Obstetric Violence: How Midwives and Doulas Help in Healing

Obstetric violence is increasingly prevalent worldwide, but it has been overshadowed by a patriarchal culture. As a result, many women are seeking alternatives for managing their fertility and maternity, turning their attention to an ancient profession that is now a recognized vocation: doulas and midwives. According to Andrea Lorena Rubiano Carrillo, an integral doula, and midwife who embraces ancestral wisdom and studies the customs and traditions of the Muisca people.

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Upon delving into her background, I discovered that she is a specialist in natural and integrative gynecology, and a Master's degree holder in nutrition, hormonal health, and women's medicine. She is also a yoga and prenatal/postnatal movement instructor, among other specialties. I understood why she spoke with great authority about women, sacred sexuality, and other holistic topics that I am passionate about, capturing my attention with her knowledge.

TWP: How did you become a doula, and what does it mean to be one?

ALRC: I became a doula due to the needs of women and my journey. Everything I experienced during my childbirth led me to pursue doula training. Being a doula means providing support and care to families and women. We have many tools for support, such as herbal medicine, massage, weaving, and active listening. We accompany families and women, and being a doula also means supporting the birthing of a new humanity, facilitating births free from obstetric violence, with genuine care and recognition that the gynecologist-obstetrician is not the protagonist in childbirth, but rather the women themselves.

TWP: What is the difference between a doula and a midwife, and what does each one do?

ALRC: The difference between a doula and a midwife lies in their roles. A doula is a woman who provides emotional and informational support to families during childbirth. We inform and care for families about lifestyle choices, pain management during childbirth, and other aspects. Some of us are also yoga instructors and educate about nutrition, lifestyle, and what to expect during childbirth and the postpartum period. On the other hand, a midwife is a woman who accompanies the entire journey of life, from the first breath to the last. They are involved in all processes of life and community transformation. When necessary, they can perform interventions, such as vaginal exams, although these are kept to a minimum. Midwives possess a wealth of knowledge and tools to handle emergencies, complications, and births. Doulas do not have the same level of expertise. Some midwives are trained to administer oxytocin and perform sutures when necessary. Midwives have a broader range of skills. Doulas often support midwives or families during labor and then accompany them to the hospital for childbirth. Midwives can support home births as they have the necessary knowledge to ensure the health of the baby, similar to a pediatrician, as well as attend to aspects such as mortality, fertility, preconception, postpartum, and more.

TWP: You mentioned that you experienced obstetric violence during your son's birth. What does it mean, and what are the signs for a woman to know if she is experiencing it?

ALRC: Yes, indeed. In the clinic where I gave birth, my birth plan was never respected. I was restrained for a cesarean section, and I don't find it respectful to be tied down. My cesarean section was unnecessary; it was a medical protocol, and this, too, is a form of violence. A child born vaginally has a different development of their lungs and colonization of beneficial microbes compared to a child born through cesarean section. It was a highly unnecessary cesarean section, which was not only detrimental to my son's life but also to mine because cesarean sections carry high risks. I underwent many unnecessary medical vaginal exams, where my body was treated as a reproductive machine or a baby-making machine.

I felt that my rights as a woman, as a citizen, and as a political being were violated.

Obstetric violence is defined as a specific form of violence exerted by healthcare professionals (predominantly doctors and nursing staff) towards pregnant women during labor, childbirth, and the postpartum period. It constitutes a violation of women's reproductive and sexual rights.

Signs that a woman might be experiencing obstetric violence include:

• When a woman is not allowed to speak during childbirth.
• When her pain is minimized.
• When her birth plan is not respected.
• When she is subjected to statements such as, "Of course, you scream now, but you didn't during sex" or "Here, you're in pain, but you don't remember the day you had sex…"
• When unnecessary vaginal exams are performed without consent.
• Any word or action that makes her feel vulnerable and mistreated.
• Administration of medication that was not requested or approved, etc.

TWP: In contrast, how does the presence of a midwife counteract obstetric violence?

ALRC: Midwives respect each woman's decisions, accompany them, provide information, and respect their voices. This changes the whole narrative of violence.

How can one find a suitable doula or midwife?

ALRC: In Colombia, there is a directory of doulas and midwives. You can contact those in your area to get to know them and connect. Choose the one you feel most comfortable with. That midwife is probably the one your baby and your family have chosen.

You can also read: Incidence Of Uterus Healing On Women´s Overall Health

TWP: What requirements should they fulfill?

ALRC:There are different types of midwives, including autonomous, traditional, urban, and community midwives. Each branch of midwifery has different regulations.

TWP: What is the importance of doulas and midwives for mothers today?

ALRC:There is ample scientific evidence showing that the presence of doulas and midwives reduces interventions, unnecessary cesarean sections, and pain. This support from both midwives and doulas improves the physical, spiritual, and emotional well-being of women. We care for women, families, and communities. We strive for a good life, a good birth, and a dignified death. We promote dignified births and deaths, ensuring well-being in every breath. That is what we advocate for, and that is the true importance.

The presence of a doula and/or midwife also reduces the risks associated with cesarean sections and unnecessary interventions. We care for and protect the lives of women and babies because their well-being matters greatly to us. We utilize all the tools at our disposal.

TWP: What advice can you give to expectant mothers regarding their connection with midwives and doulas?

ALRC: Midwives continue to exist because there is a community of women who still believe in this ancient and age-old practice that has existed since the beginning of time. The connection with midwives depends on each woman's way of life, her relationship with her body, and what she wants for her maternity. Their lifestyle, journey, beliefs, customs, and mindset shape the connection they establish with the doula and/or midwife, as well as with themselves and, most importantly, their decision to have their child at home or not.

In conclusion, the importance of doulas and midwives in today's times depends on the significance that each woman decides to give them in her life. It depends on whether she considers their presence necessary to provide physical, mental, emotional, or spiritual support.