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The Missing Element in Addressing Obstetric Violence

Obstetric violence is a global phenomenon. Nowhere is it more frequently observed and recorded than in South Africa. It is a violation of human rights that requires urgent attention.

Suggested remedies range from punitive measures to teaching the perpetrators (in the workplace this is usually the midwives, as obstetricians are mistakenly presumed to know this already) how to treat women in labour well.

The interventions are not making a deep enough impression. Midwives report that they are just one more item of requirements on a back-breaking to-do list. Abuse remains unabated. Drastic measures are called for. And the most drastic measure is the recognition that the missing element in the equation is love.

On a continuum of love, with unconditional love placed on one end, it is not hate that we find on the other, but fear. Love versus fear. We live in a fear based society, and nowhere is this more prevalent than in maternity.

Mothers are terrified of pain. To let go of pain they need to let go of fear. To let go of fear they need love and support.

Midwives are afraid of retribution for mistakes made. They hold fiercely onto control. The control of ordering women around and of seeing efficiency as the gold standard of maternity care. While efficiency is important in busy hospital wards, it happens at the expense of feeling. To let go of this control and the fear that drives it, the midwives need love and appreciation for the wonderful work they are doing.

Obstetricians hold the final responsibility for maternal and neonatal outcomes on their shifts and in their wards. It is natural for them to be afraid of mistakes and poor outcomes. Birth can be dangerous, and obstetricians have to pay the highest insurance premiums of all doctors for malpractice because things do go wrong at birth. Nobody wants our mothers or babies to die. Once again the response to this fear is one of looking for ways to maintain control. The best way to control labour is to intervene with inductions, vacuum extractions and caesarean sections, even though evidence shows that overuse of interventions leads to negative outcomes. Interventions reduce fear though, so their use continues to rise unabated. Once again, the best way to let go of this fear is through love.

All care providers in maternity, including the obstetricians, need to be respected, listened to and loved enough to allay fear that is deep seated and suppressed under layers of control and years of training to put their own feelings aside. This fear is often not even recognized until it is squarely faced. Like racism, religious intolerance and gender discrimination, the fear at the heart of maternity is an unconscious shadow. It is the pervasive and underlying demon at the heart of obstetric violence.

When did we lose the sacred, awe-inspiring love that is the birthright of every baby? If we bring joy and love back to the birthplace for both the perpetrators and the victims of this violence, then and only then do we have a real chance to slay the monster of fear.