Dr. Lorraine and Dr. Brie join HeHe to discuss the critical and often overlooked topic of obstetrical violence. In this eye-opening episode, they break down what obstetrical violence is, its impact on women globally, including psychological trauma and avoidable morbidity, and how it violates human rights. The discussion highlights the importance of informed consent, respectful maternity care, and midwifery as potential solutions. The duo also emphasizes the need for systemic changes within the healthcare system to prevent obstetrical violence and improve maternal outcomes. Tune in to learn about practical steps women can take to avoid birth trauma and the crucial role of midwifery in transforming maternity care.
Understanding Obstetrical Violence
Examples and Impact of Obstetrical Violence
Legal Recourse and Advocacy
The Iceberg Analogy and Measurement Tools
Respectful Maternity Care and Systemic Issues
Transparency and Hospital Reporting
Midwifery Care and Trauma Prevention
Systemic Obstacles and Solutions
Navigating the Complexities of U.S. Healthcare
Challenges Faced by Healthcare Providers
The Impact of Insurance on Birth Choices
Midwifery Care and Its Benefits
Policy and Systemic Barriers
The Role of Consumer Advocacy
Future Directions and Solutions
Connecting and Collaborating for Change
Lorraine M. Garcia, PhD, WHNP-BC, CNM does research on the problem of obstetric violence in the US maternity care system and the public health and ethical duties to implement solutions. She also works as a Certified Nurse Midwife with experience in home birth, birth center, and hospital-based care. Lorraine is a reproductive justice advocate and frames most of her research with critical lenses from healthcare systems science, structural and organizational theories, and social justice in nursing. Her perspective on the systemic, normalized abuse and mistreatment of childbearing people is aligned with advocacy workers, interdisciplinary scientists, and all interested and affected parties working to end obstetric violence and achieve birth equity.
Dr. Brie Thumm is an Assistant Professor at the University of Colorado College of Nursing. She has been practicing midwifery domestically and internationally since 2001 when she completed her Masters in the Science of Nursing at Yale University. She obtained her MBA in Healthcare Administration at Baruch College in New York City and her PhD in health systems research at University of Colorado College of Nursing. Her area of research is perinatal workforce development to address disparities in maternal health outcomes and improve the well-being of health care professionals. Prior to her current position, Brie provided care at Planned Parenthood of New York City, served as the Assistant Director of the Sexual Assault Response Team for the Manhattan public hospitals, conducted mental and behavioral health research at the Rocky Mountain Regional Veteran’s Affairs Medical Center, and led the clinical and research arms of the Maternal Mortality Prevention Program at the Colorado Department of Public Health and Environment. She continues to practice clinically at Denver Health.
SOCIAL MEDIA:
Connect with Lorraine on IG
Connect with Lorraine on LinkedIn
BIRTH EDUCATION:
Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!
Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!
LINKS:
Lorraine’s website: https://www.makingbirthbettertogether.com/
Lorraine’s Online Store:https://makingbirthbetterstore.com/
References:
Association of Women's Health, Obstetric and Neonatal Nurses. (2022). Respectful maternity care framework and evidence-based clinical practice guideline. Nursing for Women's Health, 26(2), S1−S52. https://doi.org/10.1016/j.nwh.2022.01.001
Beck, C. T. (2018). A secondary analysis of mistreatment of women during childbirth in healthcare facilities. Journal of Obstetric Gynecologic and Neonatal Nursing, 47(1), 94−104. https://doi.org/10.1016/j.jogn.2016.08.015
Borges, M. T. (2018). A violent birth: Reframing coerced procedures during childbirth as obstetric violence. Duke Law Journal, 67(4), 827−862.
Carlson, N. S., Neal, J. L., Tilden, E. L., Smith, D. C., Breman, R. B., Lowe, N. K., Dietrich, M. S., & Phillippi, J. C. (2019). Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: A Consortium on Safe Labor study. Birth, 46(3), 487-499. https://doi.org/10.1111/birt.12405
Chadwick, R. (2021). The dangers of minimizing obstetric violence. Violence Against Women, 29(9), 1899−1908. https://doi.org/10.1177/10778012211037379
Cohen Shabot, S. (2021). Why ‘normal’ feels so bad: Violence and vaginal examinations during labour: A (feminist) phenomenology. Feminist Theory, 22(3), 443−463. https://doi.org/10.1177/1464700120920764
Cooper Owens, D. (2017). Medical bondage: Race, gender, and the oigins of American gynecology. University of Georgia Press.
Crear-Perry, J., Correa-de-Araujo, R., Lewis Johnson, T., McLemore, M. R., Neilson, E., & Wallace, M. (2021). Social and structural determinants of health inequities in maternal health. Journal of Women's Health, 30(2), 230−235. https://doi.org/10.1089/jwh.2020.8882
Davis, D. A., Casper, M. J., Hammonds, E. & Post, W. (2024). The continued significance of obstetric violence: A response to Chervenak, McLeod-Sordjan, Pollet et al. Health Equity, 8, 513-518. https://www.liebertpub.com/doi/10.1089/heq.2024.0093
Davis, D. A. (2019). Obstetric racism: The racial politics of pregnancy, labor, and birthing. Medical Anthropology, 38(7), 560-573. https://doi.org/10.1080/01459740.2018.1549389
Garcia, L. M. (2020). A concept analysis of obstetric violence in the United States of America. Nursing Forum, 55(4), 654−663. https://doi.org/10.1111/nuf.12482
Garcia, L. M. (2021). Theory analysis of social justice in nursing: Applications to obstetric violence research. Nursing Ethics, 28(7−8). https://doi.org/10.1177/0969733021999767
Garcia L. M. (2023). Obstetric violence in the United States and other high-income countries: An integrative review. Sexual and Reproductive Health Matters, 31(1), 2322194. https://doi.org/10.1080/26410397.2024.2322194
Garcia, L. M., Jones, J., Scandlyn, J., Thumm, E. B., & Shabot, S. C. (2024). The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence campaign. International Journal of Nursing Studies, 160, 104911. https://doi.org/10.1016/j.ijnurstu.2024.104911
Hardeman, R. R., Karbeah, J., Almanza, J., & Kozhimannil, K. B. (2020). Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth. Healthcare, 8(1). https://doi.org/10.1016/j.hjdsi.2019.100367
Howell, E. A., & Zeitlin, J. (2017). Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Seminars in Perinatology, 41(5), 266−272. https://doi.org/10.1053/j.semperi.2017.04.002
Jolivet, R. R., Gausman, J., Kapoor, N., Langer, A., Sharma, J., & Semrau, K. E. A. (2021). Operationalizing respectful maternity care at the healthcare provider level: A systematic scoping review. Reproductive Health, 18(1), 194. https://doi.org/10.1186/s12978-021-01241-5
Julian, Z., Robles, D., Whetstone, S., Perritt, J. B., Jackson, A. V., Hardeman, R. R., & Scott, K. A. (2020). Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminars in Perinatology, 44(5). https://doi.org/10.1016/j.semperi.2020.151267
Logan, R. G., McLemore, M. R., Julian, Z., Stoll, K., Malhotra, N., GVtM Steering Council, & Vedam, S. (2022). Coercion and non-consent during birth and newborn care in the United States. Birth (Berkeley, Calif.), 49(4), 749–762. https://doi.org/10.1111/birt.12641
Margulis, J. (2013). The business of baby. Scribner.
Mena-Tudela, D., González-Chordá, V. M., Soriano-Vidal, F. J., Bonanad-Carrasco, T., Centeno-Rico, L., Vila-Candel, R., Castro-Sánchez, E., & Cervera Gasch, Á. (2020). Changes in health sciences students' perception of obstetric violence after an educational intervention. Nurse Education Today, 88, https://doi.org/10.1016/j.nedt.2020.104364
Morton, C. H., & Simkin, P. (2019). Can respectful maternity care save and improve lives?. Birth (Berkeley, Calif.), 46(3), 391–395. https://doi.org/10.1111/birt.12444
Neal, J. L., Carlson, N. S., Phillippi, J. C., Tilden, E. L., Smith, D. C., Breman, R. B., Dietrich, M. S., & Lowe, N. K. (2019). Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: A Consortium on Safe Labor study. Birth (Berkeley, Calif.), 46(3), 475–486. https://doi.org/10.1111/birt.12407
Nelson, H. O. (2022). Conflicted care: Doctors navigating patient welfare, finances, and legal risk. Stanford University Press.
Niles, P. M., Baumont, M., Malhotra, N., Stoll, K., Strauss, N., Lyndon, A., & Vedam, S. (2023). Examining respect, autonomy, and mistreatment in childbirth in the U.S.: Do provider type and place of birth matter? Reproductive Health, 20(1), 67. https://doi.org/10.1186/s12978-023-01584-1
Oparah, J. C., Arega, H., Hudson, D., Jones, L., & Oseguera, T. (2018). Battling over birth: Black women and the maternal health care crisis. Praeclarus Press.
Salter, C., Wint, K., Burke, J., Chang, J. C., Documet, P., Kaselitz, E., & Mendez, D. (2023). Overlap between birth trauma and mistreatment: A qualitative analysis exploring American clinician perspectives on patient birth experiences. Reproductive Health, 20(1), 63. https://doi.org/10.1186/s12978-023-01604-0
Scott, K. A., Britton, L., & McLemore, M. R. (2019). The ethics of perinatal care for Black women: Dismantling the structural racism in "Mother Blame" narratives. The Journal of Perinatal & Neonatal Nursing, 33(2), 108–115. https://doi.org/10.1097/JPN.0000000000000394
Smith, D. C., Phillippi, J. C., Lowe, N. K., Breman, R. B., Carlson, N. S., Neal, J. L., Gutierrez, E., & Tilden, E. L. (2020). Using the Robson 10-group classification system to compare cesarean birth utilization between US centers with and without midwives. J Midwifery Womens Health, 65(1), 10-21. https://doi.org/10.1111/jmwh.13035
Smith, S., Redmond, M., Stites, S., Sims, J., Ramaswamy, M., & Kelly, P. J. (2023). Creating an agenda for Black birth equity: Black voices matter. Health Equity, 7(1), 185−191. https://doi.org/10.1089/heq.2021.0156
Thumm, E. B., & Flynn, L. (2018). The five attributes of a supportive midwifery practice climate: A review of the literature. Journal of Midwifery & Women's Health, 63(1), 90−103. https://doi.org/10.1111/jmwh.12707
Thumm, E. B., & Meek, P. (2020). Development and initial psychometric testing of the Midwifery Practice Climate Scale. Journal of Midwifery & Women's Health, 65(5), 643−650. https://doi.org/10.1111/jmwh.13142
Thumm, E. B., Shaffer, J., & Meek, P. (2020). Development and initial psychometric testing of the Midwifery Practice Climate Scale: Part 2. Journal of Midwifery & Women's Health, 65(5), 651−659. https://doi.org/10.1111/jmwh.13160
Thumm, E. B., Smith, D. C., Squires, A. P., Breedlove, G., & Meek, P. M. (2022). Burnout of the U.S. midwifery workforce and the role of practice environment. Health Services Research, 57(2), 351−363. https://doi.org/10.1111/1475-6773.13922
Williams, C. R., & Meier, B. M. (2019). Ending the abuse: The human rights implications of obstetric violence and the promise of rights-based policy to realise respectful maternity care. Sexual and Reproductive Health Matters, 27(1). https://doi.org/10.1080/26410397.2019.1691899
Yarrow, A. (2023). Birth control: The insidious power of men over motherhood. Seal Press.
Zhuang, J., Goldbort, J., Bogdan-Lovis, E., Bresnahan, M., & Shareef, S. (2023). Black mothers' birthing experiences: In search of birthing justice. Ethnicity and Health, 28(1), 46−60. https://doi.org/10.1080/13557858.2022.2027885
