When gynecologists gaslight women

From the UK to Ukraine, women are forced to endure traumatic reproductive health procedures without adequate pain relief because their pain "is not possible" or not important enough to prevent. In some cases this leads to torn uteruses and PTSD.

Guest Mavens
Sian Norris NewsMavens, Europe
When gynecologists gaslight women   - NewsMavens
Pregnant woman, PixaBay

“This is what happens when you like men too much.” These words were spoken by a Zagreb doctor to a young woman during a surgical abortion. The woman then had her womb scraped without anesthetic, while the surgeon joked with his medical team about her sex life.

Her devastating testimony is recorded in a complaint to the UN Special Rapporteur on the Right To Health by the Croatian Parents’ Rights organization RODA. The organization invited women to submit their experiences of enduring reproductive healthcare without anesthetic under the campaign banner "Breaking The Silence" (#PrekinimoŠutnju). In the space of a weekend, they received 400 handwritten submissions.

“The stories involved women who had biopsies on their uterus, cervix or vagina without anesthetic,” RODA’s Head of Reproductive Rights Daniela Drandic told me over the phone.

“There were stories of women who had been through medically assisted fertility treatments and had their eggs removed without anesthetic. Women being sutured after childbirth, having their placenta manually removed, and surgical abortions or miscarriages, all without anesthetic.”

In some shocking cases, Drandic explained, “women were offered a shot of hard liquor before a procedure to make it easier.” One woman was scolded by her doctor while having samples taken from her reproductive organs. He said: “you didn’t cry while having sex, so shut up now.”

This is the reality of “obstetric violence” in Europe. From the UK to Ukraine, women are failed by the medical establishment and forced to endure procedures relating to their reproductive health without adequate pain relief. In some cases, the women’s experiences led to further complications such as torn uteruses, and PTSD.

Across the Adriatic Sea in Italy, birth activist and co-founder of Obstetric Violence Observation In Italy – or OVOItalia – Elena Skoko has collected similar stories via the campaign Mothers Have A Voice.

Over Skype, Skoko told me “many gynecological procedures are done without pain relief or the anesthetic is not working properly and women are not believed when they complain. Other times, as in childbirth, pain relief is forced on women. Women’s point of views [are] not taken into account when it comes to their experiences and to the care they need or want in maternity and childbirth. They are infantilized and made to feel inferior, which puts their life and the life of their babies at risk.”

OVOItalia has collected stories from women experiencing verbal abuse and even physical assault while in labor. One common technique called the Kristella Maneuver (the applying of pressure to the uterus to assist in vaginal birth), OVOItalia co-founder Alessandra Battisti described to me as “very traumatic for women because they do not expect it. The women feel they can’t breathe and many times they have broken ribs.”

The last acceptable form of violence against women

As with Croatia’s "Breaking the Silence", OVOItalia invited women to submit their testimonials of obstetric violence, including abuse during childbirth. They then conducted a nationwide survey to gather data on women’s experiences of reproductive healthcare.

“Our campaign is the first time in Italy so many women have talked about their personal experiences of childbirth,” Battisti told me over Skype. “Women used to talk only in closed spaces among a few friends. There was not a public speech about it.”

According to Skoko, this silence was, in part, “because we didn’t have a discourse around this form of violence. Women, mothers, activists, researchers -- they knew what they were talking about but it was very difficult to frame this experience of traumatic birth. Then in 2006, Venezuela made a law on gendered violence and they called this ‘obstetric violence’.”

But what is behind what US writer Elisa Albert calls “the last acceptable form of violence against women”? Why are women forced to endure painful and upsetting procedures without anesthetic? And why are women experiencing such unnecessary pain and trauma in the delivery room?

“Firstly it’s a multi-generational problem that has been going on for as long as hospitals have existed,” Drandic explained. “So when a woman says to her mum or sister or friend that she had a painful procedure, the response she gets is that this is just the way it is done. Secondly it’s a culture of reproductive healthcare that’s offered to women. We’ve had stories of trainee doctors questioning why women aren’t given some kind of pain relief and the response is always that’s just the way we do it.”

“I think it has a lot to do with the cultural idea that women have to suffer in order to be worthy,” she continued. “To be worthy of being mothers, to be worthy of being women, to be worthy of being anything. It’s a woman’s job, right? To deal with pain. That’s the idea we need to be challenging.”

Slovakian activist Zuzana Kriskova, who co-authored the report Women Mothers Bodies One and Two, agreed. “The rights to make decisions on your own body is not something you are taught from infancy,” she told me over Skype. “Women are taught to behave in a pre-approved way -- not to provoke or be emotional. There’s an image of the good mother who sacrifices herself for her baby, and the pain of women is seen as good for them.”

For Alessandra Battisti, the causes of obstetric violence can also be explained by a refusal to believe women when they talk about their lived experience -- especially when it comes to pain.

“It’s the same pattern that we observe with any other forms of violence against women,’ Battisti told me. “Women are considered to be exaggerating. When women say they feel pain, as after a c-section or episiotomy, the doctors tell them ‘no you are not in pain’. People think it’s only the woman's view, and the stereotype that women tell things which are not true is still very strong.”

Kriskova reflected this analysis, telling me “male doctors are seen as having the knowledge and the knowledge that women have of their own bodies is seen as not reliable or acceptable.”

Your pain is not possible, he says

This idea that a woman’s account of her own pain is not valid or trustworthy is supported with evidence collected by OVOItalia. The campaign has received stories from women “who were receiving a c-section before the anesthesia was starting, so they could feel the cut with the knife. But when the women say they feel the pain, the surgeon says it’s not possible.”

In Hungary, the activist group Másállapotot a szülészetben (Changes in Maternity Care) has also collected women’s stories, as well as organizing direct actions such as flashmobs. They argue that “obstetric violence is a form of gender-based violence widely accepted ‘in the sake of the interest of the baby’. Women need to accept that the interest of the baby comes first [to medical doctors], and their bodily integrity and self-sovereignty is not a priority in any way.”

This is why, according to Kriskova, “we need to inform society that women have rights. We need to change the attitudes of healthcare personnel, who don’t see women as people competent to make decisions about their own bodies.”

Uteruses are STILL taboo

Earlier this year, Croatian MP Ivana Ninčević Lesandrić experienced first-hand what it meant not be believed when she spoke out in the country’s parliament about her own experience of obstetric violence. Discussing this with me over email, she explained how “I came to the emergency department because I was bleeding, and they told me I was having a miscarriage and they had to do a cutterage procedure. After that, they tied my hands and feet, and a procedure was done so that I felt every second of it.”

In response, the Parliament’s Chairman Goran Jandroković complained that he had been put “in an uncomfortable situation” by the MP sharing an “intimate thing.”

To Ninčević Lesandrić, Jandroković’s comments are an example of how “society has imposed on us to not to talk about reproductive health problems, because it's something intimate and makes other people uncomfortable. But it is not, the uterus is an organ like any other organ in our body.”

“We need to turn the lights on and change some topics from being taboo to being normalized,” Drandic agrees. “If you aren’t embarrassed about your nose or your elbow why should you be embarrassed about your uterus or vagina? There is no reason to be embarrassed when we are talking about reproductive health.”

Women in labor can't be trusted

The issues facing women’s reproductive healthcare are not confined to Central and Eastern Europe. When Dr. Wragg Sykes gave birth in France, she “found the whole process was dictatorial”, with the “notion of choice and discussing options really minimal.”

Dr. Wragg Sykes is clear in her email to me that her childbirth “wasn’t traumatic or dramatic in that I needed any emergency procedures [...] and both were overall positive experiences.”

Despite this, her struggle to have her wishes respected, meant Dr. Wragg Sykes felt her first labor ended up “far more distressing and exhausting than it needed to be”. The “very rigid” system in France meant that rather than having the freedom to move around and find a birthing position that was comfortable, she had to “get onto a raised bed and lie on my back, which often increases the pain.” She told me “I was also really upset at being pressured to use stirrups which I felt were dehumanising.”

The activists at Másállapotot a szülészetben argue that more needs to be done to improve women’s freedoms during labor -- recommending among other things that women “have free movement during labor and the pushing stage”.

But for many women, there is an inherent danger in speaking out during childbirth and asking for a different kind of care -- e.g. natural birth or wanting to move freely during labor. Kriskova told me that, in Slovakia, “when a woman is seen as un-cooperative, it is seen as an excuse to abuse her. She is not obeying so it’s dealt with via manipulation, threats and the last resort of physical violence including slaps and pushing women’s legs apart.”

This attitude all relates to the societal belief that women are not competent to make informed decisions about their bodies. “Even if you ask to give birth in a different kind of position,” Kriskova explained, “it can be interpreted by the staff that are you telling them they are doing things wrong. So some may want to teach you a lesson and the violence can escalate very quickly.”

When they cut you live and without consent

The widespread practice of episiotomy followed by the so-called “husband stitch” is raised repeatedly in RODA’s complaint. This practice is so widespread, and can have such damaging side-effects, that some activists are going so far as to compare it to genital mutilation.

Many women report physical pain and PTSD symptoms following an episiotomy -- particularly when the procedure is carried out without informed or proper consent. In Croatia, one woman told RODA:

“I asked them not to cut me. The doctor said I would tear if they don’t do it and how will I ever give birth if I can’t stand the pain. The physical pain went away but the emotional pain never. I remember that every time I see a pair of scissors. I still have nightmares about it.”

In Slovakia, Women-Mothers-Bodies conducted a qualitative survey on 15 women and 10 doctors and midwifes. A further online survey yet to be published gathered responses from 1800 women which revealed that half the respondents described their experience of suturing being “painful or very painful.”

During stitching, some women were denied painkillers, and if they complained were told they could handle it -- that it was only a few stitches and not a big deal. Yet despite this, many women still rated the treatment they received as “respectful (although 40% recognized it was not) – even though they were describing disrespectful and painful treatment,” Kriskova told me.

“There needs to be further research on this topic,” she continued. “But the hypothesis is that this may be because of high normalization of this practice. It may also be an example of women modifying their emotional responses during childbirth to be quiet, and seen as a good woman or mother.”

Meanwhile in Bulgaria, a woman contacted NewsMavens with her own painful experience. Following a difficult labor, her doctor became “extremely aggressive and by the time of the episiotomy she started the sewing phase before the anesthesia had come into effect. I could feel everything.” She said that, due to the disrespectful and traumatic way she was treated, “my experience as a mother was ruined.”

The pain and lack of consent can leave women feeling, according to Battisti, that “this practice is a kind of mutilation of their genitals, and many experience infections and problems.”

It’s shocking to hear women describing episiotomy as a form of female genital mutilation, but it’s a sentiment echoed by Drandic. “We talk about things like FGM as an othered problem – we say look how how good we are when other countries are doing that. But 50-60% of women in Central Europe are getting cut during childbirth and we’re not discussing this.”

Who's in charge here -- power dynamics in hospitals

Part of the problem facing women is that the hospital experience is not designed around a maternal experience and a women-centred approach. This patriarchal attitude towards women’s bodies and experiences was described by Másállapotot a szülészetben, who explained how in Hungary:

“The maternity care system is engrained with gender-based power dynamics on many levels: client (women) and physician (mostly men); midwives, nurses (women) and physician (mostly men); affected population (women and children) and policy-makers or decision-makers (men).”

Meanwhile, Kriskova’s research revealed that “all the rules are focused on the needs of the healthcare personnel, and women should just fit into this. It should be the other way around. Women should be the decision-makers and they are the ones who should be centered, not made to follow some made-up rules.”

These entrenched power dynamics in the medical profession could be linked to the rise of cesarean births in Romania over the last three decades. In 1990, only 7.2% of births in the country were via cesarean, rising to 36.3% in 2014. In the capital Bucharest, the rate rises to over 60% with some hospitals reporting an 80% cesarean birth rate.

There has been growing concern in Romania that c-sections are being carried out for the convenience of health professionals, not mothers as evidenced by more and more women reporting they felt pushed into having a cesarean. One woman posted online “my gynecologist told me he no longer accepts natural births […] prefers surgery and that the scheduled cesarean is OK for him.” While some women actively choose to have a c-section, others say they felt ill-informed about their choices, or were erroneously told a cesarean is always easier and has fewer risks than a vaginal birth.

Cesareans save women’s and babies’ lives and absolutely must be part of maternal healthcare. But they also come with post-operative complications and a long recovery, and no woman should feel coerced into having a surgical procedure. Andreea Constantin, a woman who wanted a vaginal birth but was pressured into a c-section, told Romanian newspaper The Recorder: “I was exhausted, I was in a state where I was very influenced, and I succumbed. What can you do? You are [in] the doctor’s hands.”

We believe you - changing culture through policy 

Whether it’s women being slapped in Slovakia and pushed towards c-sections in Romania, patronized in Poland, verbally abused in Italy, or feeling like their decisions about “my own body” are disrespected in Croatia, the patterns of obstetric violence across Europe have one thing in common. They are motivated by what Kriskova called “the idea that we need to save women from themselves.This idea that women are so stupid they can’t make decisions for themselves.” Instead, women must submit to a higher -- often male -- authority.

This matters, not least because the belief that women should not have a say or autonomy over their own reproductive health is one of the leading arguments used to restrict abortion access. Further, a culture of distrusting and disbelieving women extends to issues around rape and other forms of gender-based violence.  

RODA is now lobbying the Croatian government and healthcare system to “come out with an action plan for the next two years that’s going to include a multi stakeholder approach to reproductive health.” Drandic told me that “this action plan would address the human rights violations that have been going on.”

In this, they have the support of Ivana Ninčević Lesandrić, who stated “I will continue to work with RODA and other groups in Croatia until the government takes concrete steps to guarantee quality and human rights in women's reproductive healthcare.

But as well as a change in policy, RODA is advocating for a much wider cultural shift in favour of listening to women. They want to encourage women to understand they don’t have to accept invasive and painful procedures without an anesthetic. By breaking the silence on obstetric violence, they hope that women will “advocate for themselves and actively ask for better care.”

For Battisti, the impact of OVOItalia’s campaign has been transformative for women’s empowerment.

“To give a voice to women and to make them realize that what they suffer is real -- that was our dream,” she insisted. “It’s important that women start to believe their feelings, their emotions and experiences, and can give a name to what happened. If you understand what happened to you was wrong, and you know it was not your fault, you can start to respect yourself again and raise your self-esteem.”

“We wanted to say to women that we are close to you,” Battisti continued. “We believe you, and we understand you. It seems to be very little but for many women it is important. Through our campaign, women don’t feel alone anymore.”

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