Midwives' perspectives of obstetric violence during childbirth

Abstract

Obstetric violence (OV) at the hands of health care providers (HCPs) violates fundamental human rights and can significantly impact the physical and psychosocial health of women and their families. OV includes unconsented interventions, coercion, disrespect, overmedicalisation and abuse. International research indicates that around one third of women experience birth trauma with OV contributing to this distress. Whilst research has been undertaken regarding midwives' perspectives of OV in low- and low-middle income countries, there is scant literature regarding the perceptions of midwives from high-income countries, including Australia. This study aimed to explore midwives' perspectives of OV within the Australian context. Qualitative semi-structured interviews were conducted with 15 Australian midwives who had at least 12 months of postgraduate clinical experience providing care to women giving birth in the last five years. Critical feminist theory underpinned each stage of the research, providing the theoretical lens to understand the nuances of gendered violence, power imbalance and institutional hegemony. Thematic analysis was used to analyse the transcribed in-depth interviews. Four key themes were developed from the data: 'the historical and situational context', 'the operationalisation of obstetric violence', 'the impact of obstetric violence' and 'hope for the future'.Midwives discussed power imbalance, gender inequality, the impact of patriarchy and grooming for compliance as the enabling backdrop for OV. Continuity of care models were considered protective, though this was seen as limited within a fragmented maternity system. Midwives viewed OV as largely unchallenged in the maternity system. The 'tools of obstetric OV' described by midwives included coercion, unconsented and unnecessary interventions, and physical and emotional abuse. Midwives described the impact of witnessing or being complicit in OV, recognising that the trauma was not just experienced by women but also affected midwives themselves. Mistreatment of women in childbirth is gender-based violence enabled through patriarchal structures and power imbalances. Australian midwives are witnessing OV in both public and private maternity services. Most commonly, unconsented interventions, overmedicalisation, coercion and disrespect were observed by midwives with perpetrators being trusted HCPs. Midwives experience trauma as a result of their involvement or complicity in OV with little support provided when advocating for women. Further research is required to garner the perspectives of midwives, obstetricians, doulas, paediatricians and other birth workers in order to gain a more in-depth understanding of OV in Australian health care settings.

Date of Award	2022
Original language	English