Abstract
Mothers who give birth in Russian hospitals are often yelled at by nurses and left bleeding and shaking.
Her contractions lasted for 16 hours, and she spent them squirming on a bed covered with a rubber sheet, in pain, not being allowed to get up, and with seven other women writhing in agony in the same room while nurses yelled at them. Without her consent, doctors put her on an oxytocin drip and broke her waters to speed up the process.
When she was finally giving birth, they yelled at her that she was killing her baby. The baby was fine, but they took him away anyway. Three interns stitched up a tear in her vagina without any anaesthetic and left Ivanova, bleeding and shaking, on a gurney in a hospital corridor.
“Aftershocks of it still haunt me,” Ivanova, 28, told Index. “I blame myself for not being able to protect myself when giving birth, not [being] prepared for what happened, not considering myself important enough to argue with the medics.”
What happened to her is hardly an isolated case, there are hundreds of stories similar to Ivanova’s published in #Haciume_B_pogax (#violence_in_obstetrics), a community on VK, Russia’s biggest social network, that two doulas started in 2016 to raise awareness about obstetric abuse in Russia.
Doulas are professionals trained in childbirth who provide emotional, physical and educational support to pregnant women and new mothers. Many also significantly speak up for and advocate women’s wishes during childbirth.
Having worked in this field for years, Maria Ushankova and Yulia Goryachyova have witnessed the abuse firsthand. In 2016, inspired by the #IAmNotAfraidToSpeak campaign on social media, when thousands of women in Russia and Ukraine shared stories about sexual abuse, they decided there was a need for a similar campaign dedicated to obstetric abuse. They came up with a hashtag and called on women to speak up.
The stories poured in almost immediately. “For about two months, we were flooded with stories, receiving 60 or 70 of them a day,” Ushankova recalled.
Ivanova posted her story in the community in December 2016, more than two years after she gave birth. She immediately felt better, saying: “Before that, I only talked about it to a couple of people, and not in detail. I feared being judged or, even worse, pitied.”
In the two years since then, Ushankova and Goryachova have received and posted more than 850 stories, most of them anonymously. Currently, the VK community has more than 12,000 followers and it provides a rare platform for women to voice their grievances. Very few, if any, women resort to official complaints to hospital administrators or law enforcement. According to Ushankova, women know it is really hard to prove wrongdoing, especially if there are no physical injuries, because doctors and hospital administrators usually protect their own.
“Plus, the mother and the family use all their energy and resources on caring for the newborn baby,” she added. “This is why there is no large-scale, mass pushback against obstetric abuse, women just don’t have the [emotional and structural] resources to fight.” Ushankova says the most common issues women complain about are rudeness and humiliating comments from medical staff, their requests being ignored and, most importantly, pain.
“When a woman says that she’s in a pain, the response is usually: ‘It can’t be painful, come on, how are you planning on delivering the baby if you’re already in pain?’,” she said.
Women are often not allowed to move freely during labour or when they’re having contractions, and are forced to lie down.
Then there are procedures like inducing labour, breaking the waters or episiotomy (an incision on the posterior vaginal wall to enlarge the opening for the baby to pass through) that doctors and obstetricians carry out without asking for consent or even warning women about what is going happen.
In a survey Russia’s Association of Professional Doulas conducted last year, polling more than 2,800 mothers from across Russia, 77% of women reported undergoing various procedures when giving birth.
“The vast majority of them told us they were not informed in any way about these procedures,” Lyubov Shraibman, a doula from Novosibirsk who worked on the study, told Index.
Obstetricians, midwives and doulas disagree on how serious and widespread the problem is. Some deny it and say it died with the Soviet Union; others insist it’s more or less pandemic in maternity hospitals, the vast majority of which are state-run, often understaffed and underfunded.
Patients in a Moscow maternity ward. Often there are only three to four midwives and four doctors for 30 to 40 women
CREDIT: Robert Wallis/Corbis/Getty Images
Everyone agrees, however, that the way the system works today doesn’t allow a lot of room for individualised care and for women having a voice.
Many maternity hospitals offer paid-for services that include single rooms and personal midwives, but most women opt for whatever is covered by the state insurance, and that means sharing attention from the doctors with dozens of other women.
“Imagine, it’s three to four midwives and four doctors for 30 to 40 women in labour,” said Yulia Vuchenovich, an obstetrician and gynaecologist at the state-run Maternity Hospital No. 29 in Moscow.
Working in these conditions, obstetricians and midwives often choose to do what is faster, be it inducing labour or going for a C-section, adds Tatyana Sadovaya, midwife and founder of the Centre for Traditional Midwifery.
“Doctors barely have the time to change their gloves, let alone be nice to women,” she said. “They see a medical problem that needs to be solved, not a woman with needs.”
Exhausting 24-hour shifts that make doctors and midwifes burn out quickly, and professional habits based on old, procedure-heavy protocols, only add insult to injury.
At the same time, specialists interviewed by Index all agree that the situation has started to change for the better. More and more maternity hospitals offer options that were not available five years ago – such as giving birth with your partner, having a personal obstetrician or doula, a water birth, or giving birth in any position that is more comfortable for a woman, said Lyubov Yerofeyeva, gynaecologist and head of the Moscow-based Population and Development NGO.
Professional standards have improved, too, adds Vuchenovich. A lot of medical procedures that used to be routine and were carried out on all women are now deemed unnecessary, unless there are medical issues that require intervention.
For now, though, Ushankova continues to receive and publish stories of women who are traumatised by what happened in maternity hospitals, and the VK community seems to be the only place for them to talk about it.
“There is very little support for women [who went through obstetric abuse] when it comes to their friends and family,” said doula Shraibman. “If a mother is healthy and her baby is healthy, but she continues to cry herself to sleep recalling what happened to her during labour, the reaction usually is: ‘Forget it, it’s all good, the baby’s healthy, time to pull it together’.”
Society judges women for having troubles while giving birth, added Ushankova. “Examining a baby, a paediatrician would always ask how the labour went. And if you tell them you had a C-section or induced contractions, they would often say something like: ‘Oh really? So you failed to do it on your own, huh?’. It knocks the wind out of a woman.”
And, generally, giving birth, just like anything else related to women’s physiology, is a taboo subject.
“We either talk about the beauty of a woman’s body or don’t talk about it at all… Plus, maternity hospitals remain quite closed-up institutions, where even relatives are not always allowed,” Ushankova said.
“So the way it works is we send a woman to the hospital, and in a few days she comes out with a pretty little bundle and a smile on her face. What happened in between doesn’t really interest anyone.”