Fifty years have passed since a scandal broke over inhumane treatment of laboring women in U.S. hospitals, yet first-person and eyewitness reports document that medical care providers continue to subject childbearing women to verbal and physical abuse and even to what would constitute sexual assault in any other context. Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. Mistreatment is not uncommon and persists because of factors inherent to hospital social culture. Concerted action on the part of all stakeholders will be required to bring about systemic reform.
Keywords: abuse of childbearing women, dysfunctional hospital social systems, patient safety, post-traumatic stress disorder
Cruelty in Maternity Wards” was the title of a shocking article published just over 50 years ago in Ladies’ Home Journal in which nurses and women told stories of inhumane treatment in labor and delivery wards during childbirth (Schultz, 1958). Stories included women being strapped down for hours in the lithotomy position, a woman having her legs tied together to prevent birth while her obstetrician had dinner, women being struck and threatened with the possibility of giving birth to a dead or brain damaged baby for crying out in pain, and a doctor cutting and suturing episiotomies without anesthetic (he had once nearly lost a patient to an overdose) while having the nurse stifle the woman’s cries with a mask.
The article shook the country and triggered a tsunami of childbirth reform that included the founding of the American Society for Psychoprophylaxis in Obstetrics, now known as Lamaze International. Nonetheless, as Susan Hodges (2009) recently noted in her guest editorial published in The Journal of Perinatal Education, despite enormous differences in labor and delivery management, decades later, inhumane treatment remains distressingly common. American childbearing women still suffer mistreatment at the hands of care providers, ranging from failure to provide supportive care to disrespect and insensitivity to denial of women’s right to make informed decisions to common use of harmful medical interventions to outright verbal, physical, and even sexual assault. Furthermore, the more extreme examples are not aberrations but merely the far end of the spectrum. Abuse, moreover, results from factors inherent to the system, which increases the difficulties of implementing reforms.
ABUSE IN CHILDBIRTH: PARALLELS WITH DOMESTIC ABUSE
According to domesticviolence.org (an online resource devoted to helping individuals recognize, address, and prevent domestic violence), domestic violence and emotional abuse encompass “name-calling or putdowns,” “keeping a partner from contacting their family or friends,” “actual or threatened physical harm,” “intimidation,” and “sexual assault” (“Domestic Violence Definition,” 2009, para. 2). In all cases, the intent is to gain power over and control the victim. One could add that perpetrators, obstetric staff or otherwise, feel entitled to exert this control on grounds of the victim’s inferior position vis-a-vis the perpetrator as the following illustrate: …”
— J Perinat Educ. 2010 Summer; 19(3): 33-42. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920649