Kimberly Turbin stands about 5 feet tall, with dark hair and dark eyes, glasses, and a warm smile. Her right arm is covered in a sleeve tattoo of flowers, and she has other flower tattoos on her chest and foot. Originally from the Los Angeles area, she moved to Chicago in 2009 for college. She was working at the front desk in a dental practice when she found out she was pregnant.

“I knew something was different right away,” she says. “It was my first pregnancy, but right then and there, I already knew it was a boy. I was so happy.”

Turbin decided to move back to Los Angeles to be closer to her family during the pregnancy. It was an easy pregnancy – she didn’t even experience morning sickness – and she hoped her birth experience would be similarly smooth. What she got was an unwanted episiotomy.

© Noa Snir

The experience left her feeling traumatised, upset and violated, but the hospital staff said there was nothing to be done. A representative from the hospital came to her room the next day to ask if she was okay and Turbin said she wasn’t. According to Turbin, the woman handed her a pamphlet about post-partum issues… and that was it.

When Turbin got home, she told family, friends and coworkers about what had happened. Many responded that episiotomies were a standard part of giving birth and she had nothing to complain about because her baby was healthy. But Turbin didn’t think that was right – what happened to her couldn’t be normal. She decided to post her birth video to YouTube and see if it got a reaction. Within a day, the video attracted 13,000 views. Within a few weeks, it hit 100,000. Today, it has over 500,000 views.

“I was very surprised when we hit 13,000,” says Turbin. “A lot of the responses said, ‘Oh my God, that’s horrible,’ like they knew something was wrong with the situation. I felt very validated. People were making it seem like I was making a big deal out of nothing, but I knew I wasn’t crazy or whiny.”

Turbin sent her video to a group called Birth Without Fear, which she came across while searching for online breastfeeding forums. They brought it to the attention of Dawn Thompson, the founder and president of an advocacy organisation, Improving Birth. In many ways, it was the case Thompson had been waiting for. She had tried to raise awareness about “obstetric violence” for years, but one of the biggest obstacles was scepticism that such a thing actually existed. The video meant Turbin’s story could be proved. There was no doubt that she said no and the doctor proceeded anyway.

“There are thousands of stories like Kim’s, but hers was caught on video,” says Thompson. “Just before she reached out to us, I had been saying that we needed to find documentation, a video, of a doctor being abusive to substantiate the case, so people would know that this is not unusual. Kim’s story is an extreme version, but it’s an issue everywhere.”

Disregard of consent during childbirth and the use of unwarranted interventions are more common than one might like to think. In the Listening to Mothers III survey, a 2013 study of maternity care in the US, 59 per cent of participants who had experienced an episiotomy said they did not have a choice about having the procedure. Between 8 and 23 per cent of mothers also reported experiencing pressure for a range of other interventions, including labour induction, epidurals and C-sections. The same pattern holds in the UK. Over 12 per cent of women said they did not give their consent to examinations or procedures in a 2013 survey conducted by Birthrights.

Research from the Harvard School of Public Health has found that bias, prejudice and stereotyping by healthcare providers can contribute to decreased agency for patients and the delivery of lower-quality care. In the Listening to Mothers survey, about one in five black and Hispanic women reported poor treatment from hospital staff due to race, ethnicity, cultural background or language, as compared to one in 12 white women.

“Women face many violations during maternity care and it is as if their human rights – dignity, bodily and psychological integrity, privacy, equality – do not exist,” says Camilla Pickles, who studies obstetric violence and the law at the University of Oxford. “Subjecting them to a cascade of medical interventions unnecessarily and without informed consent is wrong, harmful to their overall wellbeing and can be dangerous.”

In an ideal world, physicians would only recommend or perform interventions when medically necessary and the necessity of those interventions would be clear. That, however, is not the world we live in. Research shows that the prevalence of certain childbirth interventions has far more to do with where and when the physician was trained, the culture of the hospital, and even the time of day or day of the week. A labour that one doctor views as too slow, another may view as slow but safe.

“There could be ten women with the same clinical chart and they could make ten different decisions,” says Hermine Hayes-Klein, founder and executive director of Human Rights in Childbirth. “There is so much medical uncertainty with childbirth – the decision-making is not black and white.

“Underneath the idea that childbirth is somehow complicated or different compared to other kinds of informed consent is the idea that somehow because a woman is pregnant, she has less authority over her body than other people.”

There is a long line of precedent establishing that all competent patients, including those who are pregnant, have the right to decline unwanted medical procedures. In practice, this can be overshadowed by the idea that doctors know better than their patients what is right. If a doctor says something is best, the impulse is generally not to push back.

“We have this cultural ideal about pregnant women and women in labour as hysterical,” says Holly Fernandez Lynch, professor of bioethics at Harvard. “There is a hierarchy in medicine and you don’t have much control over [what happens]. Then after the fact, people say you are overblowing this. It’s a symptom of how deeply ingrained the idea is that the doctor wouldn’t do anything to harm you.”

Fernandez Lynch adds that there could theoretically be an ethical grey zone if a mother was refusing an intervention that would save the life of her baby, but these cases are exceptionally rare because women in labour are not, in practice, inclined to make choices that put their babies in danger. A situation may be confusing and progressing fast, but physicians still have an ethical duty to inform their patients fully and honestly about what is happening and involve them, to the extent possible, in the decision-making process.

Turbin’s case did not appear to exist in this grey zone. The video of the birth does not indicate that she or the baby were in danger. This is backed up by her medical notes, in which Abbassi wrote: “She progressed as per usual… and she delivered a baby boy… spontaneously.”

These records show that some of her wishes were followed: “The patient refused any surgical intervention and vacuum, so the 2nd stage was prolonged.” But then, Abbassi noted, without further explanation, “it was necessary to perform episiotomy under local anesthesia”.