When a United Nations panel ruled that Nahia Alkorta had suffered obstetric violence during the birth of her first child, it was the culmination of a 10-year quest for justice.
Alcorta was diagnosed with post-traumatic stress disorder after being treated at a hospital in northern Spain in 2012 and appealed to the UN, having failed in Spanish courts.
The UN Committee on the Elimination of Discrimination against Women (CEDAW) found in July that she had been subjected to a litany of unjustified interventions that amounted to obstetric violence, including a caesarean section without her consent, with her hands immobilized and her partner locked out from the room.
“Since the decision, more than 100 women have contacted me saying something like this happened to them,” Alcorta, now 36 and a mother of three, told AFP in an interview.
“It’s not talked about because of the pain it causes, because of the sense of shame. There’s an idea that that’s just the way it is,” he said.
The CEDAW resolution described obstetric violence as “violence experienced by women during childbirth in medical facilities”, adding that it is a “pervasive and systemic phenomenon”.
It said Spain should compensate Alkorta for physical and psychological harm and ensure that women’s reproductive rights are protected by the health and justice systems.
The decision came as campaigners across Europe raise awareness of obstetric violence, which often goes unrecognised.
Some national medical associations in Europe even disagree with the term itself, saying it cannot be applied to their practices.
But Alkorta argues: “Women tell a different story.”
– “At their mercy” –
Alcorta suffered nightmares, insomnia and flashbacks after an ordeal that began when her waters broke at 38 weeks.
At her local public hospital in San Sebastián, in Spain’s Basque region, she was induced with the drug oxytocin, despite contractions and with no medical reason given, she said. The staff’s responses to her questions became increasingly aggressive, she recalls.
The day after she was admitted, gynecologists decided to deliver the baby by caesarean section, without asking her consent and even though a midwife told her that her labor was progressing, she said.
“When I asked for a clear explanation, they just said they would take the baby out and it would be over in 40 minutes,” Alcorta, who lives in the Basque town of Zijurkil, told AFP.
With her hands tied, a protocol followed by some hospitals during cesarean deliveries, and her husband barred from the room, she trembled with fear. “I felt completely at their mercy,” he told AFP. Alcorta was unable to hold her son, who was healthy, in the first few hours of his life.
There is a lack of comprehensive data measuring obstetric violence in Europe, but advocacy groups say women are routinely denied informed consent, subjected to rude and degrading treatment by medical staff and, in some cases, unsafe practices.
A recent “Stop Obstetric Violence” petition in Serbia gathered 70,000 signatures in five days, calling on the state to cover the cost of accompanying a woman to the delivery room — currently some Serbian public hospitals require the extra person to pay, even and if he is the woman’s partner.
“Many mothers in Serbia would rather forget the day they gave birth because they experienced various forms of violence from medical staff,” the report said, citing insults, humiliation, shouting, neglect and medical errors among the problems.
Some countries in Europe, including Spain and Italy, have set up obstetric violence observatories, but activists say legal cases are rare.
“We are approached by many mothers who have suffered a traumatic birth, but almost none end up filing a lawsuit,” Nina Gelkova, from the Bulgarian campaign Rodilnitza, told AFP.
“The state does not recognize that there is such a problem.”
– Consent and Respect –
Spain’s submissions to CEDAW as part of the Alkorta case warned that “there is no such thing as an ‘a la carte’ birth” and supported the national courts’ findings that the hospital was not at fault.
Alcorta counters that what she is fighting for should not be considered a luxury.
“I wasn’t looking for an ‘a la carte’ delivery, I was looking for humane treatment,” she told AFP.
“I’m not against justified interventions, I think they save a lot of lives — but they should always be done with consent and respect.”
Lawyer Francisca Fernandez Guillen, who has worked with Alkorta since the beginning of her legal journey, explained that health professionals and even the women’s own relatives can downplay traumatic experiences during childbirth.
“Sometimes even the partner or family advises the woman to just ‘forget’ what happened,” Fernandez told AFP.
However, some doctors believe that attitudes are changing.
Daniel Morillas, vice-president of the Spanish Federation of Midwives (FAME), told AFP that in his 16 years working as a midwife, he has seen an increased awareness of the mother’s rights and her role as an “active participant”. in childbirth, although she admits there is still a long way to go.
“The first thing we have to do to fight obstetric violence is to recognize that it exists,” she told AFP.
“Many doctors and midwives are already recognizing that it’s happening and trying to change things.”