All Those Who Labor: Enduring Obstetric Violence In Sri Lanka
Photo courtesy of Western Hospital
Today is the International Day for the Elimination of Violence against Women
In Sri Lanka, motherhood appears to be publicly venerated: the country is called The Motherland, and mothers are universally regarded as a powerful force and influence in the lives of their children.
Yet when we look beyond the happy family pictures regularly presented to us at Sinhala and Tamil New Year with prosperity and abundance equated with fertility and progeny, we become aware of the negative experiences endured by women in Sri Lanka in the process of giving birth.
For many women, their experience of childbirth is unnecessarily traumatic and difficult, both physically and emotionally, due to the shortfall in sensitivity training and empathy on the part of the doctors and nursing staff involved in the Obstetric and Gynecological sectors of the health care industry. Gestational violence is a terrifyingly real experience for many women and it is one endured in silence because it is suppressed in cultural shame.
Many women educated in Sri Lanka are brought up in relative ignorance of the workings of their own bodies due to cultural stigma and repression of female awareness surrounding sexual matters and this lack of accurate information as part of sexual education leads to unwanted pregnancy and teenage or underage pregnancy. In addition to this knowledge gap, the lack of social progressiveness and openness in matters of romantic and sexual relationships offers a poor foundation for the stable creation of families.
It is ironic and sad that the very process of becoming part of the creative energy of life and the growth of expanding a family, which we believe should be joyful, instead becomes a violent and isolating experience for women. The personal experiences of women who undergo these ordeals require empathy on the part of the reader for the myths to be challenged and deconstructed.
A graphic example is that of Kanya D’Almeida, whose harrowing story was first publicly told in an episode of Shhh! Talk About Taboos, facilitated by Shanuki De Alwis, which was screened on YouTube. She describes her ordeal.
I birthed my son in a private hospital in Colombo, in a labor room that resembled a medical supply closet. I had a clear birth plan in place, which I’d discussed with my obstetrician months in advance of my due date: a vaginal delivery without medication, pain relief or surgical intervention, following – as much as possible – the physiological cues of my own body. That meant allowing for spontaneous labor and labor progression, spontaneous breaking of my waters, mobility during labor, pushing out my baby without the need for an episiotomy (cutting of the perineum) or forceps and spontaneous delivery of the placenta.
What transpired in the hospital was the opposite of what I’d planned. My labor was induced, for reasons I am now unsure were medically necessary. I was put on a Pitocin drip, a drug that stimulates artificial uterine contractions. I was subjected to a non-consensual vaginal exam by a male doctor. And I ended up with an epidural, a catheter, a fetal monitoring machine, an episiotomy, an attempted forceps delivery and finally a vacuum extraction of my son. I missed the golden hour – he was taken away from me at birth. I did not get to deliver my placenta or see it as I’d requested. And after my doctor had stitched me up, I was left alone in the labor room shivering uncontrollably, unable to walk, and feeling like I’d just barely survived a disaster.
At no point during this ordeal did I get any emotional support from the so-called care providers around me. Besides that one nurse, whose shift ended halfway through my 24-hour labor, no one took the time to answer my questions or to heed my concerns. Not one person spoke to me with kindness or respect. At every stage, I was instructed to wait, to submit and to comply to the doctor’s orders or the hospital’s regulations. I – the laboring person – became merely a vessel, someone whose body was not only incapable of this task but was actually standing in the way of the birth. The best thing I could do was lie still, make as little noise as possible and allow a higher authority to do the job for me.
I had imagined my son’s birth to be a sacred passage from the world of my womb into the world of my arms. What it ended up being was a violent extraction. Still, four years later, my body grows cold when I remember it.
There is a language for this – for the feeling that something awful was done to you, for a lingering suspicion that you were abused or molested in some way. It’s called obstetric violence and it is considered to be the most under-reported, under-studied, misunderstood forms of gender-based violence in the world today. It is defined as verbal, emotional, physical, medical or sexual abuse at the hands of a care provider during labor and delivery. That enormous range of possibility includes things such as being subjected to medical procedures without consent, being shouted at or hit, being restrained, being denied a companion and being sexually assaulted.
In 2018 the BMC medical journal published a paper entitled When Helpers Hurt, the only study of its kind to document mothers’ and midwives’ stories of obstetric violence in government hospitals in Colombo. Throughout extensive interviews, the researchers uncovered accounts of laboring women being subjected to racial slurs, physical violence, verbal abuse and even sexual misconduct on the wards of public health institutions. The study concluded that while Sri Lanka has a robust maternal health service, including a cadre of Public Health Midwives (PHMs) who provide crucial pre- and postnatal support, the quality of care during labor and delivery needs much improvement especially when it comes to the ethics of consent, respect, autonomy and dignity in the obstetric space.
But these changes won’t come easily. Part of the reason obstetric violence is sometimes referred to as a “silent epidemic” is because pregnancy and childbirth have become so routinely medicalized that everyone involved, from doctors to laboring women, tend to pathologize the process. Women in labor are referred to as “patients”, a misnomer that pushes the act of birth from a natural, physiological event into the realm of sickness, something that requires an obstetrician to resolve, or “cure”. And because we are so unaware of our rights in medical settings, it is easy for women to be abused under the guise of “standard” or so-called mandatory practices such as repeated cervical checks, episiotomies or artificial rupturing of the membranes (ARM), all of which are invasive procedures that require consent.
As occurs in many areas of healthcare around the world, what the institutions fail to provide patients in their care, individuals operating in a more informal and community based way can supply. When going forward into this potentially heart breaking pro-creative terrain, it is best to equip ourselves not with myths and illusions but with practical realities: proactive self-support and due diligence about what services are available and a combination of private and community based care will help bring about a better outcome for birthing mothers.