A pregnant woman stands at the door of her room in the Ramón González Coro gynecological birth center in the municipality of Plaza de la Revolución in Havana. This is one of the hospital centers in Cuba that participates in a respectful midwifery project.
Photo: Jorge Luis Banos/IPS
Havana, October 20th- “It was difficult for me to realize. For years I kept thinking about the bad times I went through and only now have I understood that it was all violence. I took the pain like a donkey, the insults from a nurse, the lack of privacy, my partner’s absence and everything they did to me to rush my delivery without telling me first.”
Four years after giving birth to her daughter, this 29-year-old Cuban woman, who asked not to be identified, does not want to give birth again.
“I dreamed of having two children, but not even dead now: I will not go through that again. I haven’t even told my husband that,” the young woman, who has long believed “everything was for the sake of the baby,” told IPS in Havana.
His perception changed when he recognized himself in the testimonies compiled by an independent journalistic investigation into obstetric violence in Cuba. The initiative, titled Broken Births, includes the results of a random survey of 514 women who had at least one birth in the past five decades.
A nurse lived in a similar way in an eastern province of the country. “I saw myself portrayed and I felt sorry,” said Raquel Gómez, an expert with more than 10 years of experience and a proponent of calling things like they are. “It’s violence and I have to acknowledge it. It’s the first step if you want to change,” he told IPS from the city of Santiago de Cuba.
“Obstetric violence is a multifactorial problem, like any public health problem, and part of a long biomedical tradition in which women’s bodies have been excessively pathologized and operated on.”: Michelle Sadler.
Just over 40% of the women surveyed in the study reported having suffered an episode of verbal or psychological violence, 48% were not consulted about medical procedures, 58% were prevented from walking to ease their labor, and 61% had no contact with your baby at birth.
Episiotomy was routinely performed in 76% of vaginal deliveries, in 73% of cases without anesthesia. This deep incision in the perineum, which extends to the pelvic floor muscle and is only intended to facilitate childbirth when necessary, can have consequences for a woman’s health and sex life.
The family is important in supporting birth and upbringing. In the picture, Oliver Antonio Ramírez López, one year old, with his father Jorge Ramírez and his mother Isabel Cristina López Hanze as they put the boy’s shoes on before going for a walk at his home in a central Havana neighborhood.
a global phenomenon
Global debates about the phenomenon intensified in July when the Committee on the Elimination of Discrimination Against Women (Cedaw) issued a historic ruling.
In it, he blamed Spain, as a state party to the Convention, for all forms of discrimination against women in a case of violence in midwifery that was brought before this United Nations (UN) body.
Earlier, a report by then-UN Special Rapporteur on violence against women and girls, Dubravka Šimonović, confirmed that sexual and reproductive health and childbirth abuse “occurs across the world and affects women of all socioeconomic strata.”
Victims are often “silenced or afraid to speak out for fear of taboo, stigma, or the belief that the violence they have suffered may be an isolated act.” But the testimony proves “that abuse and violence during childbirth is a widespread and entrenched practice in healthcare systems,” the 2019 text reads.
Or simply, as can be deduced from studies by UN agencies and international organizations defending women’s rights, she is so naturalized that people do not recognize her as such.
In some cases, such as forced sterilizations, pelvic augmentation surgery to facilitate childbirth, unnecessary caesarean sections, or routine episiotomy without prior consultation with the woman, some of these organizations even consider it torture.
“Obstetrics is a multifactorial problem, like any public health problem, and it is part of a long biomedical tradition in which women’s bodies have been excessively pathologized and operated on,” said Michelle Sadler, director of Chile’s Obstetric Violence Observatory.
Far from understanding childbirth as a normal process of the physiological cycle, “many medical schools still teach a tremendously interventionist approach to obstetrics” that denies the most up-to-date recommendations from international organizations on “human-centered care, dignified care,” warned the anthropologist in an interview with IPS from Santiago.
Exterior view of the Ramón González Coro gynecological birth center in Cuba, one of the participants in the respectful midwifery pilot project being carried out in Havana with the support of the United Nations Population Fund.
recommendations
The World Health Organization (WHO) in its “Recommendations for a positive birth experience” regards obstetric violence “as part of an ongoing form of abuse that occurs in the broader context of structural inequality, discrimination and patriarchy and also results from lack of education and training and lack of Respect for women’s equality and their human rights’.
The conclusions of the 2019 UN Special Rapporteur draw on the testimonies of women from around the world in the absence of comparable national statistics that allow trends to be documented.
In Latin America and the Caribbean, Venezuela was the first country to enact obstetric violence legislation in 2007, followed by Argentina (2009), Mexico (2014), Suriname (2014), Brazil (2017), and Uruguay (2017). Bolivia enacted reproductive rights violence legislation, while Uruguay and Colombia regulated humanized births.
Back to the parturients
Because of the denounced dehumanization, a growing number of women today are looking for alternatives to the already traditional hospital stay. Alternative rooms are growing within the hospitals themselves, in independent centers and in home services. Midwives, once banned, are playing an increasingly important role in both rural and urban areas.
Colombian midwife Carolina Zuluaga is aware that home birth is an option for healthy women and never for high-risk pregnancies. In just over a decade she has accompanied more than 700 births of this kind and promoted initiatives such as ConSent Childbirth and The Revolution of Love
“Mothers enjoy the freedom of movement, listening to their music, wearing their clothes, eating and drinking, being in the most comfortable positions, spending the time it takes to give birth without pressure, accessing multiple tools to manage the pain cope and counting on the support of her partner, listed Zuluaga in an interview with IPS from Bogotá.
As an additional advantage, the “optimal cutting” of the umbilical cord stands out, a practice that guarantees the complete transfer of placental blood to the newborn, where a significant amount of iron, immunoglobulins and calcium is concentrated, among other elements essential for life outside the womb.
While other countries encourage midwifery movements and home births, in Cuba about 99% of births take place in public health facilities. The results show a reduction in infant mortality to 4.9 per 1,000 live births under the age of five and maternal mortality to 40 per 100,000 live births, according to 2020 data.
Existing studies of obstetric violence in this Caribbean island nation date back about two decades and were largely conducted by nurses.
In an apparent answer to this problem, a guide released this year by the Department of Health outlines guidelines for “respectful birth” in health facilities.
The booklet is part of a respectful midwifery pilot project being implemented at three maternity centers on the island, including Havana’s Ramón González Gynecobstetric Teaching Hospital Choir, with support from the United Nations Population Fund (UNFPA) office in Cuba.
As in the case of this proposal, one hears more and more often about “humanized” or “respectful” birth without reproducing the term obstetric violence.
There are those who argue that it shouldn’t be called that “because it creates unnecessary animosity with healthcare teams.” I think this is extremely necessary because it is a structural violence that needs to be dismantled from its origins,” says specialist Sadler.
It’s about more than “a change in certain behaviors,” it’s about “a profound transformation of social and cultural structures,” he concluded.
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