Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives.

Júlia Martín-Badia,Noemí Obregón-Gutiérrez,Josefina Goberna-Tricas

doi:10.3390/ijerph182312553

Abstract

Background: obstetric violence is still far too invisible; the word “violence” generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. Methodology: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. Results and Discussion: four categories were arrived at; they are “the maleficence of forgetting my vulnerability”, “beneficence requires respect for my integrity and dignity”, “my autonomy is being removed from me” and “a problem of social justice towards us, women”. Conclusion: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

Highlights

Obstetric violence is “the appropriation of women’s bodies and reproductive processes by healthcare providers, which is expressed in a hierarchic dehumanizing treatment, an abuse of medicalization and the pathologization of natural processes, producing a loss of autonomy and free decision-making capacity in women regarding their bodies and sexuality, all of which has a negative impact in their quality of life” [1]
Rights have been infringed on in many countries by the introduction of protocols that are inappropriate, not evidence-based, and harmful for women and their babies [60]. In this paper it has been analyzed how, according to midwives, obstetric violence infringes on the basic principles of bioethics, both the American ones and the European ones, which should not be seen as compartmentalized, but as inextricably linked
The conclusion is that women are victims of malpractice as long as their vulnerability is not considered, and, it is increased

Summary

Introduction

Obstetric violence is “the appropriation of women’s bodies and reproductive processes by healthcare providers, which is expressed in a hierarchic dehumanizing treatment, an abuse of medicalization and the pathologization of natural processes, producing a loss of autonomy and free decision-making capacity in women regarding their bodies and sexuality, all of which has a negative impact in their quality of life” [1] This phenomenon has been widely studied [2,3,4,5,6,7] with the aim of defining its main elements, which have been classified into the following categories: mistreatment or abuse, stigmatization and discrimination, violation of professional care standards, poor healthcare relationship between professionals and women, and the healthcare system’s conditions and limitations.

Objectives

Methods

Results

Conclusion