At healthcare facilities worldwide, women during childbirth undergo medical procedures they haven’t consented to and experience mistreatment and disrespect. This phenomenon is recognized as obstetric violence (OV), a distinct form of gender violence. The resulting trauma carries both immediate and long-term implications, making it vital to address for promoting women’s health. OV is partly shaped by a narrow, paternalistic conception of vulnerability. A flawed conception of the vulnerability of pregnant women and fetuses has opened the door to medical control and (...) coercion during childbirth. In this paper we examine what role notions of vulnerability play in perpetuating OV and consider recent attitudinal shifts in research ethics as a model for addressing it. (shrink)

As a form of academic activism this paper proposes an epistemic redress of obstetric violence by arguing for a more birther-defined conceptualization of the construct, in order to further the agenda of reproductive and social justice. Since the term was first used in the early 2000s in Latin America, the construct has evolved, and contemporary understandings of obstetric violence note it as a complex and multifaceted phenomenon with various configurations of analysis depending on the stakeholder that is discussing it. While (...) the ontology of obstetric violence has been grappled with, the most ubiquitous challenge that is foregrounded in this paper is that of its conceptualization, specifically its epistemic leanings and origins. Drawing primarily on Fricker’s framework of epistemic injustice, particularly hermeneutical injustice, I argue that current interpretations of obstetric violence are epistemically tenuous, and I posit that any understanding of obstetric violence must include the subjective and lived experience of all birthing persons, leading to a more socially and epistemically fair understanding of the construct. (shrink)

This article examines obstetric violence in Spanish prisons through the lens of feminist bioethics and an intersectional perspective. A qualitative study was conducted in four mother-and-child prison units, involving thirty incarcerated women living with their children. Using semistructured interviews and participant observation, instances of obstetric violence were identified during pregnancy, childbirth, the postpartum period, and breastfeeding. The findings indicate that such violence constitutes a severe violation of human rights. This article emphasizes the urgent need to render these harmful experiences visible (...) through feminist bioethics, frame them within a social justice agenda, and promote intersectional and feminist research and public policies that protect reproductive rights. (shrink)

During the French Revolution, obstetrics underwent substantial transformations in practice, teaching, and the physical spaces where it was conducted. The revolutionary authorities implemented reforms in French medical institutions that promoted an instrument-centred style and the dissemination of novel surgical techniques in obstetrics. The selection of professors for the obstetrics chair at the newly established École de santé and the appointment of chiefs for the new maternity ward in Paris favoured proponents of a mechanistic approach to labour assistance. (...) This essay explores the theoretical principles and societal pressures that guided these transformative reforms and the remarkable changes they introduced in healthcare and in the practise of medicine and surgery. Furthermore, it examines the consolidation of new epistemological, ethical, and professional boundaries within the context of late eighteenth-century French obstetrics. A critical section of this study focuses on the debate ignited by the contemporaries who voiced concerns that the rise of surgical interventions on pregnant women's bodies might result in unwarranted violence, in a diminishing of midwives’ roles, and in a departure from the tradition of natural childbirth. These controversies among obstetricians highlight significant contradictions within the Revolutionary medical reforms. (shrink)

This article analyzes the moral relevance of technological artifacts and its possible role in ethical theory, by taking the postphenomenological approach that has developed around the work of Don Ihde into the domain of ethics. By elaborating a postphenomenological analysis of the mediating role of ultrasound in moral decisions about abortion, the article argues that technologies embody morality and help to constitute moral subjectivity. This technological mediation of the moral subject is subsequently addressed in terms of Michel Foucault’s ethical position, (...) in which ethics is about actively co-shaping one’s moral subjectivity. Integrating Foucauldian ethics and postphenomenology, the article argues that the technological mediation of moral subjectivity should be at the heart of an ethical approach that takes the moral dimensions of technology seriously. (shrink)

This article explores the ways in which ultrasound screening influences the temporal dimensions of prevention in the obstetrical management of pregnancy. Drawing on praxeographic perspectives and empirically based on participant observation of ultrasound examinations in obstetricians’ offices, it asks how ultrasound scanning facilitates anticipatory modes of pregnancy management, and investigates the entanglement of different notions of time and temporality in the highly risk-oriented modes of prenatal care in Germany. Arguing that the paradoxical temporality of prevention—acting now in the name of (...) the future—is intensified by ultrasound screening, I show how the attribution of risk regarding foetal growth in prenatal check-ups is based on the fragmentation of procreative time and ask how time standards come into play, how pregnancy is located in calendrical time, and how notions of foetal time and the everyday life times of pregnant women clash during negotiations between obstetricians and pregnant women about the determination of the due date. By analysing temporality as a practical accomplishment via technological devices such as ultrasound, the paper contributes to debates in feminist STS studies on the role of time in reproduction technologies and the management of pregnancy and birth in contemporary societies. (shrink)

The article argues against the common notion ofdisciplinary medical traditions, i.e. Obstetrics, asmacro-structures that quite unilinearily structure thepractices associated with the discipline. It shows that the various existences of Obstetrics, their relations with practices and vice versa, the entities these obstetrical practices render present and related, and the ways they are connected to experiences, are more complex than the unilinear model suggests. What allows participants to go from one topos to another – from Obstetrics to practice, from (...) practice to politics, from politics to experience – is not self-evidently induced by Obstetrics, but needs to be studied as a surprising range of passages that connect (or don't). Techniques and devices to supervise the delivery, to render present the fetus during pregnancy, and to monitoring birth, are described in order to show that such techniques acquire different roles in connecting and creating Obstetrics as a system andobstetrical practices. (shrink)

In September 2020, Project South, along with numerous other organizations, released a report detailing abuses in a Georgia Detention Center – including forced hysterectomies. Whatever other factors are at play, one of them is an intrinsic connection between obstetric violence against pregnant migrants and immigration injustice. It is not incidental that these acts – in US detention centers, along the US‐Mexico border, in Colombian hospitals and clinics – are being perpetrated on immigrant bodies. And it is not accidental or random (...) which immigrant bodies are vulnerable to these violations. Understanding and confronting obstetric violence directed at pregnant migrants, though, requires reconceptualizing the nature of obstetric violence itself. In particular, we must recognize that obstetric violence against pregnant Latin American migrants in the United States and Colombia is a type of immigration injustice, a means to perpetrate immigration injustice, and a product of immigration injustice. As such, bioethicists need to collaborate with immigration scholars to resist it.After providing some background on the nature of obstetric violence and some ways it is perpetuated against pregnant migrants in the United States and Colombia, I will give a brief overview of how I conceptualize immigration justice. From there, I explain how this type of obstetric violence constitutes a type of immigration injustice, a means to perpetrate immigration injustice, and a product of immigration injustice. My hope is that this analysis motivates bioethicists throughout the Americas to engage with immigration scholars and activists to confront the issue more forcefully. (shrink)

Since its global uptake, ‘obstetric violence’ is increasingly used to capture any/all violations during reproductive healthcare, with few conceptual limits. Consequently, it runs the risk of becoming an overgeneralised concept, making it difficult to operationalise in socio-legal reform efforts. This article draws on the Latin American origins of the concept and aims to provide a theoretical framework to support a focused and coherent socio-legal reform agenda. It offers a universal definition of violence, being the violation of physical or psychological integrity, (...) and localises this definition using the ‘view from everywhere’. The article proposes that violence will qualify as ‘obstetric violence’ if the violation of integrity occurs in the context of antenatal, intrapartum and postnatal care. Further, the subject of the violence is the birthing woman, trans or non-binary person. Thinking in terms of a ‘continuum of violence’ in reproductive healthcare ensures that different forms of obstetric violence are recognised and helps envisage overlaps with other violences. (shrink)

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is (...) often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy. (shrink)

Background Obstetric violence is a widespread form of institutional abuse that violates women’s sexual and reproductive rights during childbirth. Although informed consent is a fundamental ethical, legal, and human right requiring adequate information and active participation, it is frequently absent or incomplete, even in non-emergency obstetric care. Aim To identify which clinical practices, according to their context (emergency or routine) and the presence or absence of informed consent, are associated with higher perceptions of obstetric violence. Additionally, it is to assess (...) the influence of professional treatment on these perceptions. Research design Cross-sectional observational study. Participants and research context: 2,367 women who gave birth in Spanish public hospitals. Perceptions of obstetric violence and quality of care were measured using the Childbirth Abuse and Respect Evaluation-Maternal Questionnaire (CARE-MQ) and the Quality from the Patient’s Perspective–Intrapartal Questionnaire (QPP-I). Ethical Considerations The study was approved by the Clinical Research Ethics Committee of Reina Sofía University Hospital of Córdoba and by the ethics committees of Ciudad Real University Hospital and Mancha-Centro Hospital. Findings Clinical practices performed without informed consent or adequate information were significantly associated with higher CARE-MQ scores (p <.001). Procedures such as episiotomy and oxytocin administration, when carried out outside emergency situations, had a particularly strong impact on perceptions of abuse. Negative evaluations of professional treatment were also significantly associated with higher CARE-MQ scores (p <.001). Midwives received the highest ratings among healthcare professionals. Conclusion The absence of informed consent is a key determinant of women’s perceptions of obstetric violence, regardless of clinical context. Identifying procedures with low consent rates and highlighting the protective role of respectful professional behavior, particularly midwife-led care, provides actionable targets to improve maternity services. Strengthening communication, ethical training, and midwife-led models is essential to promote respectful maternity care and safeguard women’s rights during childbirth. (shrink)

Although the global healthcare system is paying increasing attention to obstetric violence, this form of gender-based violence during childbirth remains a serious issue. The primary objective of this comprehensive study is to explore the experiences and needs of women subjected to obstetric violence on a global scale. A systematic search was conducted in December 2024 across the Web of Science, Embase, PubMed, and CINAHL databases to identify eligible studies. Data synthesis was performed using the three-stage thematic and content analysis method. (...) A total of 39 eligible qualitative studies were included in this review. Thematic synthesis identified 6 themes and 17 sub-themes: (1) Obstetric Violence Types; (2) Gaslighting Effect: The Authoritative Position of Healthcare Providers; (3) Stigmatization and Discrimination Experienced by Women; (4) Who is Normalizing Obstetric Violence? (5) Substandard Medical Institutions; (6) Trauma Induced by Obstetric Violence. Obstetric violence continues to persist in various countries and regions. Women have endured various forms of obstetric violence, with their autonomy and rights to informed consent being severely compromised. They have experienced neglect and abandonment by healthcare providers, and face discrimination and differential treatment due to factors such as race, socioeconomic status, age, and culture. The primary cause of obstetric violence is the unequal power dynamics between healthcare providers and women, with the authoritative position of healthcare providers leading to a lack of communication and recognition between both parties. (shrink)

Obstetric violence refers to abusive behaviors by healthcare staff towards women during childbirth, including the pre-birth and post-birth phases. Although it falls under gender-based violence, it is still widely overlooked and underexplored in bioethical, legal, and sociological literature. However, an international debate is growing, involving physicians, patients, lawyers, and institutions. This volume addresses various aspects of obstetric violence, examining international and national debates, particularly in Europe and Latin America, where significant legislative reforms emerged. Birthing cultures and organizational models of childbirth (...) care are key factors. The research hypothesis links obstetric violence to models of motherhood. It also includes the viewpoints of potential perpetrators. This involves examining midwives' working conditions, deontology, and culture as factors in obstetric violence, on the basis of empirical research. Adopting an interdisciplinary approach, the volume brings together bioethics, sociology, law, philosophy, and anthropology. It appeals to specialists and the general public, contributing to the growing international debate and serving as educational material for medical staff and lawyers. (shrink)

The story of Eve and the Curse of Eve in Genesis provides a powerful lens through which to explore the biological challenges of human childbirth. As stated in Genesis 3:16, God declares, “I will greatly increase your pains in childbearing; in pain you will bring forth children.” This curse has long been interpreted as a divine decree linking pain and suffering with the act of childbirth. It also serves as a poignant metaphor for what anthropologists refer to as the “obstetric (...) dilemma,” the evolutionary challenge humans face in balancing the need for a large brain, which confers significant cognitive advantages, with the constraints of the female pelvis, which must remain narrow enough to support bipedal locomotion (Rosenberg and Trevathan 2002). In this evolutionary narrative, we also encounter what can be termed “Darwin’s Dilemma.” This dilemma speaks to the broader challenge of evolution itself—how natural selection and evolutionary pressures shape not just the physical form of species but their existential paths. For humans, Darwin’s Dilemma is exemplified in the continuous struggle to adapt and evolve in a way that transcends the limitations imposed by our biology. It encapsulates the quest to balance our advanced cognitive abilities with the physical realities of childbirth, survival, and adaptation (Futuyma 2009). The human pelvis has evolved uniquely to balance these conflicting needs. Unlike other primates, humans have a wide, rounded pelvis, which aids in childbirth but also presents significant risks due to the size of the human infant’s head. This evolutionary compromise has defined human childbirth for millennia, making it a process fraught with danger, especially before the advent of modern medical interventions (Wells 2015). Biblical narratives illustrate the complexities of childbirth, often linking birth to divine intervention. In Genesis, Sarah’s conception of Isaac is depicted as a miracle, overcoming natural biological limitations. Similarly, the tumultuous birth of Jacob and Esau reflects the struggle inherent in human birth, while Rachel’s death during childbirth underscores the inherent risks and sacrifices. These stories reveal a recurring theme: birth is both a gift and a challenge, a divine blessing intertwined with human suffering (Alter 1996; Kass 2008). (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

The snub-nosed, reclining, and serene image of the fetus is commonplace in cultural representations and analyses of obstetric ultrasound. Yet following the provocation of various feminist scholars, taking the fetal sonogram as the automatic object of concern vis-à-vis ultrasound cedes ground to anti-abortionists, who deploy fetal images to argue that life begins at conception and that the unborn are rights bearing subjects who must be protected. How might feminists escape this analytical trap, where discussions of ultrasonics must always be engaged (...) in the act of debunking? This article orients away from the problem of fetal representation by employing a method which may appear to be wildly unsuitable: media archaeology. Media archaeologists typically reject the body and the human sensory apparatus as the default subject of media and argue that the interpretive methods of the humanities are incapable of accounting for the ontology of machines. I propose, however, that media archaeological methods provide a necessary vocabulary to attend to obstetric ultrasound outside of iconography. I develop and deploy a media archaeological method that integrates feminist concerns—including advocation of subjugated persons and the making visible of maligned subjects—to examine the ultrasonic experiments performed by gynecologist Ian Donald on working-class Glaswegian women during the 1950s and 1960s, ultimately arguing that, in the case of ultrasound, there can be no separation between technical process and the historically situated body. (shrink)

Khalafzai, Rida Usman; Hameed, Imran Obstetric fistula is the most devastating complication of parturition. The impact of this ailment extends beyond physical morbidity, with immense social repercussions for the women who suffer from it.

Background Obstetric violence is a significant ethical and human rights concern in maternity care that undermines women’s dignity, autonomy, and respectful care during childbirth. Although women’s experiences of mistreatment are widely documented, less attention has focused on factors that enable midwives to prevent obstetric violence and provide respectful maternity care, particularly in low-resource settings. Research aim This study explored midwives’ perspectives on facilitators of respectful maternity care for the prevention of obstetric violence in maternity centres in South-West Nigeria. Research design (...) A qualitative descriptive design was adopted, and data were analysed using Braun and Clarke’s reflexive thematic analysis. Participants and research context Thirty registered midwives with at least 5 years of maternity care experience participated in three focus group discussions conducted in three state-owned secondary health facilities in Oyo State, South-West Nigeria. Ethical considerations Ethical approval was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee and the Oyo State Ministry of Health Research Ethics Review Committee. Written informed consent was obtained from all participants. Findings/results Five themes were identified as facilitators of respectful maternity care and obstetric violence prevention: improvements in maternity facilities; improvement of midwives’ welfare; formal institutional and legal actions; training and re-training of midwives; and orientation of pregnant women. Midwives described how supportive infrastructure, staffing, remuneration, institutional policies, legal accountability, continuous professional education, and women’s awareness contribute to respectful and ethical maternity care practices. Conclusions Preventing obstetric violence requires supportive health systems that strengthen midwives’ capacity to provide dignified and respectful maternity care. Addressing structural, institutional, legal, and educational facilitators is essential for promoting ethical childbirth care and protecting women’s rights. (shrink)

Surgical Informed Consent has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (...) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter had no formal education. More than half of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used and related complications. Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs. (shrink)

Obstetric violence has been analyzed from various perspectives. Its psychological effects have been evaluated, and there have been several recent sociological and anthropological studies on the subject. But what I offer in this paper is a philosophical analysis of obstetric violence, particularly focused on how this violence is lived and experienced by women and why it is frequently described not only in terms of violence in general but specifically in terms of gender violence: as violence directed at women because they (...) are women. For this purpose, I find feminist phenomenology most useful as a way to explain and account for the feelings that many victims of this violence experience and report, including feelings of embodied oppression, of the diminishment of self, of physical and emotional infantilization. I believe that the insights to be found in feminist phenomenology are crucial for explaining how and why this phenomenon is different in kind from other types of medical violence, objectification, and reification. Iris Marion Young’s description of feminine existence under patriarchy, as conformed by a perpetual oppressive “I cannot,” is at the center of my analysis. I argue that laboring bodies are at least potentially perceived as antithetical to the myth of femininity, undermining the feminine mode of bodily comportment under patriarchy and thereby seriously threatening the hegemonic powers. Violence, then, appears to be necessary in order to domesticate these bodies, to make them “feminine” again. (shrink)

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery.Material and Methods: A randomized controlled study at a university hospital in Sweden in 2015–17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support (...) or standard care during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity.Results: Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care. Women in the continuous support group tended to have lower cortisol levels and low cortisol during the first and second stages of labor were correlated with shorter active labor. Continuous support was followed by spontaneous delivery in 73%, instrumental delivery in 24% and emergency cesarean section in 3% in contrast to standard care which was followed by spontaneous delivery in 62%, instrumental delivery in 24% and cesarean in 14%. The continuous support group received combined analgesic methods more often. Women's satisfaction with delivery and neonatal morbidity were comparable.Conclusion: Continuous labor support was followed by shorter active labor compared to standard care. Women with continuous support had a high rate of vaginal delivery and tended to have lower cortisol levels during all stages of active labor reflecting a lower stress level. Low cortisol was correlated to shorter active labor. Based on these results, we recommend continuous labor support for all primiparous women during active labor. (shrink)

This paper presents the Obstetric and Neonatal Ontology (OntONeo). This ontology has been created to provide a consensus representation of salient electronic health record (EHR) data and to serve interoperability of the associated data and information systems. More generally, it will serve interoperability of clinical and translational data, for example deriving from genomics disciplines and from clinical trials. Interoperability of EHR data is important to ensuring continuity of care during the prenatal and postnatal periods for both mother and child. As (...) a strategy to advance such interoperability we use an approach based on ontological realism and on the ontology development principles of the Open Biomedical Ontologies Foundry, including reuse of reference ontologies wherever possible. We describe the structure and coverage domain of OntONeo and the process of creating and maintaining the ontology. (shrink)

This paper explores the rhetoric of obstetric ultrasound technology as it relates to the abortion debate, specifically the interpretation given to ultrasound images by opponents of abortion. The tenor of the anti-abortion approach is precisely captured in the videotape, Ultrasound:A Window to the Womb. Aspects of this videotape are analyzed in order to tease out the assumptions about the (female) body and about the access to truth yielded by scientific technology (ultrasound) held by militant opponents of abortion. It is argued (...) that the ultrasound images do not offer transparent confirmation of the ontological status of the embryo and fetus. Rather, the window of ultrasound is constructed through a complex combination of visual and verbal devices: ultrasound images, photographic images, verbal argument, and emotional appeal. (shrink)

The Chicago Maternity Center provided obstetrical services for the medically underserved on Chicago's Near West Side for nearly eight decades (1895–1974). While its founder's vision, its outreach to underserved communities, the reasons for its decline, and the perceived abandonment of the community when it closed have been well documented, less attention has been paid to the role of trainees in providing obstetrical care. Medical students and residents routinely delivered babies in patients' homes, often without adequate supervision. This aspect of the (...) center's history can help illustrate the evolution of experiential education in clinical medicine, along with emerging concepts of equitable access and quality of care. This work explores the center's role in medical education in light of contemporary perceptions of some participants—trainees, faculty, and institutional leadership—and through analysis of scholarly and popular publications, institutional archives, and communications with alumni and retired faculty. The popularity of the experience with trainees and its constituents, segregation of the center's activities from those of the sponsoring medical center, and its well-respected history led to the persistence of a model for clinical medical education that was an anachronistic remnant of earlier approaches to education and to care for the poor and disenfranchised. (shrink)

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a (...) severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be. (shrink)

I never set out to prove anyone wrong. What I am about to describe started just over a decade ago when I simply wanted to learn more about what fascinates me most, which is human evolution. Where it goes, I hope, is towards ongoing efforts to improve maternity and childbirth care, particularly when it comes to supporting physiologic birth.As a freshly minted PhD in biological anthropology and a postdoctoral researcher, I had the spark and the freedom to look into the (...) evidence behind a textbook example of natural selection in human evolution: the "obstetrical dilemma". Though the ideas were already floating around in the early days of the field of physical anthropology—like in... (shrink)

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons (...) giving birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)

The process of technological change in obstetrics must be understood as contingent on the exigencies of the professional project, rather than in terms simply of improvement or dehumanization of care. Transformation in the procedures by which the female pelvis and the fetal head have been measured illustrate this point. The development of new measurement techniques was profoundly influenced by the shifting locus of obstetric care and by changing professional concerns, including the initial demarcation of a professional practice and subsequent (...) debates about preferred modes of intervention. (shrink)

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a “good” pregnant woman and to be a “good” mother. Activities in the medical field of reproduction contribute to (...) “kinning”, that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: informed consent in prenatal care, obstetric sonogram, and birth plan. Their widespread application issupposed to serve the moral goal of effecting patient autonomy. A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework. (shrink)

Background: The quality of care in maternity facilities significantly influences women’s autonomy and their right to make decisions about their bodies. Obstetric violence, a form of gender-based violence during childbirth, poses serious threats to women’s rights and health worldwide. Aim: The research aimed to examine women’s experiences and perceptions of obstetric violence using the micro-level constructivist grounded theory strategies of Mena-Tudela et al. (2023). Research design and methods: This study used a phenomenological qualitative research design. Data were collected from 17 (...) eligible women using a Participant Information Form and a Semi-Structured Interview Form, applying maximum variation sampling to ensure a wide range of sociodemographic characteristics and diverse views and experiences. The data were analyzed using the seven-step phenomenological analysis method. Participants and research context: A total of 17 women who had vaginal labor at least 6 months ago were interviewed. Ethical considerations: The study was approved by the University Ethics Board for Non-Interventional Clinical Studies. Ethical considerations were closely aligned with the principles of respecting women’s rights, ensuring that participants’ autonomy and consent were central throughout the research process. Results: Five themes and 13 subthemes were extracted from the data analysis, including “Ignoring women in care,” “The commodification of women,” “Are the healthcare professionals the only authority?”, “Ineffective childbirth management and its effects on women’s health-seeking behavior,” and “Types of obstetric violence.” Conclusions: This study underscores the urgent need to address obstetric violence, recognizing its detrimental impact on women’s rights, and well-being during childbirth. Protecting women’s rights by prioritizing individual-centered care, informed consent, and respectful treatment is essential to uphold ethical standards and ensure dignified childbirth experiences for all women. (shrink)

Obstetric violence – psychological and physical violence by medical staff towards women giving birth – has been described as structural violence, specifically as gender violence. Many women are affected by obstetric violence, with awful consequences. The phenomenon has so far been mainly investigated by the health and social sciences, yet fundamental theoretical and conceptual questions have gone unnoticed. Until now, the phenomenon of obstetric violence has been understood as one impeding autonomy and individual agency and control over the body. In (...) this article I will argue that the phenomenon of obstetric violence occurs in a specific state of embodied vulnerability and that might be destructive for subjectivity since it fails to recognize that state and instead disallows support and demolishes relationships and interdependence. This might introduce a conceptual shift and the phenomenon might be reconceptualized as a moment where vulnerability is misrecognized and ambiguity, relations and support are banned. In this case violence is recognized as cutting the original links to our bodies and the world that constitute our phenomenological condition, instead of as hurting the autonomous subject. Obstetric violence, thus, calls to be reflected upon through de Beauvoir’s ideas on ambiguity, the embodied and situated subject and the subject as essentially construed in relations. I believe that de Beauvoir’s conception of the authentic embodied subject as necessarily ambiguous – immanent and transcendent at the same time and ineludibly linked to the world and its others – will be extremely useful for construing this new understanding of how obstetric violence happens and of what precisely constitutes its damage. (shrink)

This article examines the question of whether private obstetric care in South Africa can be saved in view of the escalation in medical and legal costs brought about by a dramatic increase in medical negligence litigation. This question is assessed with reference to applicable medical and legal approaches. The crux of the matter is essentially a question of affordability. From a medical perspective, it seems that the English system as well as American perspectives may be well suited to the SA (...) situation. Legal approaches are assessed in the context of the applicable medicolegal framework in SA, the present nature of damages and compensation with reference to obstetric negligence liability, as well as alternative options to the present system based on fault. It is argued, depending on constitutional considerations, that a system of damages caps for noneconomic damages seems to be the most appropriate and legally less invasive system in conjunction with the establishment of a state excess insurance fund. (shrink)

It has frequently been suggested that science and religion are innately in conflict. One example from the history of medicine is the introduction of anaesthesia into obstetrics in 1847, which is commonly said to have stimulated massive religious opposition. Historians have almost unanimously averred that such opposition arose from the belief that obstetric anaesthesia interfered with the primeval curse— ‘In sorrow thou shalt bring forth children’ . Despite considerable opposition to obstetric anaesthesia upon medical, physiological, and general moral grounds, (...) evidence of genuine religious opposition in contemporary sources has proved to be virtually non-existent. On examination, this particular ‘conflict’ appears to be an artifact of historiography based upon a contemporary defence prepared against an attack which never materialized. (shrink)

Obstetric violence—violence in the labor room—has been described in terms not only of violence in general but specifically of gender violence. We offer a philosophical analysis of obstetric violence, focused on the central role of gendered shame for construing and perpetuating such violence. Gendered shame in labor derives both from the reifying gaze that transforms women's laboring bodies into dirty, overly sexual, and “not‐feminine‐enough” dysfunctional bodies and from a structural tendency to relate to laboring women mainly as mothers‐to‐be, from whom (...) “good motherhood” is demanded. We show that women who desire a humane birth are thus easily made to feel ashamed of wanting to be respected and cared for as subjects, rather than caring exclusively for the baby's well‐being as a good altruistic mother supposedly should. We explore how obstetric violence is perpetuated and expanded through shaming mechanisms that paralyze women, rendering them passive and barely able to face and fight against this violence. Gendered shame has a crucial role in returning women to “femininity” and construing them as “fit mothers.” To stand against gendered shame, to resist it, on the other hand, is to clearly challenge obstetric violence and its oppressive power. (shrink)

The loss of the federally protected constitutional right to an abortion is a threat to the already tenuous autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions. Even before Roe’s demise, pregnancy led to constraints on autonomy evidenced by clinician-led legal incursions against patients who refused obstetric interventions. In Dobbs v. Jackson Women’s Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a (...) pregnant person’s right to an abortion. With Roe’s demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse. Here we discuss how the elevation of fetal and embryonic rights may lead to a cascade of medical intrusions and deprivations of liberty against pregnant persons, and offer an argument opposing these improprieties. (shrink)

This article builds on existing feminist literature on obstetric violence in the context of childbirth to argue that there is a continuum of obstetric violence that also includes that perpetuated in relation to pregnancy prevention and termination, as well as antenatal healthcare and birth. This structural violence is highlighted in relation to conscientious objection, the reporting of people suspected of illegal abortions by their healthcare providers, and contraceptive coercion. Recognizing the limitations of criminal and human rights approaches to obstetric violence, (...) this article takes Martha Fineman’s vulnerability theory as the foundation for the transformative structural change of healthcare institutions. (shrink)

BackgroundInformed consent, whose goal is to assure that participants enter research voluntarily after disclosure of potential risks and benefits, may be impossible or impractical in emergency research. In low resource settings, there is limited information on the experiences of the informed consent process for randomized clinical trials in the emergency care context. The objective of this study was to explore the experiences of the informed consent process and factors that motivated participation in two obstetrics and newborn care randomized clinical (...) trials (RCTs).MethodsThis was a qualitative study conducted among former participants of RCTs in the emergency obstetric care context, conducted at Kawempe National Referral Hospital, Uganda. It employed 30 in-depth interviews conducted from June 1, 2019 to August 30, 2019. Issues explored included attitudes about research, the purpose of the research in which they participated, motivations to take part in the study, factors that influenced enrolment decisions, and experiences of the informed consent process.ResultsRespondents felt that research was necessary to investigate the cause, prevention or complications of illness. The decisions to participate were influenced by hope for material or therapeutic benefit, trust in the healthcare system and influence of friends and family members. Many were satisfied with the informed consent process, though they did not understand some aspects of the research.ConclusionRespondents valued participation in RCTs in emergency obstetric and newborn care. Hope for benefit, altruism, desire to further scientific knowledge and trust in the investigators featured prominently in the motivation to participate. Both intrinsic and extrinsic factors were motivators for RCT participation. (shrink)

This essay is an inquiry into the socio-cultural history of the use of forceps in 19th-century Mexico. It argues that the knowledge and practices that the use of such instruments implied were related to complex and controversial issues of the time regarding gender, race and national identity. In my study of operations involving forceps, I found that the adoption of medical instruments depended not only upon their supposedly greater operative efficiency but also upon the political and medical meanings attributed to (...) the pelves of Mexican women. Early 19th-century obstetrics conceived the womb as an example of ‘living nature’ whose qualities assured that births were ‘normally happy events’ making the use of forceps and other instruments unnecessary. However, by mid-century, in the aftermath of independence, Mexico was desperately attempting to forge its identity as a nation. Due to European theories of race, Mexican women came to be characterized as having pathologically deformed pelves that evidenced possible defects of racial formation. The analysis of operative practices involving forceps reveals just how strongly such medical instruments became charged with a complex political definition of the ‘mestizo race’, which was seen to hold political promise for the future. In this context, forceps ceased to symbolize the threat of death, with which they had been associated since colonial times, and became artefacts that helped to assure the safe delivery of newborn mestizos by overcoming the problems of Mexican women's pathological pelves; although by the same token, the status of women as biologically inferior beings in need of medical assistance was reconfirmed. (shrink)

In France between 1780 and 1815, doctors opened a broad correspondence with medical faculties and public officials about foetal anomalies . Institutional and legal reforms forced doctors to encounter monstrous births with greater frequency, and they responded by developing new ideas about heredity and embryology to explain malformations to public officials. Though doctors achieved consensus on pathogenesis, they struggled to apply these ideas in forensic cases, especially with doubtful sex. Medical networks simultaneously allowed doctors to explore obstetrical techniques, as licensing (...) regulations forced practitioners into emotional encounters with child anomalies. Doctors thus developed a new ethics for treating monstrosities, viewing them as pathological specimens, forensic objects, and obstetrical tragedies. (shrink)

The dual purpose of this article is to present a formal theory analysis combined with recommendations for the use of social justice in nursing as a framework for the study of obstetric violence in US hospitals. A theory analysis of emancipatory nursing praxis as a middle-range theory of social justice in nursing was conducted using the strategy by Walker and Avant. The theory of social justice in nursing was determined to be logical, useful, and generalizable. The soundness and usability of (...) the theory support the recommendations made for it to be applied to the study of obstetric violence, plus quality and outcome problems in maternity care that have been resistant to sustained progress and may benefit from a new paradigm for continued study. The alignment for obstetric violence to be studied with a social justice framework is linked to the theory’s origins in critical social theory and the evolving concept of obstetric violence as a sex-specific form of violence against women that is a violation of human rights. The postmodern expansion of the body of work based on critical theory provides examples from emancipatory and feminist researchers for recognizing how the study of obstetric violence is compatible with a theoretical framework for social justice in nursing. The suitability of this framework to guide the further research needed to better understand, identify, and minimize harms from the occurrence of obstetric violence is argued. In addition, “The Code” for the American Nurses Association (ANA) is cited as a professional reference that outlines nurses’ responsibilities for practice based on ethics, human rights, and social justice that are antithetical to the occurrence of obstetric violence. (shrink)

Obstetric violence is a structural form of gender, medical, and sexual violence perpetrated by health providers and institutions during pregnancy, birth, and postpartum. It can produce physical, psychological, and symbolic harm to pregnant/birthing people and their families. Obstetric violence results from structural conditions in the technocratic model of birth and the acceptance of biomedicine as the authoritative knowledge in health care. This phenomenon produces patients’ loss of autonomy and capacity to provide informed consent, which increases their vulnerability to unjustified medical (...) procedures, resulting in negative birth experiences. In this paper, I argue that individual autonomy is necessary but not sufficient for legitimately consenting to obstetric care and preventing violence. The liberal framework of individual autonomy often ignores that childbirth is a social event where multiple individuals and cultural factors influence the consent process. Consequently, I discuss the role of relational autonomy in obstetric decision-making and describe some structural barriers that negatively intervene in this process. Finally, I propose that doulas and midwives can help nurture autonomy and caregiving skills in obstetric patients and health providers. This strategy protects the informed consent process, prevents obstetric violence, and can be effective in recentering childbirth in pregnant people and their families. (shrink)

The objective of this study was to examine the impacts of obstetric violence (OV) on maternity healthcare professionals (MHPs) in Israel and the coping strategies they employ. This qualitative study was conducted in various maternity care settings across Israel. Data were collected through semi‐structured, in‐depth interviews with 21 MHPs, who had witnessed or had been involved in incidents of OV. The interviews were transcribed and analyzed thematically to identify key patterns related to the emotional and professional effects of OV, and (...) to the coping strategies used by the participants. The analysis revealed two primary themes. The first relates to the consequences of exposure to OV on MHPs, including the impact on professional identity and functioning, emotional and psychological distress, and ambivalent responses to colleagues involved in such incidents. The second theme addresses MHPs' coping strategies such as disclosing incidents despite anticipated repercussions and feelings of isolation alongside coping through personal initiatives (raising awareness and promoting action regarding OV within and beyond the workplace). Findings highlight the imperative for a dual strategy: eradication of OV and providing meaningful support to all affected individuals, both the women subjected to OV and the MPHs exposed to or involved in such events. (shrink)

This article considers how seventeenth-century writer John Milton engages in modes of thinking that register the obstetric revolution occurring during the period. During a time when physicians were gaining entry to the birthing room, a medical rhetoric of childbirth was developing that cast childbirth in new pathological terms. Milton's A Masque Presented at Ludlow Castle demonstrates how childbirth was influenced by emerging obstetrical language and practice, as well as the ways in which a writer might question such influence. Finally, this (...) article also draws links between disrupted historical rituals of childbirth and modern anxieties about medically-centred birthing practices. (shrink)

This essay teases out the intimate connections between the scientific and fiscal realms in the context of American germ theory and obstetrics. By uncovering the economic and medical contexts of Henry James’s Washington Square—set during the infancy of germ theory and the heyday of American obstetrics—this essay exposes a previously unexplored subtextual history of contagion in the text. Although this scientific history seems relegated to the novel’s margins, understanding the changing scientific cosmologies and professional organizations in the context (...) of the novel’s setting and composition reveals that these tiny infectious particles and their vectors fundamentally shape the plot of the novel. (shrink)