Thursday, 21 August 2014

Obstetrics - Bastion of misogyny


by Barbara Kruger
Misogyny (miss-odge-a-knee) literally means 'hatred of women' - but just as we understand that a paedophile doesn't really 'love' children, so the term misogyny has come to refer to having an inherent prejudice towards women, usually to their detriment.

I get that referring to obstetrics as a bastion of misogyny is a strong statement to make - Didn't huge numbers of women die in childbirth before maternity wards and hospitals and operating theatres? What is wrong with that? You don't become a gynaecologist or obstetric nurse unless you want to help women, right? How is that missy-, misod... hating women?

This has been a very difficult post to write. It is a real challenge to get the balance between describing the misogyny, if not outright abuse that women are experiencing under obstetric care, whilst acknowledging that there are many care providers who do not intend to practice in this way. I would like to put forward the idea that it is not every individual in the obstetrics industry that is consciously misogynistic (although some are), but that the institution of obstetrics itself utilizes deeply entrenched misogyny as its foundation. For one example, see here.

Therefore even those who are not personally invested in the practice of misogyny feel stuck in a system that cannot function without it.

If you are still a wary, let's try something. I found this site (among others) containing a list of the characteristics of a misogynist. If we personify the obstetrics industry, how many of the characteristics of a misogynist does it fulfill?
Before you read the list below - please remember this is not about doctors vs midwives or men vs women - I have seen internalised misogyny practiced and perpetuated by midwives and doctors, male and female. I believe we are dealing with a system that is inherently misogynistic, but is allowed to continue as such because women are told that the misogyny is for their own good. 

Characteristics of a misogynist:
  •  Controls women by destroying their self-confidence
    • 'Are you sure you don't need an epidural?' (x10)
    • *checks dilation* 'You are only 3cm dilated.'
    • 'Failure to Progress.'
  •  Needs to ensure that women are always less powerful than he is
    • Stirrups
    • Lithotomy position
    • 'My gynae said he/she will/won't let me...'
  • Intimidates women by constantly finding fault with them
    • 'Let's see if this naughty cervix is behaving.'
    • 'This perineum is far too small - we'll need to do an episiotomy.' *head not even visible*
    • 'Be quiet - You're making too much noise!'
    • 'What size shoe are you?'
  • Humiliates women in public and devalues their opinions
    • *Calls the doula over to show her why the episiotomy will be necessary and why more time won't help by demonstrating how 'small' the mother's vagina is with his two fingers while she has full sensation and without her consent.* (Mother is on her back. Ends up cutting three times.)
  • Must ALWAYS win in a discussion with or about women – all encounters with or about women are seen as a battle to be won.
    • 'Well if you want to have a doula you'll have to find another gynae...'
    • 'Well, you can either listen to me or you can have a dead baby.' - otherwise known as playing the 'Dead Baby Card'
    • 'You know you can't trust Dr Google,' when a mother tries to present a peer-reviewed journal article on how delayed cord clamping may be beneficial.
  • Blames women for failings that are in no way related to them
    • 'Failure to Progress' is often more a case of 'Failure to Wait'. When a mom is strapped to monitors and not allowed to stand up and eat and be normal it is no wonder that labour stalls!
    • 'We'll have to give formula because your milk hasn't come in yet.' *Less than 24 hours after birth.* Anyone who knows the least bit about breastfeeding knows milk only comes in at around three days after birth. 
    • 'It seems your pelvis is too small to deliver this baby.' Said by the same person requiring the mother to be on her back in the position most likely to restrict opening of the pelvis.
  • Blame women for his own failings and shortcomings
    • 'The Caesarian rate is so high because women's pelves (pelvises) are getting smaller.'
  •  Denies women's feelings and makes them wrong for feeling them
    • 'It wasn't that bad. At least you have a healthy baby!'
  • Makes jokes or derogatory comments about women and then ridicules any woman who gets offended or upset
  • Belittles or ignores women's accomplishments
    • 'It must have been the atarax.' *After mother reached 8cm from 3cm dilation in 3 hours through some Rebozo sifting, moving around and changing positions.*
  • Has no remorse or guilt for the pain he causes women
    • 'But I saved you!'
  • Tries to keep women from doing things they are qualified to do
    • Like being able to make decisions about what they do with their own bodies.
  •  Selectively quotes authorities to substantiate his views and positions on women
    • 'Cochrane Review? Pfft! I only trust the British Medical Journal on these matters.' i.e. the extent of his research is on how to do better surgery, not on how to avoid surgery to begin with.
  • Will confuse issues by changing the subject, denial, word jugglery, lying, twisting the facts or acting as if nothing happened
    • 'If you tear, it will be jagged and we will have to cut the jagged edges off and then sew it together.'
    • 'Your baby will drown if you give birth in the water.'
  • Is preoccupied with sex and is sexually controlling
    • Ever heard of the 'husband stitch'?
    • 'Don't you think your husband would rather you had a Caesarean?'
  • He has problems with authority figures in general and women in authority in particular.
    • Outspoken and experienced midwives (as opposed to obstetric nurses) in general and private midwives in particular are often seen as the enemy and are accused of giving women all sorts of crazy ideas.
  • Has a Jekyll and Hyde personality - Nice to you in public, but cuts you down in private
    • 'My gynae is very pro-natural.' *When I know his CS rate is over 85%*
    • 'My gynae is very happy for me to try for a vbac.' *When I know the success rate of VBACs in that hospital is less than 5%*
    • 'My gynae said I can have a water birth.' *When the midwife on duty says she's never seen this doctor allow a first time mom to deliver in the water.* 
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So before you start roaring at me in ALL CAPS saying that birth attendants aren't all like that, I totally agree. I know some truly incredible birth attendants and caregivers who have utmost respect for the birth process and birthing women. But they struggle in a system that does not represent these ideals. Read Dr Gauri Lowe's account of her obstetric training as a GP here: Thoughts on expecting natural birth service from your doctor...

Even though all the quotes above are actual quotes or situations I have heard / experienced / read, I understand that they do represent extremes, and yes, I understand that many individuals do not consciously perpetuate these misogynistic language and behaviour patterns, but until someone calls them out, the abuse will continue. A woman should feel safe and secure and supported no matter what her race or social class or education or risk category. 

Edited to add:
In describing obstetrics as the last outpost of misogyny, I don't intend to minimise other expressions of misogyny, both explicit and implicit, but I do feel that obstetrics is a particularly well guarded bastion of the ideology, because it is one of the most widely accepted and widely justified areas of misogyny. In short, 'It's for their own good.'

Further reading: 
Birth: A surprising history of how we are born by Tina Cassidy (On Takealot)
Dr Robbie Davis-Floyd (Anthropologist) - Articles on Childbirth and Obstetrics


  1. Replies
    1. Thanks Laurette... When I first made that connection and checked the list, the blood just drained from my face and I wondered how I hadn't seen it before! I'm trusting this can help someone to break free of the cycle.

  2. I changed gynaes at 16wks, the first one was horrendous! Pretty much said all of the quotes above and then some. We wanted a home birth and she scared my hubby out of it! Luckily my doula recommended another and she was much more open to natural things, but still very much stuck in the medical world. I had a wonderful birth with my midwife, bit weirdly enough she also tried to push certain medical "necessities" on me... But overall it was great.

    1. I'm hoping women will read the post and recognise the signs early as you were able to! I'm so glad you had a doula for support. I think your comment also shows how there needs to be a shift in training. I know 'routine' can be helpful in making sure you don't leave out something important, but routine interventions are not always in the best interests of the mom and baby...

  3. I'm desperate to become a midwife (in the UK though we may move back to SA one day) and these situations worry me, the established norm is hard to break

    1. I hear you! I feel the same way. But one thing is that even though I am speaking about a misogynistic system - it takes individuals within that system to bring change. Maybe that is part of your role?

  4. Well done. "until someone calls them out, the abuse will continue. "

    1. I think the next hurdle is overcoming the bit about 'But it's for your own good.'

  5. I am sitting here with tears in my eyes. I am so proud of you for taking this on.

  6. As a doula and woman who has given birth, I have experienced this. Sadly, males and females display misogynistic practice. Given that some midwives do not embrace doulas and women-led practices and decisions, it is unsurprising that some (many?) OB/GYN practitioners continue to embrace a historically misogynistic obstetric practice. Many manipulate women into believing their wishes will be honored and at the last minute throw in the dead baby tactic or the authority of being medically trained. Research and stats are ignored in favor of sometimes outdated practices that lead to numerous interventions that become increasingly destined to render the woman's wishes null and void during her labour and delivery.

    1. It is frustrating when there are so many other factors at play, usually unrelated to the particular laboring mom and baby present...

  7. Gosh, reading this list has made so grateful that I had a great experience with my gynae.

    1. That is wonderful! We must celebrate those individuals, and encourage them!

  8. Thank you so much for this powerful piece. Had tears in my eyes, and wanted to have a good cry, but have company over.
    Touched me so deeply, and brought up my traumatic birth experience of my gorgeous daughter.
    I am very strongly thinking of doing midwife or doula training as well as lactation training, do not want other women to be bullied or made to feel incapable.
    Modern medicine definitely has its place, and has indeed saved many mothers and their children. But the need for intervention is in fact the exception and not the rule, while we are continuously being told it is the other way around.
    Please keep on fighting!
    And thank you again!

    1. Thanks for your encouraging words! I think many women who train as doulas and midwives do so out of a strong conviction that there is something better than what most women are settling with now. The more women there are who have positive birth experiences, the more women will not be satisfied with horrible ones!

    2. I still have not come to terms with it, I still have a lot of anger about what happened. Hopefully it will improve as I deal with it little by litte, but it has definitely motivated me to want to change things.
      Keep on with this!