The Weekly Dose: Violence in the labour room
Doctors work in a result-oriented manner i.e. safely delivering a baby, and protecting the mother’s health – disregarding how the latter feels during labour. Labour rooms everywhere are understaffed, and often without essential drugs; it is easy, and natural for sleep-deprived, overworked healthcare staff to feel frustration, which is only stoked by yet another patient’s cries for reassurance.
The day I almost slapped a pregnant woman in labour is the day I knew that the healthcare system is sicker than I knew it to be.
She was very young, very thin and very, very pale. Her obvious anaemia threatened the lives of both her and her soon-to-be-born child; she had been referred for a safe delivery to the specialty public hospital where I was on duty as a medical intern in the labour room. In the 15th hour of my 24-hour shift, my seniors tasked me with arranging an emergency blood transfusion for her. While I’d been tracking the progress of ten other women at the same time, I dropped what I was doing to draw a blood sample from her arm, so that I could get critical blood counts and her blood group determined with a quick dash to the all-night pathology lab.
Her limbs flailed in agony. She ranted and raved in pain. No matter what I said or did, she wouldn’t let me collect a sample. Already working on adrenaline, I was getting increasingly infuriated at how her behaviour was delaying my other tasks; besides, why the hell wouldn’t she understand that I was doing things for her own good?
A primal instinct made me want to slap her into submission. Fortunately, I didn’t. But it wasn’t the first time I’d felt the urge, and it wasn’t the last. Nor am I the only doctor – male or female – to have felt it.
What is obstetric violence?
Defined as recently as 2007, it is “the appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.”
While it has many facets, the ‘dehumanised treatment’ of pregnant women can take the form of physical assault or verbal abuse – by doctors, nurses, and attendants.
What happens in the labour room?
When a woman in labour enters the labour room, she may be curtly ordered to change into a gown, with little or no privacy. She is asked to climb onto a high metal delivery table – cold, and uncomfortable – where the attending obstetrician conducts a quick preliminary examination. This requires the woman to spread her legs wide; most women feel shy to expose themselves to a stranger – however qualified – in a room full of other women in various stages of labour. Irritated by the delay, the doctor may slap her knees open, or have a nurse forcibly keep them apart.
I have heard tales of even more horrid behaviour: women slapped when they scream too much, hit on the thighs when they don’t “PUSH!” to the doctor’s satisfaction, and sometimes, pinched out of sheer spite.
This spite is triggered by moral judgements that doctors and nurses have no right to pass: when a patient has already had ‘too many’ children, when she conceives despite being medically advised not to, when she suffers from infectious diseases like HIV or Hepatitis B, which a doctor or nurse can contract if he or she is not careful. Taunts like “you enjoyed making the baby, now why are you complaining?”, “you are breeding like some kind of animal”, and “you deserve the pain” are not uncommon.
Not all OBGYNs behave this way. Some of my seniors refused to let the high-pressure working environment get to them, and were scrupulously patient and polite, no matter how recalcitrant the patient. And some – I am sorry to say – were needlessly harsh, and brutal, even with co-operative patients during relatively lighter work periods.
All healthcare workers know this happens; not all will admit they know. Sometimes, this behaviour falls into a somewhat acceptable grey area, as reported by the matron of a public hospital in Mumbai:
“Suppose the [baby’s] head has come out and she needs to bear down, but she is not pushing. Then we have to shout because if she doesn’t push, both will suffer. Both might die. Now people say later, ‘that doctor shouted, sister shouted, sister slapped’. Now, I know these things are not right, it is against human rights, [but] they do it for the good of the baby.”
Why does it happen?
Most first-time mothers have absolutely no idea what to expect when they are expecting. Antenatal OPDs are so crowded that between examining hundreds of pregnant women one after another, healthcare staff don’t have a spare moment to counsel them about what will happen once their waters break. Many women who deliver in specialty hospitals have been referred there from one or more lower healthcare centres; by the time they arrive, they are exhausted and still clueless about why they’re there. Hence, the pain of labour comes as a shock, for which they are unprepared.
On the other hand, doctors work in a result-oriented manner i.e. safely delivering a baby and protecting the mother’s health – disregarding how the latter feels during labour. Labour rooms everywhere are understaffed, and often without essential drugs; it is easy, and natural for sleep-deprived, overworked healthcare staff to feel frustration, which is only stoked by yet another patient’s cries for reassurance. Should they attend to a real medical emergency, or ‘waste’ their time talking to someone who is experiencing perfectly uncomplicated labour?
The unsaid bottom-line is that most patients who visit public hospitals come from lower socio-educational strata, and do not know their rights. Inside the labour room, it’s an entire healthcare team vs a single, scared, vulnerable woman; there is no third-party who is vigilant for obstetric violence, and the staff knows it can get away with it, with impunity.
This system is unfair to both parties: it dehumanises pregnant women, whose lower halves are attended to while their physical and mental feelings are neglected, as well as dehumanises healthcare staff, who are capable of showing gentleness and understanding in a more conducive working environment. No child deserves to be born amidst such violence.
It’s time we paid more attention to what really happens to mothers on the day they become mothers. Because in a labour room, every day is Mothers’ Day.