Obstetric Violence in NYC Hospitals

Commentary: Obstetric Violence in NYC Hospitals

December 2017

Laura Zeidenstein, CNM, DNP, FACNM

“…When midwifery students begin new clinical experiences, what they find most troubling is their observation that women are often treated with disrespect, disdain, and condescension; this is all the more traumatizing when they observe such treatment coming from other midwives. How does this happen? Some midwives become burned out and buckle internally from professional struggles that may have injured their self-esteem and confidence. When midwives feel isolated in their workplace, they may over assimilate the medical model to gain approval from the health care establishment. Once this happens, they may then lose the ability to connect their own humanity with the humanity of women entrusted to their care….”

The Hallmarks of Midwifery (ACNM, 2012) include empowerment of women as partners in health care, the right to self-determination and the integration of cultural humility. Midwives pride ourselves in our awareness of human dignity and our priority to advocate for our clients.

Yet, midwives are not strangers to violence against women. Midwives all over NYC find ourselves in hospital environments of obstetric violence. As women come forward in numbers we have never seen before to report sexual harassment and assault it is time to take stock of the culture of obstetric violence that is tolerated in NYC hospitals.

The violence we have witnessed is difficult to bear: providers using their forearms to shove a woman’s legs open for pelvic exam or telling a woman that her perineum is ugly; rude and insulting statements directed at patients, calling them ‘stupid’ and not believing their stories; threatening women who push back with, “do you want your baby to die?”; yelling at patients in a language they don’t speak; conducting rough pelvic exams while on a cell phone and telling a woman, “ If you can have sex you should be able to handle this”; sharing inappropriate videos/photos with colleagues; and insulting a patient’s body size and type. Misogyny provides the roots for this maltreatment to flourish. Obstetric violence is the intersection of institutional violence and interpersonal violence (IPV).

Perpetrators include obstetricians, residents, PAs, RNs and even midwives. Abuse behavior intersects with discrimination based on race, poverty, socioeconomic class, gender identity, LGBT, nationality, education and bias against women who are homeless or who have had multiple STIs, and/or abortions. Rough pelvic exams are often the norm. Many medical students continue to ‘learn’ their first pelvic exams on anesthetized women.

When perpetrators are midwives our challenge is even greater. What we practice we become. If midwives perpetrate violence in our own work environment we need to address it in order to protect the patients that bestow their trust in us.

Midwives have learned to be creative to deflect the abuse with indirect actions such as a physical stance to block another provider or simple eye contact to hold a woman near. We have to do more. What is yours to do? Thoughtful action requires practice on how to respond. We have to practice again and again and again. We need to create unified practice within our midwifery community to end this violence.  It is our responsibility. Zero tolerance.

Laura Zeidenstein is currently the Co-Chair of NYC Midwives. Laura has practiced midwifery in NYC for the past 30 years. She is Program Director of Columbia's Graduate Midwifery Education.