Citation

Chervenak FA, McLeod-Sordjan R, Pollet SL, DE Four Jones M, Gordon MR, Combs A, Bornstein E, Lewis D, Katz A, Warman A, Grünebaum A. Am. J. Obstet. Gynecol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Elsevier Publishing)

DOI

10.1016/j.ajog.2023.10.003

PMID

37806611

Abstract

The term "obstetric violence" has been used in the legislative language of several countries with the intention of protecting mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures such as induction of labor, episiotomy, and cesarean delivery and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to intentional physical force used to cause harm, injury, or damage to another person (eg physical assault, domestic violence, street fights or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as non-consensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but since obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use "psychiatric violence" for appropriately used professional procedures in psychiatry such as electroshock therapy or using "neurosurgical violence" when drilling a Burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using a term such as "mistreatment in healthcare", instead of the more limited "obstetric violence", is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment such as biased care, neglect, emotional (verbal), or physical abuse including performing procedures that are unnecessary, unindicated, or without informed patient consent. We must promote unbiased, respectful and patient-centered professional care, provide an ethical framework for all healthcare personnel, and work toward systemic change to prevent any mistreatment or abuse in our specialty.

Language: en

Keywords

professionalism; professional practice; abuse; ethics; violence; abuse in healthcare; anesthesia; cesarean delivery; epidural; episiotomy; induction of labor; mistreatment; obstetric violence; pain relief; pelvic examination