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Abstract
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We are responding to a letter to the editor concerning our publication "Obstetric violence is a misnomer".
The authors and others using this term fail to adequately define their definition of "obstetric violence (OV)," leading to potential misunderstandings and conflation of different issues within obstetric care. While a discussion about systematic obstetric issues is important, the definition of "obstetric violence" remains imprecise. Including many indicated medical interventions under this term, as those supporting the term OV have done, is unacceptable because it risks vilifying necessary indicated and consented clinical practices that ensure the safety and health of our patients. Using the term "obstetric violence" is overarching and should not be used, as it politicizes clinical care and undermines the trust between patients and healthcare providers necessary for effective and safe medical practice. That is why we and others proposed and27 defined the term "obstetric mistreatment" to provide a clearer and more accurate description o the issues at hand.
Framing OV as perpetuated by a few clinicians indeed risks decentering the broader issue of structural violence within obstetrics and the medical field. However, it is crucial to recognize that indiscriminately labeling all medical interventions as obstetric violence can also mislead and vilify well-intentioned healthcare providers who follow evidence-based practices. Such an approach can undermine trust in medical professionals and obscure the necessary focus on systemic reforms to address true instances of structural violence and abuse. Most interventions are not inherently violent; many are evidence-based actions aimed at preventing complications and ensuring positive outcomes for our patients. Interventions performed in obstetrics should be based on the best available evidence and on fully informed consent to respect the autonomy and well-being of our patients. A balanced perspective that differentiates between individual misconduct and systemic issues is essential for meaningful progress. The argument that OV should encompass emotional and psychological harms, especially those disproportionately affecting pregnant patients of color, is compelling. Yet, it is crucial to differentiate between harmful practices rooted in systemic issues and indicated and consented medical interventions. It is inappropriate, as the authors do, to equate the "overuse of medical interventions during pregnancy" with "the physical and emotional abuses that pregnant people experience." These are distinct issues and conflating them undermines the nuanced understanding needed to address each effectively. Overgeneralizing OV to include medical interventions of often life-saving procedures such as cesarean delivery and induction of labor obscures the real issues of structural violence and impedes efforts to address them effectively. To improve obstetric care, we must focus on systemic changes that address structural issues while protecting medical professionals from undue vilification. Labeling necessary and evidence-based practices as "obstetric violence" unfairly vilifies healthcare providers and can detract from addressing genuine instances of obstetric mistreatment, abuse and systemic problems. Clear, precise definitions of obstetric racism and mistreatment are vital for effective academic, legal, social, and political communication. This approach will enable all to address structural oppression in obstetrics/gynecology without undermining essential, indicated and consented medical practices that safeguard our patients' health
Language: en |