By Carolyn Hecken
Trigger Warning: This article contains discussion of obstetric violence.
November 25th is Roses Revolution Day.
“What’s that?” you might ask.
The Roses Revolution is a movement established in 2013 to raise awareness about the prevalence and institutionalization of discrimination, violence, abuse and gross disregard for the authority and autonomy that a birthing woman has over her body and her baby throughout pregnancy, childbirth and the postpartum period.
It’s a call to action to stand together in solidarity and to raise our voices.
It’s a call to action to tell our stories and to have them heard, acknowledged and validated.
It’s a call to action to initiate desperately needed change in the way health professionals in childbirth approach, respect and honor a woman’s ability to make informed, autonomous decisions pertaining to her own medical care, that of her baby and her right to exercise this authority.
How is Roses Revolution Day recognized?
On this day, women who have experienced obstetric violence place a single rose, and perhaps a letter, in front of the doors of the labor and delivery wards and Kreißsäle to share their very real personal and lasting experiences of the violence, abuse, negligence and disregard to which they were subjected. According to www.gerechte-geburt.de, in 2016, roses were laid before the doors of Kreißsäle in 22% of all clinics across Germany. And, in 2017, that statistic rose to over 25%. It is anticipated that it will be even higher in 2018 as the Roses Revolution continues to make its way into the spotlight.
How many women does obstetric violence affect?
Although official statistics have yet to be gathered, the nonprofit organization, Human Rights in Childbirth, estimates that some 40%-50% of women experience physical or psychological violence during childbirth.
Berlin-based midwife Jana Friedrich addresses more local statistics in a blog article on Hebammenblog.de. Specifically, she cites a 2015 interview with Dr. Katharina Hartmann in the widely respected midwifery journal, Hebammeninfo. Dr. Hartmann, the founder of Roses Revolution Day Deutschland, contends that as many as 10% to 25% of birthing women may be affected by some type of obstetric violence.
What constitutes obstetric violence?
Obstetric violence has been and continues to be a largely overlooked and normalized form of violence against women. According the organization, Human Rights in Childbirth, obstetric violence can be manifested through:
- “Denial of treatment during childbirth
- Disregard of a woman’s needs and pains
- Verbal humiliations
- Invasive practices
- Unnecessary use of medication
- Physical violence
- Forced and coerced medical interventions
- Detention in facilities for failure to pay
- Dehumanizing or rude treatment
- Discrimination based on race, ethnic or economic background, age, HIV status, gender non-conformity, among others.”
Click here to see the original infographic.
What does obstetric violence commonly tend look and sound like in Germany?
Examples of physical and psychological violence range from the use of physical restraint to coercion and more. Below is a translation (mine) of such instances as published on the Gerechte Geburt website. View the original German here.
- Physical restraint
- Strapping down or restraining a woman’s legs
- The lack of choice in birthing position (i.e being required to lie on one’s back)
- Carrying out routine medical procedures in an unnecessarily rough manner (i.e. inserting a saline lock with demonstrative disregard for the pain it may cause)
- Performing an examination that is not medically indicated (i.e. repeated pelvic exams to assess cervical dilation when not medically necessary)
- Performing an episiotomy without consent and without medical indication
- Performing a caesarean section without consent and without medical indication
- Performing any other kind of medical intervention (use of medications, extra-uterine pressure [‘Kristellern’], saline lock) without consent and without medical indication
- Hitting, slapping or pinching
- Forcing a laboring mother to remain physically still during contractions
- Verbal abuse: for example, saying: “If you don’t cooperate now, then your baby is going to die.” or “Will you be quiet!/Would you stop moving!” or “Just look at yourself, girl. You are exhausted. You have to accept an epidural.”
- The use of insults
- Discrimination (age/weight/country of origin/etc)
- Pressure or blackmail
- Leaving a birthing mother to labor on her own (unless she has expressly requested to be alone)
- Allowing no (real) freedom of choice when it comes to medical interventions
- Abuse of power
- Sexualized violence in the form of words or jokes
- Denial of food/water; freedom of movement
- Inadequate capacity – an insufficient number of birthing suites or insufficient staff: clinic obstetrics & gynecology departments turn away women in labor despite being pre-registered
- The widespread shortage of midwives
- Pregnant women are unable to receive midwifery care prenatally, during labor and birth or in the postpartum
- Mothers of newborns are unable to find a postpartum midwife to provide lactation support (*this affects both mother and child (in terms of health and bonding, my clarification))
- The quality of care in Obstetrics and Gynecology is decreasing: laboring mothers are left in the Kreißsäle alone, as midwives are providing care for up to as many as five women at once; thus, birth becomes increasingly programmed (i.e. physical violence), for example, pain relief is administered via an epidural so that the laboring women is quiet/calm.
- The nationwide closure of hospital obstetrics departments, lack of locally accessible obstetrics care
- Issues regarding the drastic rise in medical professional liability insurance rates, specifically for midwives; midwives have no other recourse but to leave the profession
- Hierarchies in the Kreißsaal, fear of compensation claims, the system itself exerts a considerable amount of pressure on all those involved
- Economic optimization, DRG-based payment systems, intervention-free obstetrics care are not seen as being worthwhile
What options or course of action can mothers take after having experienced trauma as a result of obstetric violence?
It is important to recognize that everyone processes their experiences differently – and that the perceptions of these experiences are fluid and have the potential to change as time and information shape and inform personally held views and beliefs.
Each mother determines whether and when she is ready to take any of the steps or engage in any of the options available to her.
Below are just a handful of the various support options available per telephone, online or in person:
- The Violence against Women Support Hotline – 08000 116 016; online counsellors direct callers to local support resources
- Support Hotline: “Pregnant and in need” – 0800 40 40 020; online counsellors direct callers to local support resources
- Schatten & Licht e.V
- Talk through your experience with a postpartum midwife or OBGYN whom can trust to truly listen and offer professional support as well as relevant local resources.
- Contact Birgit at the Counselling Center for Natural Birth and Parenting, e.V. – Häberlstraße 17 Munich
- Contact the Quality Management Department at the clinic in which you experienced obstetric violence
- Be a part of the Roses Revolution: send a Roses Revolution postcard, leave a letter or lay a rose at the entrance to the Kreißsaal, for in-person support in the Munich area, contact the Roses Revolution Day Deutschland Facebook page.
- Participate in Dr. Katharina Hartmann’s survey (in German) in order to share your experience and raise awareness about the prevalence of obstetric violence
- Become involved: Association for Improvements in the Maternity Services (AIMS), Humans Rights in Childbirth, Mother Hood e.V. (German website), Improvingbirth.org, The Birth Trauma Association
By acknowledging and validating our experiences of obstetric violence, we not only begin the healing process, we simultaneously stand in solidarity with fellow mothers in the sisterhood of motherhood and set the course for change.
And, now, to end with a few words of gratitude:
Thank you to the countless midwives, nurses, doctors and other birth professionals who:
- passionately dedicate themselves to uplifting birthing women
- trust in women’s intuitive knowledge of their bodies, their babies and themselves
- respect and have reverence for women’s ability and right to autonomous decision-making
and, most of all,
- do all of this while protecting and ensuring the safety of mothers and their babies.
Carolyn Hecken is an avid learner of life, mother of four vibrant, spirited children, doula (D.A.M.E., June 2013), childbirth educator (HypnoBirthing®, June 2016) and breastfeeding counselor (EISL, September 2017). She holds a BA in Linguistics from the University of Washington and an MA in European Linguistics from the University of Freiburg. Home is wherever she’s surrounded by the laughter and shenanigans of her children, the zany humor of her husband and the company of compassionate friends. Admittedly, sunny weather and an exceptionally good cup of coffee don’t hurt either. In August 2017, this ÜberMoms writer’s nomadic family travels landed her for a two-year stint in Hamburg. Carolyn is passionate about supporting mothers, babies and their families during one of the most memorable and momentous experiences in life – pregnancy, the birth of baby and familyhood.