It is not easy to define obstetric violence. Sometimes we only associate it with the hospital environment and especially the moment of birth. However, obstetric violence can also occur during pregnancy and the postpartum period, through practices, comments, or decisions that violate the rights of women and their babies.

Although cases are gradually decreasing, it is important to understand this clearly. Naming these experiences helps to prevent, report, and heal them.

Why is Obstetric Violence Important?

In my view, it has been thought that women do not have the ability to make their own decisions during pregnancy and childbirth. For many years, medicine has been very hierarchical and paternalistic: the expert decides, the patient obeys.

Moreover, the fact that it is necessary to provide protection not only for the woman's health during pregnancy but also for the baby has often been used as an excuse to cancel the mother's autonomy, and any questioning has been presented as a risk to the fetus.

In the past, women were seen as individuals who needed to be monitored; it has taken many years to progress towards equality. Since gynecology and obstetrics are fields exclusively focused on women, they carry the professional/patient inequality that other male-centered specialties have largely escaped.

The necessity to protect the baby's health has traditionally been an excellent excuse to maintain the superiority relationship between the health professional and the woman. Thus, behaviors such as withholding information, belittling pain, mocking fears, or intervening without explanation have become normalized.

Today, thanks to many studies, we know that obstetric violence is a public health and human rights issue. It is associated with postpartum depression, post-traumatic stress disorder, breastfeeding difficulties, and difficulties in bonding with the baby. It can also reduce the desire to have more children and affect the woman's self-esteem, couple life, family life, and work life.

What is Obstetric Violence?

When a pregnancy and/or birth is assessed as low risk and the process develops normally, the role of health professionals is to support, assist, and be prepared for possible complications. We should not intervene unless things become complicated.

Obstetric violence is defined as any action that disrupts the natural course of pregnancy, childbirth, or the postpartum period and unnecessarily medicalizes this process, without a real need or informed consent. It also encompasses verbal, emotional abuse, or discrimination.

Thus, not following the recommendations given for normal birth and low-risk pregnancy by the Ministry of Health and international organizations, or ignoring the woman's autonomy and rights, is considered obstetric violence, even if it is a medical indication.

The Most Common Forms of Obstetric Violence

Behaviors considered obstetric violence include:

  • Systematic intervention without demonstration or consent: routinely shaving the woman in labor and performing enemas; unnecessarily rupturing the amniotic sac; performing episiotomy; planning induction of labor without a medical justification; unnecessarily applying maneuvers such as the Kristeller maneuver (pressure on the fundus of the uterus).
  • Forced or uninformed medical procedures: repeated vaginal examinations by different specialists without explaining the reason; performing a cesarean section without a clear indication or presenting it as inevitable; administering medication (e.g., oxytocin) to speed up labor without informing about the benefits and risks.
  • Non-human or degrading treatment: yelling at the woman during childbirth, mocking her, or blaming her for her behavior (comments like "stop yelling so much" or "you're complaining too much, you're not dilating enough"); treating her like a child; ignoring her questions or mocking her fears and preferences.
  • Neglect or lack of attention: ignoring pain complaints or requests for analgesia; not responding to the woman's call; belittling significant symptoms during pregnancy or the postpartum period (e.g., bleeding, severe pain, serious emotional symptoms).
  • Violation of privacy and confidentiality: sharing private information in front of individuals not involved in her care; conducting examinations without adequately protecting physical privacy; allowing constant entry and exit of specialists.
  • Unjust separation of the baby: preventing skin-to-skin contact immediately after birth when both mother and baby are healthy; taking the newborn "due to protocol" without an emergency, complicating breastfeeding and bonding.
  • Discrimination: less respect, more distrust, or more unnecessary intervention due to socioeconomic status, origin, race, age, or gender identity.

International research estimates that approximately half or more of women worldwide experience such mistreatment or unauthorized interventions during the maternity period. This indicates that these are not just isolated cases, but a structural issue in how we understand and organize birth services.

It is important to note that not every medical intervention is obstetric violence. In some cases, it may be necessary to change the birth plan or add or modify procedures to ensure the safety of the mother and baby. The difference lies in the presence of a clear medical justification and genuine informed consent along with respectful and honest communication.

Are We Under Legal Protection?

In Spain, there are various laws to protect patients. The most comprehensive is the Patient Autonomy Law, which clearly states that the patient should choose their treatment when well-informed. It is mandatory for the healthcare professional to provide accurate, clear, and understandable information for this right to be exercised.

This regulation states that all actions in the health field require informed consent; this is usually given verbally, but if the intervention carries significant risk, it should be requested in writing. The law also protects the right to privacy, confidentiality, and dignified treatment.

In recent years, other regulations regarding sexual and reproductive health and respectful childbirth have also been strengthened; these laws require health services to collect data on obstetric practices, train staff on women's rights, and develop protocols aimed at reducing non-evidence-based interventions and ensuring informed consent.

International organizations, such as the World Health Organization and United Nations committees, recognize obstetric violence as a form of discrimination against women. They have called on states to provide services that respect human dignity, autonomy, and physical and emotional safety during childbirth.

What is Happening in the Obstetric Field?

Although there have been discussions about the need for changes for some time, in recent years, the true magnitude of the problem has been recognized. The decrease in maternal and neonatal mortality rates has provided an opportunity to assess more and has made it possible to evaluate the quality of the woman's pregnancy and childbirth experience.

In Spain, the Patient Autonomy Law (approved in 2002) has opened an important path for the recognition of individual rights. Subsequently, the Ministry of Health prepared significant documents such as the "Normal Birth Care Strategy in the National Health System" in 2008 and the "Clinical Practice Guide on Normal Birth Care" in 2010. These documents aim to prevent the misuse of certain techniques and practices and to restore the lost physiological quality of births.

These documents contain recommendations based on the best available evidence, such as limiting routine episiotomy practices, avoiding systematic enemas and shaving, promoting movement and free positions, supporting early skin-to-skin contact and demand-based breastfeeding; they also allow for the presence of a companion chosen by the woman.

The preparation of a birth plan by the Ministry of Health has been a significant recognition of the woman's right to make decisions during childbirth and the postpartum period. This official model allows for preferences regarding companionship, analgesia, positions, and contact with the baby to be documented in writing. Click here if you would like to review it.

However, the actual implementation of these recommendations is unequal according to hospitals and autonomous communities. While some maternity wards have made significant progress in respectful childbirth, others still adhere to outdated protocols with high intervention rates. Therefore, it is extremely important for women to be aware of this framework and to be able to demand treatment in accordance with their rights.

How Can I Prevent This Situation?

Obstetric violence is never the woman's responsibility, but there are tools that can help reduce risks and enhance your sense of control and safety during pregnancy, childbirth, and the postpartum period.

Get Informed and Choose Your Birth Place

Almost all hospitals, especially in large cities, organize guided visits or informational meetings to familiarize themselves with birth care protocols and facilities. If possible, get informed and visit a few. This way, you can decide which hospital is more suitable for your expectations.

Some questions that may be helpful include: cesarean and episiotomy rates, whether a companion is always allowed, whether skin-to-skin contact is performed after cesarean, whether movement is allowed during labor, or how pain management and analgesia are provided.

Birth Plan and Your Rights as a Patient

Find out if the hospital has its own birth plan. If not, you can use the Ministry of Health's birth plan. This document is not just a letter of wishes, but also a legal tool: it collects your preferences and guides the healthcare team.

Remember that you have the right to informed consent. No intervention (neither rupture of membranes, nor the Hamilton maneuver, nor an induction without necessity, nor a routine episiotomy) can be performed without explaining the risks, benefits, and alternatives to you and obtaining your explicit consent; except in emergencies.

Communication with the Healthcare Team

At the time of delivery, talk to the team working with the nurse. Clearly express your wishes and ask them to explain the protocol and process to be followed. You can keep your birth plan written with you and briefly mention it during hospital admission.

This is not about refusing all interventions; ask them to explain the reasons and purposes for each technique, what might happen if you wait a bit longer, or what would happen if another option is preferred. This dialogue is part of your right to make decisions.

If possible, attend prenatal visits and the birth with a trusted person (partner, family, friend, doula). This person can help you remember information, provide emotional support, and express your needs.

Emotional Preparation and Maternal Education

Information is the strongest shield for future mothers. Participating in childbirth preparation classes or maternal education helps understand physiological processes and legal rights, and allows you to understand what is happening in your body, helping you identify when something is going wrong.

These sessions cover topics such as appropriate clinical practices in childbirth, pain management, breastfeeding, postpartum, and physical and emotional alarm signs. They are usually held at health centers and are open to all women, regardless of insurance type.

Thanks to these initiatives, women can realize what the best care and services are during childbirth and better align their expectations with reality. A realistic birth plan based on quality information empowers the woman and makes her an active participant in this process.

When There Are Real Emergencies

In a real emergency, remember that there may not be time to wait for your decision, and the healthcare professional may need to act quickly to save your life or your baby's life. Even in such situations, explaining what is happening in a simple and honest way (“you are bleeding a lot, we need to intervene now”) can make a significant difference in how you experience this.

If you experienced mistreatment, a lack of information, or procedures you did not understand after childbirth, requesting a copy of your medical record and consulting with specialized associations or perinatal mental health professionals, if necessary, is recommended to review what happened and to receive support.

Experiencing pregnancy and childbirth with respect, support, and good information not only improves physical outcomes but also preserves your emotional health, your bond with your baby, and your confidence as a mother. Knowing what obstetric violence is, your rights, and the tools at your disposal is an important step towards freer, safer, and happier motherhood.