(Verbal) violence in childbirth -- Interview with Katharina

25th November is Roses Revolution Day. This is a global day of action against violence in obstetrics and aims to raise awareness of violent and abusive experiences in the birth process. Those affected are encouraged to lay roses and optionally a letter in front of the facilities where they have experienced violence. In a slightly broader interpretation of the day, attention is also drawn to the issue of violence in the postpartum period. 

And what does all this have to do with alugha?

At alugha, we know about the power of language. Language can also be used to perform violent or peaceful deeds. Another heartfelt aspect at alugha is multilingualism and global interaction. The issue of violence in obstetrics is a global phenomenon. For this reason, I found the theme quite appropriate. 

However, this topic is complex, which is why I talked about (verbal) violence in obstetrics with Katharina. Katharina is a mother of three wild children and one angel baby, a business economist, dancer, author, blogger and a well known advocate for peaceful childbirth for all women in the German-speaking world. On her blog Ichgebäre you can find birth stories, among other things.

 

Dear Katharina, I am glad that you have taken the time to introduce yourself briefly for our readers. Who are you? What do you do?

My name is Katharina Tolle. I am a mum of three children on earth and one angel baby and I write birth stories for parents who don't have the words (or the time) themselves. I also run a blog, Ich Gebäre, which is about the intersection of births, society and feminism. I advocate for obstetrics that is oriented towards the wishes of the woman giving birth. On the one hand, this requires a social consensus that births shape us and that we must not dismiss them as unimportant. On the other hand, it also requires concrete political changes and an awareness among pregnant women of their rights and possibilities.

 

The topic of "violence during childbirth" is still a taboo subject. Hardly anyone talks about it. However, it is not an isolated case. Do you have concrete figures on how many women experience violence during childbirth?

There is no uniform definition of violence during childbirth. That's what makes it so difficult to evaluate. And even if there were a definition, the number of unreported cases would be high. It is often said in the media that about every third woman experiences violence during childbirth.

 

What does the term "violence" define?

That is exactly the point: where does violence begin; where does the legitimate interest of the staff end? Every woman can experience a superficially similar situation in a completely different way. I'll give a few examples:

• An episiotomy is performed without first obtaining the consent of the woman giving birth.

• The woman giving birth is held in a position she does not want to be in -- for example, supine. This was even more extreme in the past, when women were even tied to the beds.

• There are sayings such as "Don't be so difficult, thousands of women have been through this before you".

 

This is a language blog. Let's stay on the topic of "verbal violence" and "communication". What all falls under this?

As already indicated, what is dismissed by one person as assaultive or violent does not hurt others at all. It also depends very much on the personal circumstances. It can be about not taking the perceptions of the woman giving birth seriously -- as, for example, when talking about pain. But it can also be about personal things. It sounds unbelievable, but a friend told me some time ago that she was told in the delivery room, "Oh, as an African, surely you're having your baby dancing -- you don't need any help." After that, she felt too intimidated to ask for painkillers. The example also shows that it is not always about bad faith. On the contrary, many situations that are described by the women giving birth (or their partners) afterwards as assaultive or violent arise because of inadequate conditions in the clinics. The staff is sometimes simply too overworked to listen calmly to a woman giving birth when she is trying to describe what is going on inside her between contractions.

By the way, it is also a problem to play women's experiences off against each other: "Oh, with you it was only words. I almost bled to death because no one took me seriously". It is often not clear what is "only" assaultive and what is "violent". But both women have experienced violence that is difficult for them personally to accept. Verbal violence is also very common internationally. It manifests itself in very different ways: from neglect to failure to help, from "stupid comments" to caesarean sections for financial reasons, it's all there.

 

How can midwives/doctors change their wording?

Of course, it makes sense to simply leave out comments about skin colour, origin or age of the woman giving birth. It probably helps if the delivery rooms themselves have a diverse staff. Of course, awareness-raising training also helps here. I also keep hearing the suggestion that medical staff should first formulate decisions as a question: "I'm going to do an episiotomy, if that's okay with you?" This is certainly a good solution for women who have dealt with the relevant issue beforehand. However, many women are not very concerned with the medical details beforehand. If medical staff then ask whether a certain action should be taken, this is again problematic: the responsibility for the decision then lies with the woman giving birth. Birth is an exceptional situation either way. In this situation, spontaneous decisions are not always possible.

For me, the key is therefore continuous care. If women already speak to the staff during pregnancy who will then also be present at the birth, this has several advantages: For one thing, they can get used to each other's language. The pregnant woman is then no longer surprised when a midwife uses certain phrases. The birth of our daughter was planned as a home birth. I met the midwife regularly during the pregnancy for check-ups. My husband also attended one of these appointments towards the end of the pregnancy. And there we also discussed, for example, that in case of a medically necessary transfer, our midwife would use very drastic words in the phone call to the emergency services -- even if the situation was not that urgent. "That way I can make sure they really do send the helicopter instead of the ambulance." The case didn't happen, our daughter was born very relaxed at home. And yet I am glad that we had discussed beforehand how it would have gone. On the other hand, you also get to know the preferences and behaviour of the other person and can better gauge them. By the way, this kind of continuous care is not only possible in out-of-hospital births. Some hospitals also work with midwives who take care of the pregnant woman during pregnancy and are also present at the birth. Even without a midwife, much of the verbal violence in the delivery room could probably be eliminated if the staff did not have to jump between different delivery rooms so often. If you can focus on one person (or one couple), you know faster how the communication is going than a person who is constantly attending to different people.

 

What role can the father or a doula or other birth companion play here? How can they help to make a birth less violent? With which linguistic expressions?

Normally, a partner or doula already knows the woman in labour so well that a better assessment is possible: What characterises appreciative communication for the woman in labour? These birth companions can therefore address the mother in a way that makes her feel comfortable. They can also act as a buffer between the woman giving birth on the one hand and the medical staff on the other. This can mean, for example, that the woman says "I prefer nitrous oxide instead of an epidural" between contractions, but that her partner or doula then conducts the further discussion with the staff. Although the birth is an exceptional situation for them too, they usually at least manage to speak coherently.

 

How can a woman in labour perhaps communicate in advance how she would like her birth to be?

In the case of an out-of-hospital birth, the midwife will already discuss with the pregnant woman during pregnancy what ideas she has, what fears and experiences play a role in the birth. This is also possible with hospital births if they are attended by midwives who are not working in shifts but are on call for certain pregnant women.

Even if none of this is the case, there is the possibility of addressing certain wishes during the preliminary talk at the hospital. Women's experiences here are very different. Some women have had very good experiences; with others, birth plans were rather smiled at or rejected outright: "If it's medically necessary, we'll do it, and then it doesn't matter what you wrote down there." This reveals a fundamental problem: it is often assumed that women with certain wishes would endanger their babies. But no mentally healthy woman wants to put her baby in danger. On the contrary, the women want the birth to be as unproblematic as possible for the baby and themselves. What this means in individual cases can vary greatly: it can range from an elective caesarean section to an unassisted birth.

Some women write a patient decree instead of a birth plan to give more weight to their ideas. From a legal point of view, this is not as easy to circumvent as a birth plan.

 

Where is a woman giving birth less likely to experience violence? At home?

There are hardly any women who experience violence during childbirth at home. But I believe that this has only indirectly to do with the place of birth. It has more to do with the points I have already mentioned: The woman giving birth already knows the midwife. They are a well-rehearsed team. The midwife is not looking after other women in labour during this time. She is always there. There is more time to discuss things. All this supports a birth experience without violence or violent communication.

 

What do you think? Would it make sense if linguistics also took up the topic of "violence during birth"?

In any case, it makes sense for the topic to find its way out of its niche. Linguistics is just as much in demand as other disciplines. Let's think about the words we use in German alone: Kreißsaal comes from Middle High German and means to scream. We call the rhythmic contraction of the birthing muscles during birth "Wehe" in German. In the Bible it says (at least in the German translation) that the woman should give birth in pain. There is certainly a whole range of approaches that could be linguistically processed.

And especially on the subject of violence in obstetrics, linguistics could probably achieve a lot if there were simply studies on all the "stupid sayings" that are uttered in the delivery room. This would get us out of telling anecdotes and into a scientifically sound source situation.

 

What do you wish for obstetrics in the future?

I wish that obstetrics would regain the upper hand over obstetric medicine. That women are helped when they need help, but that they are not patronised in the process. This requires commitment on a political, social, medical and personal level. It is probably a long road, but it is worth taking. Because every birth is unique and should have a corresponding value for all of us.

 

This is the last question I ask everyone. Nothing to do with obstetrics: which languages do you speak and which languages would you like to learn?

My mother tongue is German. I speak English fluently. My knowledge of Latin and Ancient Greek, on the other hand, only exist on paper. I have great fun reading the Cyrillic alphabet whenever words catch my eye. But I don't understand a word of Russian. Thanks to two stays abroad, I also speak Finnish -- although this has unfortunately become a bit rusty in recent years. But it's still good enough for family holidays. Oh, and I speak Low German with my grandma! If I had a free choice and a lot of time, I would probably learn Polish, because we live in Brandenburg and I think it's a shame that I don't understand a word on the other side of the border. The European project is too important to me to ignore that. And purely because it's very cool, I'd also like to learn a few bits of Klingon :-).

Let us summarise again in conclusion:

• Violence during childbirth can be psychological and physical. There is no single definition
• Verbal violence can range from shouting to racist discrimination.
• Self-determination is important for the woman giving birth. For this reason, it makes sense to clarify rights in advance. 

At alugha we already have a few videos on the topic of birth. If you also want to make a multilingual video about birth or any other topic, register here.

 

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Photo: Valeria Boltneva/ Pexels