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Controversies in Childbirth: from Epistemology to Practices

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Innovative approach to protecting women’s rights during childbirth

Doctors and midwives frequently fail to treat women as rational citizens during childbirth, inflicting trauma and violence on them, finds new research led by Oxford University.

Society
Health

Women frequently have their rights breached during childbirth and even suffer violence at the hands of European health professionals because, during childbirth, they are not considered to be rational, new research finds. With the support of the Marie Skłodowska-Curie Actions programme, the VOICEs project used the tools of philosophy to probe why doctors and midwives are failing their patients despite their best intentions. “Simply telling health professionals to do more listening, to have women involved, to ensure that all women are heard, will not work,” says Stella Villarmea, the philosopher professor who led the research at the University of Oxford. “We need to know why this happens before we can fix it effectively.” Villarmea concluded philosophers, lawyers and health workers are influenced by age-old stereotypes about childbirth, allowing violence in the labour ward to be considered normal. "Unnecessary episiotomies or caesareans, vaginal examinations conducted without a woman’s consent – all are examples of routine violence in countries considered to have some of the best health systems in the world," she explains. She argued in the Spanish newspaper El País article, ‘When does a woman lose her right to decide when to give birth?’, that a woman’s rights were also breached when a hospital secured a court order to forcibly induce a pregnant woman during her 42nd week of pregnancy despite no immediate risk to the baby.

Commonplace violence

The United Nations considers obstetric violence a problem worldwide, as outlined in ‘A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence’. The Council of Europe in Resolution 2306 (2019) concluded: “Obstetrical and gynaecological violence is a form of violence that has long been hidden and is still too often ignored.” “Pregnant women should not be so obviously deprived of their full capacity just because they enter the maternity ward,” states Villarmea, explaining in detail why that happens in her book 'Women’s birthing bodies and the law: unauthorised intimate examinations, power and vulnerability'. Western philosophy has traditionally focused little on birth, compared to death and mortality, and underestimated the capacity of a woman in labour to be rational, she argues. Women in popular culture are depicted as crying out during labour due to a loss of control whereas, in fact, antenatal classes teach them guttural sounds can open up the birth canal. “Nature documentaries show chimpanzees piling up boxes to reach bananas as proof of a cognitive learning process but the decisions a woman takes to get into a good birthing position are considered to be just following her animal instincts,” notes Villarmea. During her research, Villarmea collaborated with health professionals and academics at the Values-based Practice in Health and Social Care at St Catherine’s College, in Oxford, the School of Community Health and Midwifery – UCLan, based at the University of Central Lancashire and the University of Southampton, making the tools of philosophy accessible to practitioners in several papers including ‘Barriers to establishing shared decision-making in childbirth: Unveiling epistemic stereotypes about women in labour’, in the ‘Journal of Evaluation in Clinical Practice’. “Philosophy, which Plato called the ‘medicine of the soul’, can use its scalpel to open up the theories and practices which still oppress and denigrate women’s bodies,” she says.

Keywords

VOICEs, philosophy, childbirth, women’s rights, violence, unnecessary episiotomies

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