Lhe recent report of the newborn who died in the arms of his mother, left alone, in a hospital bed, trying to breastfeed him, brings a major problem to the fore of public attention. That of the loneliness of women in the phase of childbirth and post-partum. A common, widespread problem. Care during the final stages of pregnancy and the first days of a child’s life is central according to the World Health Organization. But reality gives us many, many stories of suffering, abandonment and health practices that create discomfort. Such is the mass of the phenomenon that exists, in Italy, a Observatory on what is defined as “obstetric violencea”: based on input from OvoItaliain collaboration with associations The Magic Drop And Hello Lapo Onlus who financed it, a survey was also promoted a few years ago by the Doxa research institute, which highlighted the seriousness and diffusion of the facts. Some time before, the campaign was born and the Facebook page was created Stop shutting up, mothers have a voice: in which many women recounted the obstetric violence they suffered.
Childbirth as a trauma
“I’d like to say that things have changed since then but that’s not the case,” explains Alessandra Battisti, lawyer and co-founder of OVOItalia. «The level of awareness is growing, but there are still as many stereotypes related to childbirth as they are normalized obstetrical violence. For instance that childbirth is a trauma. It is if the dignity of women is not guaranteed, a trauma that is deposited deep inside each one. This is demonstrated by the testimonies of women who, many years after giving birth, are still traumatized».
The difficulty of reporting
From the hypermedicalization of an unnecessary cesarean to epidural anesthesia not administered even when screaming is requested. From not listening to the woman to imposing maneuvers without informing her. «Reporting these facts is very difficult» continues Battisti. “Many procedures are not even recorded in medical records, they are considered so routine. And women, when they experience episodes of obstetric violence, are alone, what they say is easily denied». There is no legislation clarifying that some practices cannot be routine. “But there’s also one missing culture of childbirth», explains the lawyer. “Phrases like “NYou are not able to push”, “You don’t want to give birth to your baby”, “They have all given birth, you are not capable” or “The woman is not cooperative” are very serious and show that the situation is still very serious ».
“From what world began”, midwife violence in comics
It is no coincidence that it is called From what world began (because From what world is the world women give birth in pain) the comic investigation on obstetric violence created for La Revue Dessinèe Italia by Irene Caselli And Rita Petruccioli. A comic that tells a story of obstetric violence, from the delivery room to the complaint, and also offers a rebonding ritualaimed at re-establishing the mother-child bond that the birth trauma did not allow to fully create (the mother lies down in bed, in the dark, topless. The father gives the child a warm bath and brings him wet to the mother, wrapped in a warm blanket. The mother holds the baby on her breast, in the dark, for as long as they both want. The wet skin, the heat, the dark help recreate the experience of birth).
WHO recommendations violated: what is obstetric violence?
Already NoIn 1985 the WHO published recommendations on care during pregnancy, childbirth and postpartumrecommendations also updated in 2018. In particular, there are some practices which, according to the World Health Organization, should be avoided. Avoid because they create discomfort, which for some is a real pain. Practices that are also part of the routine in our hospitals.
Just to give a few examples of unnecessary practices: the enema or the pubic hair removal routine before childbirth. L’episiotomy. There rupture of membranes. The obligatory position during labor or delivery (for example, the “gynecological” position on the bed). There Kristeller maneuver (it is a vigorous push with the arm on the abdomen which should help the baby to come out). The prohibition of food or drink during labor and delivery. Early cutting of the umbilical cord. The separation of the newborn from the mother after birth.
The Doxa survey on obstetric violence
L’Doxa-OVOItalia survey was carried out in 2017: the research “Women and childbirth” was conducted on a representative sample of around 5 million women aged between 18 and 54 with at least one child aged between 0 and 14. Many aspects were taken into consideration, from labor to the post-partum period: from the relationship with health professionals to the treatments used, from informed consent to the possibility of the parturient to make decisions up to respect for privacy.
Objective, investigate obstetric violence, defined as “appropriation of women’s reproductive processes by medical personnel”. The first data from the survey that is impossible to ignore is that 21% of women claim to have suffered it. In other words, in about 14 years a million parturients was the protagonist of cases in which she felt a violation of her dignity as a woman.
Such is the trauma that many women do not want any more children
Other data? 6% of the women interviewed was so burnt by the experience they had to decide to do not want more children. It is estimated that in our country (which experiences a worrying drop in the birth rate) every year there are 20,000 children not born for this reason. 41% (i.e. 4 out of 10 women) affirm that they have received practices harmful to their dignity or psychophysical integrity and 33% say that they did not feel adequately assisted. Almost all (99%) gave birth in hospital. 14% would not return to the same facility, while another 14% are undecided whether to change or not in case of subsequent pregnancies.
Assistance and loneliness
For 67% of the women, the assistance received was correct. But 27% of the sample (equal to 1,350,000 women) say they were only partially followed, while they would have liked to be more involved. But there is one 6% of mothers who declare that they gave birth alone, without assistance. One out of 3 felt cut off from the decisions and choices that concerned her childbirth and which, in some way, were imposed on her by the health personnel.
After giving birth, 27% of those interviewed did not receive the right support and information necessary for the successful start of breastfeeding. 19% complain about lack of confidentiality during hospital/clinic stay, while 12% were denied having anyone around them during labor and 13% adequate therapy to keep the pain under control. Finally, a fact that these days gives the creeps: in 4% of cases (about 14,000 women a year) the poor assistance endangered the life of the mother and the child.
Episiotomy
The main negative experience lived during the birth phase is the practice of the episiotomy, suffered by more than half (54%) of the mothers interviewed. 61% of these (equal to 1.6 million) say they have not given informed consent to authorize it. Once considered an aid to women to facilitate the expulsion of the child, today, the World Health Organization (WHO), defines it as a “harmful practice, except in rare cases”. Episiotomy is, to all intents and purposes, a surgical operation which consists in cutting the vagina and perineum to widen the birth canal in the expulsive phase. Compared to the natural lacerations that often occur during childbirth, this operation requires longer times for recovery with the risk of infections and bleeding.
15% of women consider it an impairment of the genital organs, while 13% experienced it as a betrayal of their trust by health professionals.
The cesarean
According to the WHO recommendations, since it is a surgical operation, it should not exceed 10%, but it is clear that in Italy it goes much further. In 2017, the figure was 32% of caesarean sections, 15% of which were urgent, 14% scheduled for medical indications. Only for 3% was it a conscious and precise choice of the parturient.
«This does not mean that the cesarean is always obstetric violence. A natural birth could be, if the parturient needs and asks for a cesarean. The alternative between medicalized and natural childbirth is really ill-posed». Each woman should be able to be cared for and her birth managed individually, for her well-being and that of the baby.
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