On Obstetric Violence, and why that term exists at all
Trigger warning: Women with mental health issues like anxiety and postpartum depression should avoid reading this until they feel better
As the topic suggests, I am going to cross a line today. A few lines, in fact.
I cross a line between private and public. I am sharing a deeply personal story here. I considered changing my own name for this but finally decided that it will carry more power as a personal account.
I cross the line from witty to just plain angry. A better writer (or a writer in a better mood) might be able to, but I could find no jokes to make about this one.
And finally, I cross a line today by getting into some graphic descriptions which are usually uncharacteristic of this newsletter. Please heed the trigger warning above.
Let us begin with the most important day of my life so far.
I had a baby 18 months ago, almost to the day. And it has taken 18 months for me to process that the birth of my child, a difficult day for any woman, was made torturous by the very person who was supposed to be our caregiver – my Doctor.
When we first found out I was expecting, the husband and I decided – as most parents do – that our baby deserved the best healthcare we could provide. We headed to one of the most renowned private hospitals in Delhi and approached the Head of Obstetrics there for good measure.
The months of pregnancy taught us quite a lot about the healthcare system. We learned to prepare for long waiting times at prenatal visits, even when we had prior appointments. We learned to expect being relegated to junior doctors, even when a personal appointment with my Doctor was booked. Most notably, we found that these junior doctors were often nicer, more humane, and treated me like an actual human being with the fears and concerns to allay.
My actual Doctor, on the other hand, saw me with all the humanity of a Russian Doll. To her, I was merely a body carrying another body inside it. The check-ups with her were rough, quick, and business-like. The facetime given to me was short and curt. And she never seemed not-irritated during phone calls, even when she asked me to make them.
These things kept niggling at me but I kept brushing them aside, reminding myself that she is the Head of Obstetrics.
That has to be a good thing, right?
If a doctor is not giving me attention, I should count myself lucky to be healthy, right?
My delivery will go as smoothly as possible under her care, right? Right?
Wrong. So horribly wrong.
My baby was born through C-Section. Let me paint a picture of what going through surgery is like, for those of you fortunate enough to have never had one.
You are made to lie on a bed and wheeled into the operating theatre (OT). For a C-Section, you are given spinal anesthesia – a needle that looks a lot like the comical horse injections used in cartoons. Except there is nothing funny about it because for the following 30-45 mins, everything is going to be entirely out of your control and everything can go horribly wrong at any time.
It is not fun that you are awake and conscious to witness and remember it all.
It is not fun to see your guts splashing around in your own blood, reflected in the surgical lamp overhead, while you lie there, helpless. A monitor right next to your head is continuously beeping a bunch of stats at you. Pulse, BP, oxygen – screaming reminders of your very fragile mortality.
But all this is a part of any C-Section.
Here comes the part where my Doctor takes a difficult day, and makes it the most traumatic memory of my life.
10-15mins into the surgery, when she was about to pull the baby out, she began having some difficulty getting a hold of him. To my shock, she suddenly started yelling at all the staff in the OT.
At one point, I distinctly recall her shouting “OH SHIT OH SHIT OH SHIT”. While her hands were inside my body.
My mind inevitably started going to dark places. If my Doctor, my famous HEAD of Obstetrics, was screaming right now, how bad is my situation exactly?
Is the baby going to be okay?
Am I going to survive?
If I die in here right now, what with my family standing outside go through? Who will raise my baby?
Meanwhile, the doctor was going on screaming, leaving me convinced that the worst was about to happen.
I couldn’t help but wonder – as women often do – if it was somehow my fault.
I didn’t need to wonder too long. As soon as she ran out of shouting fodder against her colleagues, she turned her attention to me.
“HOW MUCH WAS YOUR SUGAR DURING PREGNANCY? HOW MUCH WEIGHT DID YOU GAIN?”
A couple of reminders. She has been my Doctor for 9 months at this point. She has all of my blood sugar test reports. She knows my weight down to two decimal points. She even had me poke myself with a needle thrice a day every day in the last month to ensure my sugar was in the normal range.
Now, there is a time and place for a doctor to show concern about a patient’s weight and blood sugar. I am no doctor, but I am fairly certain that while-she-is-lying-open-on-the-table is certainly not that time.
Once again, I was reminded that, to her, I was not a real person with real feelings. I was an inconvenience that made her come to work on a public holiday. And she thought it was perfectly okay to show me exactly how much I had inconvenienced her today. While she was still covered in my blood.
Two days after the birth of my son, as I was recovering in the hospital, my son was taken to the NICU for phototherapy for 48 hours. Jaundice in newborns is fairly common and I knew this could happen. My biggest fear was being discharged and asked to go home while my baby was still in the hospital – alone and separated from his mother, days after coming into this world.
I was visiting and feeding my son in the NICU every two hours. Being pushed across two ends of the hospital by my husband on a wheelchair, I was way past the point of thinking about the indignity of begging. I went to my Doctor, and howled and cried and begged her to let me stay in the hospital till my baby was discharged.
She ignored my pleas and discharged me anyway.
There was no way I could leave. So I spent the last 24 hours in the makeshift Waiting Room in the hospital basement. It was a dingy room, where waiting relatives watched cricket on full volume to pass the time and had access to a semi-clean public toilet. Our wheelchair privileges were taken away with our room so my husband and I begged a security guard to let us use an old rickety one in the basement. Thankfully, the security guard felt more deeply for a new mother’s plight than her own Doctor.
I slept fitfully on a sofa – stitches and everything – knowing my son was a few floors above. Just a stolen wheelchair ride away.
Needless to say, I think I had post-traumatic stress for almost a year after this, combined with postpartum hormones, lactation hormones, sleepless nights and, suddenly, a life that depended on me every second of every day. I was drowning in an unholy cocktail of depression, self-pity, shame, and self-blame.
In the few hours of disturbed sleep I would get, I had nightmares of being back on that table, my guts and blood everywhere, a machine beeping stats of my impending death, and my Doctor shouting at me, threatening to separate me from my baby.
I have never told this story before. I still don’t know how it will be received. I just felt it needed to be out there so other women know what to watch out for.
The two saddest words
As it turned out, I need not have gone through all that self-pity, shame, and self-blame because experiences like mine – and far, far worse – are shockingly common in women’s healthcare.
In fact, there is an entire field of study dedicated to it. Its name is the saddest combination of two words I have ever heard – Obstetric Violence.
People go to obstetricians (doctors who deliver babies) to bring joy and happiness into their lives.
But what do you do when the person in whose hands you put your life and your unborn child’s life treats you with violence?
Correction, the sadder two words – Birth Rape
Priya is a Physiotherapist by training and, as such, has seen the inside workings of maternity wards at many hospitals. Her sister gave birth in the general ward of a government hospital.
“My sister’s in-laws insisted she deliver in a government hospital, even though I wanted her to be in a private hospital. Being in the general ward meant that no family members were allowed inside since there were a number of other women in labour around her.”
All alone and at the mercy of the hospital staff, Priya’s sister went through 36 hours of excruciating labour before having to have an emergency C-section.
“In those 36 hours, she was subjected to a number of cervical examinations, and no one asked for her permission or consent before conducting any of them.”
This is par for the course in India. But in western countries, there is a term for it – ‘birth rape’. It may seem like an extreme term, until you realize that violation of a woman’s body without her consent is the exact legal definition of rape.
The way Priya’s sister was treated by the nursing staff can be described in no other words than pure sadistic cruelty.
“She was crying in pain. The nurses told her to stop – as if she could control it. One of the nurses commented, ‘Tab toh bahut maza aa raha tha, uchhal-uchhal ke. Ab kyun drama kar rahi hai?’ (You were having a lot of fun when making this baby, weren’t you? Must have been jumping with excitement. Why all this drama now?)“
My blood boils just writing these words down. But Priya’s tale of horrors is just getting started. Here is what her sister was given by way of pain management.
“She was asked to clench her teeth or bite her own hand during contractions to endure the pain. The staff did not even allow her to scream in pain, let alone teach her basic breathing techniques or offer her an epidural (a form of anesthesia to numb labour pains).”
Priya says that as a healthcare professional herself, she understands lack of hospital staff or resources, but the way her sister was treated was just inhuman.
“She soiled herself once during labour, which is quite common. Instead of comforting her that this is completely normal, they made her get up and clean the bed herself.”
Priya regrets letting her sister go through this and not taking a stand to protect her from this nightmare.
“I have seen this happen all too often in my work in hospitals. Once, I actually saw a nurse slap a woman to stop her from crying during labour.”
At this point in her story, I was shocked into silence.
Priya’s actual words to me: “Such stories of abuse during childbirth are very common in hospitals. I am really surprised by your reaction.”
I asked her why this happens, according to her. Many departments have fund and resource crunch. The medical profession is a high-stress job by definition. But we never hear stories of an accident victim or a cancer patient being slapped by a nurse to stop him from crying in pain.
“I think such abuse is perpetrated with impunity because women are more vulnerable than men, especially during child birth when our main thoughts are just focused on the baby. Nothing else matters. So we even tolerate abuse. And it is tolerated because, remember, most women do go through similar abuse at home, at the workplace, and in society at large. At some point, we can become so accustomed to it that we don’t even see it as objectionable anymore.”
“She must be doing this to her husband every night”
It is not even only during childbirth that women go through this abuse. Nor is it only women with no agency and no voice who suffer in silence.
Nisha would get excessive pain during her periods. Her mother-in-law took her to a gynaecologist for a checkup.
“The ob-gyn asked me to lie down on the check-up table. Then, without a word of warning, she just thrust her fist into my vagina in front of four other junior doctors. I was shocked and instinctively pushed her hands away. She turned to her team and smirked, ‘Poor husband of hers. She must be doing this to him every night.’ I was appalled at how crass, stupid and insensitive she was. And this is a very senior and well-respected doctor in my city.”
Nisha is not a woman who shies away from speaking up. Her husband – who was not in the room at the time – was surprised she didn’t call out the doctor for this unprofessional conduct and downright harrassment.
“I am normally very forthright. But in that moment, I actually felt very overwhelmed. I felt like a failure. I can’t believe it now but I actually apologized to her. I later also told my mother and mother-in-law. Both said, rather stoically, that they have seen and been through worse, especially during their deliveries.”
It gets worse.
I spoke to a friend who is a doctor. She wished to not be named, so let us call her Dr G. If you think we have heard some horror stories so far, Dr G’s account will give us sleepless nights.
“It is true that there is something about the ob-gyn practice that reeks of sexism and abuse towards patients. All doctors are over-stressed and over-stretched in a government setup. But no other discipline has the kind of systemic abuse towards patients as ob-gyn.”
“During my medical internship, I have myself delivered babies and done a rural stint at a district hospital. In one case, even though the hospital had supplies, the maternity ward gave nothing to its patients. Forget epidurals to bear pain, women were not even given bedsheets to lie on. They would be stripped and asked to deliver babies on a steel bed with no mattress on it. They would be screaming in pain and the nurses would shout at them to shut up. I remember I was giving anesthesia to a patient while doing her episiotomy (google at your own risk) and the nurse came up to me and said, ‘Madam, why are you wasting the anesthesia on her? Isko already itna dard ho raha hai, thoda aur dard hoga toh kya fark padhta hai? (She is already in so much pain, what is the difference with a little more pain?)’ I have myself seen a male doctor who would use this time when a woman is in labour and is vulnerable to touch her inappropriately when he thought no one was looking.”
“Many doctors have a God complex. Meanwhile, no one calls us out when we are not even being decent humans.”
Credit where it is due
When I think about it, I didn’t speak up about my own case until now because of all the above reasons – the shame, the vulnerability, the notion that “doctors know best”. And after all of it, a part of me still feels grateful to my Doctor for delivering my child. And maybe that is a part of the problem.
I do not wish to malign an entire profession by writing this piece. I have a lot of respect for healthcare professionals – they save lives every day, I genuinely cannot think of a more noble way to live your life. And which year has shown this better than the one gone by?
I also want to give credit where it is due: Through my entire ordeal in the OT, my Anesthesiologist was stroking my hair and talking to me in a soothing gentle voice about the joys this baby will bring to my life, even as my Doctor was shouting in the background.
She joked with me about how all mothers lose weight running behind a toddler. She gave me a beautiful vision to hold on to, even in the middle of that hellish nightmare. Her medical talents aside, she probably saved my life with her basic human empathy that day.
But it is also true that the birth of my child will forever be a memory in mind associated with the trauma of my surgery, and crying in hospital corridors afterward, and sleeping on a hospital waiting room couch because my Doctor mercilessly threw me out while my baby still needed me.
Dr G’s advice for women, husbands, and family members: “Make sure you pick your doctor wisely. If you get a sense that the person is not treating you with basic respect on a pre-natal visit, take that as a sign and change doctors before they get a chance to traumatize you for life. Make a birth plan with your doctor – both, in case of a natural delivery or a C-section. Meet your Anesthesiologist and make sure your pain management is their top priority.”
Spouses: Educate yourself to prepare for the big day. Make sure you stand up for your wife, protect her wishes, her dignity, and her humanity when she is incapacitated to do it herself.
Doctors and healthcare professionals: We say we are a culture that worships mothers, and yet we treat women worse than vermin on the day they become mothers. Childbirth is difficult enough without a woman’s own medical team making it worse for her. Remember, everyone is stressed but no one more so than the petrified human being on the table.
In the headrush of being accomplished doctors and nurses, let us not cross the line of being decent humans.