In Spain, a network of activists, lawyers and midwives break the silence on obstetric violence
They all thought it had only happened to them and they didn’t know why. It was the feeling of a small group of Spanish women who, twenty years ago, set up an email chain to talk about the negative experiences they had had during their pregnancies and childbirths. Soon after, they started receiving more testimonies from women all over Spain, naming an untold yet systematic and global women’s issue — obstetric violence. Their email group quickly reached 1,000 subscribers. Now it has become a pioneering Spanish association called El Parto es Nuestro (‘Childbirth is Ours’), with local groups in more than twenty Spanish cities offering a space for women to support and listen to each other, as well as to get counselling.
Together with lawyers, midwives, activists and other groups, the association forges a nationwide network of initiatives, whose work has begun in recent years to bear legislative fruit. Recently, the Spanish Ministry of Equality announced that it will include obstetric violence in the law as a type of violence against women — a step welcomed by organisations that hope the move will serve to end this type of violence, which has physical and emotional consequences for both women and their babies.
The negative experiences women more often report, says Virginia Murialdo, anthropologist and activist with El Parto es Nuestro, include unjustified and unconsented episiotomies (cutting of the skin, muscles, nerves and fascia surrounding the vagina) during childbirth, an excessive administration of drugs, a growing trend towards caesarean sections and the so-called ‘Kristeller manoeuvre’ —highly questioned by the World Health Organisation (WHO)— which consists on pressuring the abdomen to push the baby into the birth canal. Beyond these practices, “women also suffer humiliating and abusive attitudes and comments”, says Ms. Murialdo, as well as “actions that do not respect their privacy”, ranging from students being present without consent during vaginal examinations to the impossibility of choosing the birth position, to sexist comments meant to intimidate those who refuse the epidural.
These cases are not unusual. The United Nations described obstetric violence in 2019 as a “widespread phenomenon” — one the WHO considers to be “a violation of women’s rights.” Yet women rarely speak about these experiences out loud, due to fear of stigma and shame, or because they downplay their importance. “Many have normalised what happened to them, so the first step is to break the silence and spread awareness,” says Ms. Murialdo.
Specialized in obstetric violence for 18 years now, Spanish lawyer Francisca Fernández Guillén has gone precisely as far as to the UN to defend the cases of four Spanish women whose complaints had been dismissed by Spanish courts. Since she first started working in this field, she says she has seen “a good evolution,” with important rulings that have served to pave the way to ending impunity for this type of violence. “I am getting good rulings in the courts. Before it was much more difficult to get recognition, for instance, of the need to get informed consent from the patient to perform an episiotomy or to induce labour.”
However, some still resist to recognise, medically and judicially, the harm these practices cause to many women. One of the four complaints the lawyer brought before the UN Commission on Human Rights in 2018, was the case of a woman (who wished to remain anonymous and we’ll name ‘S’) who gave birth in the Cruces Hospital in the Spanish Basque country in 2012. “She has behaved poorly”, “She doesn’t deserve the child”, “I should take the child away from you, you have behaved very badly,” were some of the comments S’s heard during childbirth from her midwife, who also performed a non-indicated episiotomy despite S’s refusal. She hadn’t been allowed to drink anything since she was admitted to the hospital, and was forced to remain on her back without moving and alone at all times — not even her baby’s father was allowed in the room. The episiotomy’s consequences later included urinary incontinence and “severe” repercussions on her sexual and couple relations.
In 2020, the UN Commission finally reprimanded Spain for the obstetric violence committed against one of Francisca Fernández Guillén’s clients. In its resolution, the Commission stated that the woman had been subjected to several practices, such as labour induction, “without apparent justification” and qualified the events as gender-based violence. However, the introduction of obstetric violence in Spanish law will be for nothing, says the lawyer, unless there is a real commitment to comply with respectful childbirth protocols and regulations, which already advise against many of these practices and require women to be informed.
Many hospitals are already evolving. Soledad Carreguí, who has been a midwife for more than 20 years now at La Plana University Hospital in the eastern Spanish province of Castellón, says much has changed since she first started working there thanks to a group of professionals who began questioning the “excessive medicalisation” of childbirths and started looking into new practices that would humanise the experience, aligning it with new medical evidence.
“Many clinical practices were questioned on a scientific level, but because of the hospital’s own routine they are difficult to change,” she explains. The hospital now has a childbirth protocol in which the staff applies what they have learned: “We encourage women’s mobility while they dilate, ensure they give birth in the most comfortable position, allow them to eat, drink and be accompanied by whoever they want, avoid medication, oxytocin, episiotomies and labour induction when they are unnecessary, and we indicate caesarean-sections on a case-to-case basis.” In short, says Carreguí, it’s a matter of “not working on a whim or according to old and rigid protocols, but putting women and their needs at the centre,” she says. “A humanised birth is absolutely compatible with a safe birth.”