A common form of obstetric violence in industrialized countries is denying a woman an epidural


Apparently, the term birthrape didn’t work out so well for the natural childbirth industry.

It was in vogue for several years, but generated not the outrage at obstetricians that midwives and doulas were hoping for, but rather revulsion at their appropriation of the suffering of rape victims to publicize their cause.

The new term is obstetric violence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns for normal birth are institutionalized obstetric violence.[/pullquote]

According to Birth Monopoly:

Obstetric violence is normalized mistreatment of women and birthing people in the childbirth setting. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

That’s a definition I strongly support. Sadly, natural childbirth advocates can’t stop sensationalizing all obstetric care as violence.

Amie Newman writes on Medium:

I was born in a snowstorm from a woman whose body was stolen. She was knocked out and drugged up hours after arriving at the hospital where she planned to birth her first child. Her doctor told her to stop screaming as she writhed in pain on a white-sheeted gurney, in a crowded hallway of a New York City hospital. She didn’t oblige his request and was eventually sedated, sighing deep with wet-cheeks. She did not know what she was given.


Whose hand held the scissors that cut us apart? Was it the doctor who delivered babies only on Wednesdays? It’s unlikely it was my father’s. He was not allowed in to the room until much later. My mother still does not know who severed the vessel that kept us connected — that kept me alive while in her womb. But she still wishes she knew.

Although unmedicated childbirth with a midwife is often recommended as the “cure” for obstetric violence, the truth is that midwives are among its leading perpetrators. Midwife led “campaigns for normal birth” are a common form of institutionalized obstetric violence in industrialized countries and denying a laboring woman an epidural is a common manifestation.

How could that be?

Consider Amie Newman’s definition of obstetric violence:

It is an umbrella term that includes disrespectful attitudes, coercion, bullying, and discrimination from care providers, lack of consent for examinations or treatment, forced procedures like C-section by court order, and also physical abuse.

It’s hard to imagine anything more disrespectful than telling a woman how she ought to give birth and ignoring what she might want (pain relief, interventions, maternal request C-section), yet this is precisely what campaigns for normal birth do. By campaigning on behalf of a process instead of for patients themselves, proponents of unmedicated vaginal birth are explicitly ignoring the needs and wishes of those patients.

A good rule of thumb for respectful care is: “Nothing about me without me.”

Declaring that unmedicated vaginal birth is an institutionally supported goal instead of one choice among many possible choices, midwifery organizations are most definitely making policy and determining practice WITHOUT the input of women.

Proponents of “normal birth” insist that it is safest, confusing cause and effect. Sure women who have easy vaginal births have fewer complications than women who have C-sections, but that’s like saying people who spend their hospital stay in regular rooms have fewer complications than those who spend their hospital stay in the ICU.

It isn’t the ICU that is associated complications, it’s the need for the ICU. Similarly, it is often not the C-section that is associated with complications, but the need for the C-section. Campaigns of normal birth are as effective in reducing complications as closing ICUs. Not only do those actions fail to prevent complications, they cause more serious ones.

Even if unmedicated vaginal births were safer, that wouldn’t justify pressuring women to aim for them. Paternalism is never a justification for ignoring the specific needs and desires of an individual woman. It is not a justification for obstetricians to do what they want and it is not a justification for midwives to do what they want. Women do not reclaim their agency from obstetricians by handing it over to midwives.

Denying a woman an epidural, delaying her epidural or trying to chivvy her out of getting an epidural are all forms of obstetric violence. There’s something perverse about an entire industry predicated on the concept that excruciating pain is good for women. And there’s something racist about an entire industry that expropriates the (imagined) experiences of indigenous women — who lack access to pain relief — as “authentic.”

Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia, offers a way of conceptualizing childbirth pain. In her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain, she observes:

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged…

Denying pain relief to a patient is a human rights violation and just because labor is a natural process doesn’t change that fact.

Pressuring women to breastfeed — mandated visits from lactation consultants, withholding access to formula, withholding pacifiers — is also a form of obstetric violence, a particularly infatilizing form. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

Ironically, the vaunted indigenous women often have greater freedom to choose when and how to start breastfeeding than women in “Baby Friendly” hospitals. Prelacteal supplementation is common in many indigenous cultures.

Closing well baby nurseries in an effort to promote breastfeeding is also obstetric violence. Many cultures have mandated weeks after birth as a time when women’s only task is to rest and recover. Only one culture demands that women begin caring for their babies on their own the moment the placenta is delivered: our culture!

The natural childbirth and breastfeeding industries must STOP trying to control women’s bodies and decisions. They must END violations of women’s autonomy and dignity. NO ONE should be trying to reduce epidural rates. NO ONE should be making it difficult for women to access formula. NO ONE should be mandating rooming in for new mothers and their babies.

The natural childbirth and breastfeeding industries are committing obstetric violence when they fail to heed these admonitions.