Sagging belly skin, stretch marks, dark circles, tears … since the new parents began to share their experiences on social networks, it has become clear that stinky diapers are probably one of the minor evils that the arrival brings of a new member of the family.
Many of those affected share their experiences on the Internet, and increasingly relate traumatic experiences during examinations or childbirth. The focus is often on the actions of medical personnel. Women who experience obstetric violence are often severely traumatized. But they hardly find help, because their problem is taboo in Germany.
Like a “birthing machine”, feeling like being “tortured in the Middle Ages” or “like being sacrificed”: these are the words that traumatized women use to describe the birth of their children when they seek help from the psychologist Nergiz Eschenbacher.
Every day pregnant women experience cesarean sections without effective anesthesia, episiotomies (surgical incisions in the perineum) without consent, vaginal examinations without prior notice, they are yelled at, they are blackmailed with the health of their child, they are injected catheters unnecessarily, They are given medication without information, are denied painkillers, or are forced to lie on their back despite being in labor. Some doctors even put their full weight on the pregnant woman’s belly to push the baby down, the so-called Kristeller maneuver.
Violence in obstetrics: a taboo
The list of violence suffered by women in labor is long and for some the experience becomes a trauma. In an international study published in the British journal BMC Pregnancy Childbirth, 66.7% of the women who participated said that the actions of the nurses or their interaction with them were traumatic.
“The subject has been known for a long time and yet it is an absolute taboo,” says Professor Gerlinde Debus, Munich’s chief physician and gynecologist. “Even a routine procedure like an ultrasound can represent a violent intervention in the perception of the mother and the child,” says Debus.
Many pregnant women are unaware that they don’t have to go to the hospital for routine tests, explains midwife Julia Huegel, and many vaginal examinations are also often unnecessary. “This environment may already scare some women.” Although more and more midwives are calling for better care for women, in Germany too childbirth is increasingly medicalized.
How does violence occur?
“Doctors cannot accept that they cannot be completely sure how the child is in the womb. That is why there are numerous interventions. But we do not really know how the child is until it is born,” says Huegel.
But how does violence occur in this sensitive environment? Dr. Gerlinde Debus sees a possible explanation for the increasing number of interventions in obstetrics in the so-called professional fear. To guard their backs, explains the gynecologist, professionals take all the measures they know to intensively monitor the child and the mother during childbirth. “Measures that ultimately lead to women being less able to act autonomously.”
Midwife Huegel also finds many doctors anxious: on the one hand, there is the fear of being sued if the child “goes wrong”, on the other, some are worried about his reputation among colleagues or, for example, about advancing his career , which puts them under pressure.
Therapist Nergiz Eschenbacher explains violence as an interaction between the fear of harming the newborn, the general image of women in Germany, and the working conditions of midwives and gynecologists.
“We were all afraid of the task in the delivery room.”
A survey published in the German Magazine of Midwives in July this year shows that many midwifery students become witnesses, (co) perpetrators or victims of violence during their training. “It was terrible,” recalls Julia Huegel from her studies 13 years ago. “We were all afraid of working in the delivery room,” says the Munich midwife.
Veronika Selters * from the Frankfurt region also remembers well her training as a midwife, during which the romantic idea of childbirth quickly evaporated. You have witnessed violence in your profession often. A few weeks ago, he also advised a young mother to take legal action against a senior doctor.
“The woman giving birth had explicitly said during the delivery that she wanted neither a suction cup nor an episiotomy. So she was threatened with a cesarean section. Immediately afterwards there was a contraction, during which the doctor simply cut and used the suction cup.”
After the birth of her son Susanne Reif * cries incessantly, each touch shrinks her and her whole body freezes, she is clear that something has gone fundamentally wrong. Even a year later, this success board finds it difficult to talk about that day. Her therapist rates what she experienced as serious violence.
When she was admitted to the hospital to give birth but her cervix wouldn’t open and she had to get into a bathtub against her will. When asked about the intensity of her pain, the midwife rolls her eyes and calls her pain sensation “ridiculous”, saying that if she was in so much pain she might not make it to the delivery alive. “After that, I was delirious. I would pass out and vomit all the time. Only then would I regain consciousness.”
Epidural anesthesia, which an anesthesiologist injects into your back in five attempts after several hours of waiting, does not suit you. Susanne feels paralyzed. The record shows that the midwives call the anesthetist three times without success. She feels that the medical staff had left her completely alone.
The next morning it is decided that the delivery is by cesarean section. The anesthesia is injected through the catheter that you already have in your back. A little later she is lying on the operating table, fidgeting from side to side, struggling for breath and telling the nurse anesthetist that she can no longer breathe. He yells at him to stop, slaps him, and says, “If you can still talk that much, then you can breathe too.”
She later learns that the epidural was wrongly placed early on, a so-called high spinal anesthesia, which was paralyzing her organs, including her heart and lungs. “I suffocated there on the table,” he says in disbelief and shock at the same time. When the professionals realized the seriousness of the situation, they put her under general anesthesia and delivered the baby by emergency cesarean section.
The dramatic birth of her son, who was anesthetized even for the first 20 minutes of his life, is part of her trauma. But the behavior of professional staff is especially frightening to him. Where has his humanity gone? He wonders. From physical violence and non-consensual interventions, to medical errors, to verbal violence and condescension, Susanne has experienced almost the entire known spectrum of violence in obstetrics.
The subsequent violence
And what comes next is what Catrin Domke calls “the subsequent violence.” Many women are desperate for help, explains the former surgeon, who founded an association for women traumatized after experiencing violence during the birth of their child. She herself was rejected by numerous therapists. In the self-help groups they told him that he was not in the right place. Violence is often downplayed by people around the women.
“You must be happy that the child is healthy,” they often say. This makes them feel even more alone in their already difficult situation. Dream (a) Birth eV advises pregnant women, helps traumatized women and offers legal advice.
Just six months after its founding, in 2018, the association had about 200 members. “Violence during childbirth can affect anyone,” says Domke. “The parallelism with the treatment of traumatized women and rape victims is very great.” Many relationships break down within a year after such an experience. Some women – like Domke herself – are unable to return to their jobs, which means that violence often triggers a financial crisis as well. Ten out of 15 women who come to her association for help have had suicidal thoughts, says Domke.
Image: A rose in front of the entrance to a delivery room: midwives and gynecologists often know that women send a message with her.
Consciousness is growing, slowly.
Psychologist Nergiz Eschenbacher has observed that more and more women are seeking help after a traumatic delivery. She herself has established a good network in her region, around Freising, the Department of Health even refers women but it is insufficient, she says. “There is still a lot of resistance in society.” For example, prenatal and perinatal psychotherapy is often dismissed as esoteric. “But the stories I hear are anything but esoteric,” says Eschenbacher.
More and more women come to Dream (a) birth in search of legal help or to participate in the support groups that are being created on the Internet in the wake of the coronavirus crisis. “We advise women to take legal action against the hospital or obstetricians,” says Domke. “But the judiciary has to follow up.” He says he often considers the experts appointed by the health insurance to be biased, and that many lawyers do not want to accept cases of violence in obstetrics or represent doctors and hospitals at the same time.
Melanie Woche also decided to file a criminal complaint for bodily harm because a cesarean section was performed against her will and without a clear indication during the delivery of her second child.
Before, she had asked the doctor to attend her for more time for a natural delivery, which was denied. Without their consent, the child was born by cesarean section. “It was like forced treatment,” says Woche, who realized within days after delivery that she had developed post-traumatic stress disorder. Her case, which is similar to that of many women, is now before the Federal Constitutional Court in Karlsruhe, which must decide whether the right to bodily integrity has been violated.
A rose, a destiny, a trauma
November 25 coincides with the International Day of the Revolution of Roses against violence against women in general and against obstetric violence. On that day, women can lay a rose in front of the delivery room where they suffered violence. Some write their experience on a small piece of paper. It is an initiative to break the silence, not to be left alone with what they have experienced and to create awareness on the subject among professionals.
Julia Huegel is sure that women do not need to be better prepared for childbirth, but rather help them learn to listen to themselves and their feelings. In his experience, women who have a good connection with their child and their body are less likely to give up their autonomy.
Catrin Domke hopes that midwives and doctors will reflect more on their own work and behavior and accept offers of supervision. At the same time, her association, together with a family therapist and a doula, has drawn up a living will for pregnant women, which expectant parents can discuss with hospital staff prior to delivery to avoid unwanted interventions. He would like there to be more awareness when it comes to treating traumatized women in general. Saying “this is what you’ve been through, you’re right that something’s not working” is a good start.