mothers
April 28, 2024
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Obstetric violence: physical and psychological aggression in pregnancy

To think of pregnancy as a health process and to help women take over and have autonomy in their pregnancy. For obstetrician and gynecologist Alberto Jorge Guimarães, these are essential functions of a health professional in the care of pregnant women. However, thinking, which should be agreed between doctors and nurses, is not always what happens in practice.

In Brazil, one in four women suffer some form of aggression during childbirth. The number is pointed out by the survey Brazilian Women in Public and Private Spaces, conducted by the Perseu Abramo Foundation in partnership with SESC. The research shows that many Brazilian pregnant women underwent improper procedures, poorly attended or suffered some kind of verbal violence in health institutions.

Obstetric violence causes not only physical, but also psychological and emotional harm, and ranges from a nurse asking the woman not to scream to performing procedures that accelerate childbirth solely for medical reasons.

The important thing is not only to survive childbirth, but to have the assured right of a pregnancy experience? prenatal, delivery and postpartum? dignified, positive and healthy for women and children.

What is obstetric violence?

"Any act that is against what was agreed between pregnant woman and doctor during prenatal care or the birth plan can be characterized as violence," comments Dr. Alberto And it is not only at the moment of childbirth that the woman's will must be respected: the pregnant woman must have her rights guaranteed also in prenatal, postpartum and in abortion situations.

Read also: Doula offers physical, emotional and informative support to pregnant women

? Brazil does not have a specific legal provision for obstetric violence, as is the case in other countries, such as Argentina and Venezuela. But, the legal rules currently in force in the country allow to suppress and punish such cases ?, says lawyer Tamara Amoroso Gonçalves, master in Human Rights and a member of CLADEM / Brazil.

Thus, taking into account human rights parameters and the Ministry of Health's norms, one can consider obstetric violence in public or private networks:

In pregnancy:

Denial of service;
Offensive comments of any kind;
Cesarean section scheduling without clinical indication;
Not providing enough information for the pregnant woman to make her decisions;
Neglect quality care.

At childbirth:

Refusal of hospital admission;
Prevention of childbirth being accompanied by a person indicated by the pregnant woman;
Performing medical procedures without the consent of the pregnant woman;
Performing invasive or unnecessary procedures, especially the application of oxytocin and episiotomy;
Water and food deprivation;
Any kind of verbal action that may humiliate, inferior, offend, vulnerable or cause insecurity or fear in women;
Prevent or delay the mother's contact with the child;
Prevent the right to breastfeed the newborn.

In abortion:

Denial or delay in care;
Threats, coercion or blaming of women;
Questions about the cause of abortion, whether intentional or not;
Performing invasive medical procedures or without consent and explanation.

know your rights

Regardless of the type of care? if done by professionals from public or private institutions - every woman has the right to prenatal care, which includes exams and periodic consultations. The entire process of pregnancy, from prenatal to postpartum, should be quality care and be performed by trained health staff.

In addition, it is necessary that the woman is always well informed about the risks, procedures and options so that she can be in control and make her decisions safely. In this sense, it is extremely important that the doctor provides a welcoming environment for the woman to feel comfortable and have space to ask questions and clarify any and all doubts.

This welcoming and transparent space is fundamental for women to make the best choice regarding the type of delivery, for example. In Brazil, 43% of births are by cesarean section, but the average rate considered healthy by the WHO is only 15%. In the Brazilian private network, the statistics are even more expressive: 80% of deliveries are caesarean section. Most of these cesarean sections are performed or scheduled to meet the interests of the doctor or hospital.

Read also: Humanized Childbirth: The Resumption of the Protagonism of the Pregnant Woman

ÜI am absolutely against the scheduled caesarean section. If there is no problem in pregnancy, it is important that the baby be born on the date the woman goes into labor. Is choosing the date much more aggressive for the child ?, comments the obstetrician Alberto Jorge Guimarães. Along with all the information, the woman has the right to choose the type of delivery she considers best, without having to take into account the doctor's personal interests.

The position in which the woman wishes to give birth must also be her decision: the doctor cannot intervene if the best position for the pregnant woman's body is not lying down, but squatting, for example. Procedures such as the application of oxytocin to accelerate childbirth, episiotomy, limb immobilization during childbirth and food deprivation are also violence against women.

Episiotomy, a cut between the vagina and anus, is a procedure used by doctors to speed up delivery, which can lead to future complications for women: pain, bruising, infections. According to WHO guidelines, episiotomy rates should not exceed 10%. However, in Brazil this number reaches 53.5%, as shown by the Nascer no Brasil survey.

As with cesarean section scheduling, episiotomy is often performed solely for medical purposes, without any warning or consent from the pregnant woman or actual clinical need. ? This logic [of prioritizing physician interests] needs to be reversed, the well-being of women and children must come first. Does a woman need to be empowered and know her rights and body so that she can truly make an informed choice ?, says Tamara.

In addition to the procedures, which cause physical damage to the body of women and children, verbal violence also leaves deep marks on the pregnant woman. Making a woman feel inferior, insecure, humiliated or offended in any way is as serious a form of violence as others.

What to do in case of obstetric violence?

Can victims of violence at any stage of pregnancy or childbirth performed in a public or private health network report the occurrence? and it is very important that they do so. Complaints may be filed with the hospital ombudsman, the Regional Medical Council, the Public Prosecutor's Office or the Public Defender's Office of the region. Information and guidance can also be obtained through Dial 180.

• Has there been negligence or violence on the part of the doctor or other healthcare professional? They may be nominally reported. But the hospital and the local government itself can be held responsible for the lack of care, neglect or violence at any stage of pregnancy and childbirth. A humanized service is not the exception or a choice, is it a right of all women, whether in the public or private ?, emphasizes lawyer Tamara Amoroso.

Testimonial

F. suffered obstetric violence during prenatal care. In a consultation with the doctor, at three months of pregnancy, she complained that she was in pain. The doctor's first reaction was to say that "the pain was the baby itself." Concerned, F. insisted on taking exams. With the touch exam, in the belly, the doctor's strength was such that the pregnant woman passed out. "My belly turned purple, so much so that he squeezed me," he says. When she woke up, the doctor gave the verdict: she could not have a healthy baby and suggested she not continue with the pregnancy.

The same day, F. changed doctors. The new doctor ordered an ultrasound, so she found she had a fibroid in the womb? and also that it would be perfectly possible to have a healthy child. Follow-up with the new doctor continued, and although the pregnancy was complicated due to the fibroid, the child was born healthy.

Not reported. More than 20 years later, F. is still thrilled to talk about it and says few people know what happened. Nevertheless, today she encourages other women to report, "No one should have to go through this."

Awareness Projects

In the fight against obstetric violence, projects and groups have been created to promote debate and information exchange so that women can achieve the autonomy of their pregnancies. Check out some of these projects and stay informed:

1. RANGE? Active Maternity Support Group: Directed by obstetrician Ana Cristina Duarte and psychologist Angelina Pita, GAMA's mission is to promote a positive, active and conscious attitude towards motherhood. On the site, you will find articles, products, and can learn about courses that offer information that helps you achieve this healthy and conscious attitude.

2. Birth of the Principle: The Birth of the Principle is formed by a network of Brazilian women that aims to foster female empowerment, focusing on women's sexual and reproductive rights.The network produces informational material on various points related to pregnancy; Publications can be found on the site.

3. Good Time Group: Started in 2005, Boa Hora is aimed at pregnant women and couples who go through the pregnancy process. The group seeks to provide emotional support, share information and encourage informed decision-making about prenatal, delivery and postpartum procedures.

4. Fearless Childbirth: Led by obstetrician Alberto Jorge Guimarães, Childbirth Without Fear is focused on the concept of humanized childbirth, and seeks to treat pregnancy as a moment of health and a positive experience for women.

5. Birth Narratives: Narratives of the Birth is an academic research group of the Federal University of Pernambuco. The group, which advocates respect for obstetric care as a norm, is open and you can follow the exchange of information and publications on childbirth and birth.

6. Obstetric Violence: The Facebook page already has over 5,000 followers and uses the space to share information, news and projects that put obstetric violence on the agenda.

7. 1 in 4: 1 in 4 is a project produced by photographer Carla Raiter. The goal is to encourage reflection on the theme, materializing, through photographs, the marks left in women who suffered some kind of obstetric violence.

It must be emphasized that every woman has the right to decent, respectful and quality care during the gestation period. Discussing the issue, raising awareness and reporting cases are important ways to combat obstetric violence.