"Seventh Scar," or how to protect yourself from obstetric violence during childbirth

Maria Smyk

August begins; it's the sixth month of Tony's motherhood. We're sitting in a half-empty coffee shop, but after a few of my questions, the woman's eyes reveal that in her thoughts, she's in the delivery room again. She experiences 12 hours of contractions again, asks to operate on her again, hears again that if she can't stand the pain, she won't be able to be a proper mother. And then she fixes the blanket of her sleeping son, takes a breath, and says:

"I love being a mother. But it still happens that I sit in bed and then, for a moment, remember my experience in the maternity ward and start to break down. I start believing in all the humiliations… Should a woman recall these memories, thinking about her first meeting her child?"

You DIDN'T have it coming

Obstetric violence is any act committed against the will of the mother and despite her "no." These include:

• medical manipulations to which the mother didn't consent;
• concealment or incompleteness of information from doctors;
• actions that cause excessive physical pain to a woman (for example, the so-called aggressive examination to accelerate childbirth);
• an emotional pressure on the mother and negligence.

It's a common phenomenon in Ukrainian medicine, which doesn't have correct statistics. Only a few speak honestly and publicly about childbirth, because "a woman has to be patient," "everyone gives birth and you can give birth" and "she had it coming if something is wrong."

Tonia also faced this. The woman gave birth to a son at 21. Her pregnancy was difficult because of previous gynecological operations, so the doctor decided at an early stage that natural childbirth would be a risk for both mother and child. The girl was ready for the operation. But when the baby's birthday came, everything went wrong.

"The water broke at 2 am, and they operated on me at 2 pm. That is, the child was without water for 12 hours. At seven in the morning, my contractions stopped and they were induced three times with medication. And when the doctor examined me in a chair, she did it so rudely that I fainted from the pain. I remember that before that I was screaming, and my husband was holding my hand and crying," Tonia says.

Ph.D. in Law and activist Natalia Semchuk explains that the basics of health care legislation prescribe exactly how medical staff should perform medical manipulations. However, all these norms are regulatory, not prohibitive, which is the problem.

"Doctors don't provide care the way they want, but per medical protocols approved at the legislative level. But all prohibitive rules are included only in the Criminal Code of Ukraine. And one of its main principles is that what's not included in the Criminal Code is not a crime," Natalia Semchuk says.

That is, if a woman and/or a newborn are seriously injured as a result of the actions of medical staff, it's necessary to contact the police and report the crime. But obstetric aggression in most cases affects the well-being of the mother, the mother's milk, the timing of her rehabilitation, and emotional state, which are not serious injuries, according to the law.

"I didn't know it was prohibited, I just knew the baby had to come out"

Vita became a mother for the first time when she was 24. Now, ten years later and after another birth, she says, she realizes that doctors had to be brought to justice for the birth of her first daughter. But the realization came only with time.

"When I gave birth for the first time, I knew nothing. The hospital warned only that you couldn't go to the delivery room with tied hair, because the child can 'entangle in the birth canal" and that you need to have some money in your pocket so that the baby would have some in the future. They only talked about superstitions, but nothing about my rights and what they would do to me," Vita recalls.

Her birth was traumatic. At first, despite her refusing, the woman's perineum was cut, ostensibly to facilitate childbirth. Then used Kristeller method: the obstetrician presses on the mother's abdomen with the entire body weight, actually "squeezing" the baby out. Such manipulation is prohibited in almost all civilized countries because of the high risks to the health of mother and child.

"I didn't know it was prohibited, I only knew that the baby had to come out. After I was pressed on my stomach, it turned blue until the end of the birth. It was painful and scary. From time to time I fainted, I was poured with water and it all started again," Vita says.

As a result, the woman in labor received many breakages. When she was sutured, they left a piece of bandage inside, which later caused an inflammatory process. Vita says that she quickly turned to another doctor, who explained what the doctors couldn't do with her and helped her recover from her injuries. The second birth was much easier, but the first woman still remembers with pain.

In such cases, you can contact the police, but as part of the pre-trial investigation, the court will appoint several expensive medical examinations. The plaintiff will most likely have to pay for them, but after passing a decision in her favor, the defendant will pay compensation.

In blood and sweat, and humiliations

Tonia is holding her almost six-month-old son in her arms. The baby has just woken up and smiles sleepily at his mother, who calls him a ladybug and quickly kisses his forehead before speaking to me again:

"I didn't have any serious injuries after giving birth. Physically, I recovered quickly, but for the first two months, I could hardly eat and felt like a stranger in my own body. I kept remembering how the doctors shouted at me, saying I couldn't bear the elementary pain. The obstetrician said she didn't know how I lived at all if I couldn't bear it."

After several hours of intermittently losing consciousness, the woman still had a cesarean section. And when she recovered from the anesthesia, a nurse and obstetrician came to her ward and said that they could've had the operation earlier, but they hoped till the last that she was a "normal woman" and would give birth herself.

"When the obstetrician saw I had six scars on my abdomen, she said, 'I knew it was easier for her to be cut than to suffer a little bit.' Before that, I'd always felt self-conscious about my scars. And now I have a seventh scar. I want to forget it. Just forget it," says Tonia.

The expert Natalia Semchuk explains: you should make a complaint to the ministry about the doctor in such situations. When the fact of obstetric aggression is established, the doctor will be dismissed. However, the victim won't be able to count on any compensation here.

There's another option: filing a civil lawsuit. Here, as with criminal cases, an examination will also be appointed. And the woman should consult a lawyer who specializes in medical law beforehand.

"We have Article 139 of the Criminal Code, which defines the responsibility for failure to provide medical care… Obstetric aggression arose from the fact that there's criminal liability for failure to provide care, but no liability for aggressive actions. If liability is introduced for the same breach of informed consent, obstetric violence will disappear. Because now there's no punishment for a doctor doing something extra," the lawyer concludes.

How to prevent obstetric violence

When I ask Natalia Semchuk how a woman can protect herself from unwanted actions by doctors, an expert, who's also a mother of two, encourages us: you can do it.

• Choose the doctor you want to give birth with, in advance, and agree with him/her about it.
• While consulting with your doctor, create a birth plan and put in writing which manipulations you agree to and in which cases, and the ones you don't. The plan should be in several copies and given to doctors as soon as the birth process begins.
• Go into labor with two people. For example, with a partner and a doula. One of them will be able to support you, and the other one can monitor the actions of doctors.
• Familiarize yourself with your rights and how childbirth should go. You can do this with the help of appropriate directories.
• Remember that you always have the right to refuse manipulations you consider inappropriate. This right is enshrined in the orders of the Ministry of Health and international medical standards.

If you got hurt during childbirth

During childbirth, a woman is in an over-vulnerable state; she's in pain, has limited movement, and is directly dependent on doctors. Therefore, it's impossible to eliminate all risks. You should accept it if you've experienced obstetric violence. But there's still the algorithm of action in this case.

• Consult with lawyers specializing in medical issues and women's rights during childbirth.
• Report all illegal actions of the medical staff to the hospital management.
• If you have suffered humiliation, excessive pain, and other injuries that aren't considered serious, file a complaint against the perpetrators to the Ministry of Health. After that, the Ministry of Health should start the inspection.
• If you've been seriously injured, report it to the police. Most likely, the actions of doctors are incriminated as a criminal offense. After the investigation and the court decision in your favor, you'll receive financial compensation, and those guilty of the violence directed at you will at least lose their jobs.

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