Exploring the evidence-based approaches to combat obstetric violence and promote respectful maternity care
Obstetric violence is a multifaceted problem. It's not always a dramatic event; often, it's a series of subtle and not-so-subtle actions that strip a person of their autonomy.
Shouting, scolding, or using discriminatory language during childbirth.
Performing medical interventions without clear justification or informed consent.
Ignoring requests for pain management or mocking pain tolerance.
Unnecessarily separating the healthy newborn from the mother after birth.
The core theory is simple: physiological birth is safest when the birthing person feels safe, respected, and in control. The "Rights Model" of care, supported by the WHO, posits that upholding human rights—like autonomy, information, and dignity—leads to better physical and psychological outcomes .
To move from anecdotal evidence to actionable data, researchers needed to quantify the problem and test solutions. A pivotal study, often referenced as the "Good Practices in Childbirth" survey, was conducted in Brazil, a country with high rates of cesarean sections and reported obstetric violence .
Women interviewed postpartum in Brazilian hospitals
Administered within 24 hours after birth and months later
Interventions, mistreatment, outcomes, and satisfaction
To assess prevalence of obstetric interventions and abuse, correlating with outcomes
Over 23,000 women who gave birth in Brazilian hospitals
Detailed questionnaire covering demographics, interventions, and experiences
Correlation between interventions, mistreatment, and health outcomes
The results were stark. They provided the first large-scale, data-driven snapshot of the problem and, crucially, identified what worked.
| Practice | Prevalence in Study | WHO Recommendation | Status |
|---|---|---|---|
| Episiotomy |
|
Not Recommended routinely | |
| Kristeller Maneuver |
|
Not Recommended under any circumstances | |
| Continuous Labor Support |
|
Recommended for all women | |
| Cesarean Section |
|
Only when medically justified (ideal: 10-15%) |
Table 1: Prevalence of Common Interventions vs. WHO Recommendations
Women who experienced non-consensual interventions and disrespectful treatment were more likely to report:
The study identified practices that led to positive outcomes:
| Good Practice | Positive Outcome Correlation | Impact Level |
|---|---|---|
| Presence of a Chosen Birth Companion | ↑ Satisfaction, ↓ Use of Pain Medication, ↓ Cesarean Rates | High |
| Freedom of Movement During Labor | Shorter Labor, Less Need for Interventions | High |
| Informed Consent for All Procedures | ↓ Psychological Trauma, ↑ Sense of Control | High |
| Immediate Skin-to-Skin Contact | ↑ Successful Breastfeeding, ↑ Baby's Temperature Stability | Medium |
Table 2: Protective Practices and Their Correlated Outcomes
Just as a lab scientist needs specific tools, implementing good practices requires a new set of "reagents"—concrete protocols and resources that replace outdated, harmful ones.
Replaces tradition-based or convenience-based care (e.g., banning routine episiotomy).
Ensures the patient understands and agrees to every procedure, making consent an active process.
Provides continuous emotional and physical support, acting as an advocate for the birthing person.
Facilitates communication between the patient and healthcare team about preferences and boundaries.
Offers a range of options (water immersion, massage, nitrous oxide, epidurals) respecting patient choice.
Addresses the root of verbal abuse and discrimination, fostering a culture of respect.
Increased by up to 67% with humanized care implementation
Reduced by 45% with proper informed consent protocols
Increased by 32% with immediate skin-to-skin contact
The fight against obstetric violence is not an anti-medical movement; it is a pro-evidence, pro-humanity movement. The science is unequivocal: respectful, woman-centered care is not a luxury—it is a fundamental component of safe maternity care .
The data from key studies gives us a clear roadmap. It shows that by empowering women with information, surrounding them with support, and holding healthcare systems accountable to evidence-based and rights-based standards, we can transform the experience of birth. It's a future where every person bringing life into the world is treated not as a vessel, but as a respected, active participant in one of life's most powerful moments. The tools are in our toolkit; the evidence is on our side. Now, it's a matter of implementation.