Bodhi says she was given an episiotomy incision during the birth of son August without being informed.

Bodhi says she was given an episiotomy incision during the birth of son August without being informed.Credit:Penny Stephens

The study of 8804 women found episiotomies – where a cut is made at the base of the vagina – were given without consent,women in labour had been restrained and forced to have interventions they didn’t want or consent to,or had their wishes overlooked or overturned by clinicians who convinced their partner the interventions should happen.

Some women reported multiple people doing internal examinations – including by students – without their consent,and others said they were told they were “too old[or] too fat” to birth properly.

Some said they believed they were administered procedures such as inductions and caesarean sections against their wishes to suit hospital or staffing schedules,which the study co-author,Professor of Midwifery Hannah Dahlen,confirmed did happen.

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Lead author Dr Hazel Keedle,from Western Sydney University’s School of Nursing and Midwifery,said 11.6 per cent of women reported obstetric violence including being belittled,coerced and traumatised by a range of medical staff and not only obstetricians,which some said had led to ongoing mental health issues.

“They experienced both physical and sexual trauma ... the terms that came out[in written comments] were terms we are more often used to hearing to describe sexual assault,” Keedle said.

Women told the study,to be published on Tuesday in the peer-reviewed journalViolence Against Women, it took them more than a year to recover from how they and their partner were treated during the birth.

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The “power imbalance and abuse of trust in the birth space” women experienced “can result in birth trauma,higher rates of postnatal depression and post-traumatic stress disorder (PTSD),” the paper said.

Midwives who witnessed traumatic births also described feelings of “helplessness,fear and powerlessness” and could also reach the diagnostic criteria for PTSD.

Emilia Bhat,with daughter Amna and son Sismail,says her obstetrician ignored her screams to stop being stitched without adequate pain relief.

Emilia Bhat,with daughter Amna and son Sismail,says her obstetrician ignored her screams to stop being stitched without adequate pain relief.Credit:Edwina Pickles

Obstetrician and senior lecturer Dr Daniella Susic said the findings in the report were “a black mark against all maternity care providers”.

She said obstetric violence,which is recognised by the United Nations as a form of gendered violence,“happens at the hands of both genders”.

Susic said she had witnessed instances where women felt like they had not had the opportunity to consent to procedures,contributing to 29 per cent of women in NSW reporting they have experienced traumatic birth.

“This cuts to the heart of myself,and comes to the notion of how can we do it better? It comes down to how we educate our maternity care providers across both disciplines[midwifery and obstetrics] to work together,” she said.

Lawyer Bashi Kumar Hazard,the legal director of Human Rights in Childbirth,said she had handled complaints about women being restrained by security while procedures were done to them and who were locked in rooms until they complied.

She said lack of consent for episiotomies and repeated vaginal examinations,which were done to comply with hospital protocols regardless of whether they were medically necessary every four hours,were common and extremely distressing.

Melbourne woman Bodhi,a registered nurse,said she had specified to her doctor she did not want an episiotomy during the recent birth of her son,August,but was given one during a vacuum birth.

“It was very quick,they[medical staff] were talking to each other,but they didn’t really talk to me,” she said.

Bodhi says she remains angry at her treatment when giving birth to son August.

Bodhi says she remains angry at her treatment when giving birth to son August.Credit:Penny Stephens

“One of the doctors just said,‘I’m just going to sew up the snip we gave you’. I was like,‘Wait,what are you talking about?’

“They had their hands inside me assuming I had had an epidural[pain relief],but no one actually asked me whether I had,I had only had the gas.” She said she remained angry about her treatment.

Sydney woman Emilia Bhat said despite telling her doctor,while greatly distressed,that she could feel stitches being done on a tear and needed more anaesthetic,she was ignored.

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“I was telling the obstetrician to stop,but she didn’t listen to me. I was just shocked – I was screaming to stop,and she didn’t care. My midwife had to tell her to stop,” Bhat said.

“I was screaming and yelling saying,‘I can feel it. This isn’t right.’

“I talk to other women,and it was also common for them;you don’t get adequate pain relief when sutured after birth,” she said. “There is very,very little regard for your pain in these medical procedures.”

A spokesman for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists said women should receive accurate and evidence-based information about the benefits and risks to enable informed and timely decisions about modes of birth.

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“Choice is important within maternity care,and clear information about each option should be available to all pregnant women,” the group’s statement said.

“Many women report difficulties in accessing reliable,comprehensive,evidence-based information about the risks and associated outcomes of vaginal birth,instrumental birth and caesarean sections.

“Consequently,there is a risk of decision-making based on poor or minimal information which could contribute to adverse outcomes for both the mother and the baby.”

College board director Julie Hamblin,the chair of the organisation’s Informed Birth Working Group,said:“Quality maternity care is fundamental to the health of every community. It should be guided by the best available evidence and delivered with the individual woman as its focus.”

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