusive or violating treatment.
What statements like these tell us is that, for the most part, the industry still doesn’t know what constitutes disrespectful services or how it impacts the recipient.
A recent study in British Columbia asked participants to complete a survey asking them to rate their interactions with their care providers. The results were analysed using the MADM (The Mothers’ Autonomy in Decision Making) scale. Almost all of the participants wanted to lead the decisions around their care, but very few felt they had a say in the care they received.
“Ninety-five per cent of women said it was ‘very important’ or ‘important’ that they lead decisions about their care,” lead researcher Dr. Saraswathi Vedam said in a press release. “But very few said they were able to.”
The study revealed that the more vulnerable the client, the more likely they were to report less respectful interactions. These vulnerable clients included recent immigrants, refugees, having a history of substance abuse, prior incarceration, homelessness, or living in poverty. Even more worrisome is that clients with greater medical and social risks were four times more likely to report lower levels of respectful interactions.
Acts of overt sexual or physical violence are rare. While that gets the most attention, disrespectful care is subtler and far more pervasive. Of the hundreds of complaints that CBC news discovered in their investigation, they identified complaints regarding the quality of the treatment they received, allegations of discrimination, unprofessional comments, and a disregard for the client’s dignity and consent.
Birthing clients overwhelmingly want to lead the decisions regarding their care, and overwhelmingly, this is being denied them.
In February, 2018, Dr. Princess Nothemba Simelela, the World Health Organization’s Assistant Director-General for Family, Women, Children and Adolescents, published a commentary entitled ‘A “good birth” goes beyond having a healthy baby’. She writes,
Today, there is a massive discrepancy in the support provided to women around childbirth. At one end of the spectrum, they are offered too many medical interventions too soon. At the other, they get too little support too late – or none at all.
Women are also reporting high levels of disrespect and abusive care during facility-based childbirth in all regions and cultures. This can totally overshadow one of the most pivotal moments in a woman’s life – the day she welcomes her baby into the world.
The consequence of disrespectful or inappropriate care is that these clients are less likely to seek health care services in the future. For the medically or socially at-risk client, this can be dire.
While disrespectful care has been extensively defined throughout the literature, clinicians still seem largely unaware of what aspect of their own behaviour contributes to the breakdown in the relationship between client and clinician that is at the heart of a traumatising experience.
A significant change in how clinicians are trained would help to address the knowledge gap between what constitutes disrespectful care and what happens when clinicians and clients interact.
Now that the industry is aware that this is a pervasive issue that is nothing less than a global health crisis where about one in ten mothers enters parenthood with postpartum post-traumatic stress disorder, it seems the next step is to help clinicians understand what exactly is disrespectful care.
However, what is complicating this next step is that far too many clinicians are dealing with professional burnout, including primary and secondary trauma as a consequence of bullying, disrespect, lack of support, and lateral abuse within their professions. Suicide rates amongst physicians are shockingly high with doctors being twice as likely to commit suicide than members of the general population and female physicians four times more likely to commit suicide than other women. The truth is that too many members of the birthing industry are unwell.
The issue of disrespect in birth services runs deep and needs to be addressed holistically and compassionately. Birthing families have been told for a few generations that the answer to a “safe” experience is to avail themselves of regulated and institutional services. Unfortunately, the result is that too many families are left traumatised and damaged and too many service providers are no longer who they want to be as professionals.
Disrespectful maternity services are the result of a toxic medical culture where the woman with the baby in her belly is the final recipient of a long history of patriarchy, hierarchical abuses of power, and plain old misogyny. Just ask the families of those dear women physicians who departed this world much too soon by their own hands.
We are on the cusp of a new breakthrough where disrespectful maternity services will include healing through compassionate connection. It’s not just the mothers who are traumatised.