“My childbirth shouldn't be the worst memory I have in my life” is one of the phrases read on the posters that several women took to the demonstration on 6 November against the opinion of the Medical Association which said that Obstetric Violence does not exist in Portugal.
After all the complaints in this regard, “nobody expected an opinion of this nature from the Medical Association. They completely ignored the numbers,” said Carla Santos, one of the spokespersons for the Obstetric Violence movement behind the protest.
According to her, going to a protest like this means for many of these women two things: fear and sadness. “Some had to relive their traumatic moments, which made some cry at the protest – it was very emotional. Furthermore, there were health professionals who said they did not come for fear of retaliation”.
If, on the one hand, Portugal has a low mortality rate for both pregnant women and newborn children, revealing good medical care, on the other hand, it has high rates of unnecessary caesarean sections and episiotomies.
What does Obstetric Violence consists of?
If this term is unfamiliar to you, Obstetric Violence occurs whenever a person in labour or childbirth suffers abuse or disrespect for their rights, including physical, sexual or verbal abuse, intimidation, humiliation, and aggression by the medical team, namely doctors and nurses.
It may include being forced into procedures without informed consent such as improper or excessive vaginal touching, forced caesarean sections, perineum stitches, sexual assault during exams or procedures, induction of labour, episiotomy without medical reasons and being treated with disrespect.
Suffering in the expat community
Sara do Vale, founder of the Portuguese Association for Women's Rights in Pregnancy and Childbirth, which since 2014 has been fighting obstetric violence and helping women, told The Portugal News that obstetric violence is a reality that does not only affect Portuguese women, having a very strong impact on the foreign community.
Sara do Vale is also a doula in Lisbon and, as 70 percent of her clients are foreigners, she is very aware of the reality. “Beyond the language barrier, understanding how the system works in Portugal is not always easy, especially when it comes to women who come from northern European countries where, in general, they are much more aligned with the WHO recommendations, with midwives caring for low-risk births and an idea that childbirth is more physiological. And when they arrive in Portugal in a system where the obstetrician is at the top of the pyramid, it can be difficult to understand and even to accept”, said Sara do Vale.
A problem that with the pandemic got even worse. “Unfortunately, the pandemic brought many restrictions that are taking a long time to be eased, for example, the right to have a birth partner, which is a very important part of the female birth experience. It's important to realise that a woman's birth experience will stay with her for a lifetime.”
Obstetric violence also hits men
Although women are the main victims, men also suffer from obstetric violence, something that was seen during the demonstration by the number of men who were there to support the cause.
“Men also suffer from it, they see the person they love being humiliated and mistreated, they are prevented from entering and it hurts to see the baby born in this context,” said Carla Santos.
Furthermore: “In the labour room, they are often treated as if they had some kind of cognitive impairment or if they were children. They heard comments like "look, this is not good for you, it is not good for your intimate life because you will never see her the same way again".
Options for a humanised birth
In fact, according to Carla, there aren't many options for those couples who want something different for childbirth. In Portugal there are no birth centres and midwives are almost a thing of the past. Childbirths are mainly performed in hospitals, including low-risk pregnancies.
When I asked why, Carla explained that: "The medical association was indirectly restricting birth centres as an option for women, as it forbidden for doctors to carry out water births and home births, indeed the obstetricians were told that they would have a disciplinary procedure and may lose their professional licenses. And to set up a birth centre they need an obstetrician to be clinically responsible. So, if doctors are banned by their professional association then birth centres cannot exist in Portugal”.
However, for couples looking for more support at this stage of their life, Doula Sara recommends making a birth plan, finding a doula, and making all possible arrangements. Furthermore, the Pregnancy and Childbirth Association is available to support you, including in English, by phone or email, on what to expect from the Portuguese NHS.