Inappropriate remarks, mockery, invasive or violent gestures made without their consent, the list is long of the violence that some women may suffer during their pregnancy or childbirth. Until then, this word had not been heard. We tended to say “Baby is fine, mom is fine = there is nothing to report”. However, this violence, sometimes minimized by the entourage or the medical staff (persuaded to do well), can lead to serious consequences. Some mothers will have difficulty attaching themselves to their child, or slowly slide into postpartum depression. Others, because of traumatic stress, are afraid of having another child because they are afraid of reliving the violence they have suffered. Some, more rare, will decide to give birth at home, without any assistance (ANA). However, health professionals, aware of the problem, suggest that practices must change to better take into account the expectations of women and couples.
“Health professionals sometimes forget basic empathy reflexes. “
Professor Philippe Deruelle, National Secretary of the National College of French Gynecologists and Obstetricians (CNGOF)
Parents: The women who sent us their testimonies speak of mockery and even violence, verbal and physical, while they were giving birth. However, some health professionals seem to be acting as if this does not exist. Isn’t this what we can call a “denial of the feelings” of women?
Philippe Deruelle: “The idea is not to say that these inappropriate attitudes do not exist, because they do exist. On the other hand, we cannot say that this violence is the result of a profession, because it is mainly the result of individuals, all professions combined (midwives, obstetricians, auxiliaries, etc.). Overall, it is the work of a whole professional environment, the medical world. Sometimes it’s good to be reminded by patients, or couples, that certain things are not accepted. In these testimonies, the problem is often not due to the technique itself, but rather to the way in which one brought and explained things before doing certain acts. “
The women who testify speak of childbirth without analgesia. In some, the epidural did not work. However, they experienced very violent acts: uterine revisions, live caesarean sections. It sounds crazy not having time to put off an epidural, how do you explain that?
“Regarding epidural analgesia, you should know that when the pain has been very strong, for a very long time, the pain receptors are completely saturated. Suddenly, we may add more product, it will be useless. In these cases, it is better to put the patient to sleep completely. But in that case, if she doesn’t see the birth of her child, won’t she also be traumatized to have “missed this moment”? It’s hard to know where to place the cursor.
In this case, shouldn’t we just ask the patient for his opinion? Yet this is what the Kouchner law provides du March 4, 2002, with the request for consent which must be made systematically before any medical act.
“Yes, that’s the right thing to do, of course. But sometimes the patient herself can no longer respond, so caught up in this whirlwind of pain. But of course, we should take the time to explain things. We realize that we are out of step with what couples expect. This is a fundamental problem throughout the health sector. Everyone discovers it when they fall ill: health professionals are so overworked and abused themselves that they sometimes forget the basic empathy reflexes: holding a hand, supporting, listening… ”
We hear that in some hospitals, the baby’s health is privileged to the detriment of the integrity of the woman’s body, because there is a risk of lawsuits for health professionals. What do you think ?
” It’s wrong. Obviously, this sword of Damocles weighs down on every healthcare professional: if something happens to the baby, he risks a trial. It is certain that certain gestures, such as episiotomies, have sometimes been practiced because we were frightened and we wanted to speed up the baby’s release. We sometimes see babies after emergency cesarean sections who are doing very well. We can say to ourselves, after the fact, that we could have waited a little longer before operating, but this line is so tiny that we do not risk endangering mother and child. “
However, on the episiotomy, the figures are edifying. Admittedly, the figure has fallen a lot to reach 27% on average, but if some establishments are at 1,53% this means that other establishments are at over 70%! How do you explain these differences?
“Regarding episiotomy, we should not compare the establishments but rather the published studies. The next Perinatal Survey * will show that the figures have fallen significantly compared to the previous survey in 2010. The episiotomies that are still performed provide a real benefit compared to a severe tear of the perineum. But perhaps, in fact, health professionals should be better trained. It comes little by little. We have seen practices evolve over the past twenty years, but it will still take time. ”
Do you want to add something on childbirth?
“I think that in general, we do not prepare women well enough. Yes childbirth is violent. There are women who experience it as a real trauma. Perhaps we wanted too much to believe that it was idyllic. We do sophrology, but the reality is that you really have to prepare well. Before, women were accompanied and prepared by their mother, a sister, a cousin, and they managed this event between women. From now on, it is the fathers who are in the maternity hospitals, at the heart of the turmoil. Perhaps the loss of this family unit that was around the expectant mother is detrimental. This is why more and more women are accompanied by doulas. They are looking for an experienced and reassuring presence. Failing to take the time to explain to them or ask them for their opinion before certain procedures, it would at least be necessary to strengthen the place of specific post-childbirth consultations, as is done in some countries. Women who have not experienced it well could come and talk about it again. “
* which will appear in October 2017