CATCHING her breath between screams, Jodie Gibbons yelled at the consultant to stop. “I was halfway through a contraction in the labour ward, and the pain was horrendous,” she remembers.

“I begged the doctor to stop doing my vaginal exam, but he just ignored me. So I asked again, then again and even kicked at him to stop, but he wouldn’t.”

7 Jodie a week after her traumatic birth experience with baby Frankie Credit: Mother May I/Birth Monopoly Foundation

In fact, it was only when Jodie’s husband, James, 28, and the two midwives in the room intervened that the consultant finally desisted.

“One midwife pushed him away from me,” says Jodie, 38. “I was so shocked and felt completely violated, as if I had no right over what was happening to my body or my baby.”

While some experts may argue that such examinations are to be expected in the fast-paced atmosphere of a maternity ward, a growing number of people claim it falls under the umbrella of obstetric violence, where patients are subjected to painful gynaecological procedures and invasive treatment without consent during pregnancy and childbirth.

The term was first used legally in Venezuela, when it was brought into legislation in 2007 to protect women giving birth. Within two years Argentina followed suit, with Mexico doing the same in 2014 – yet no such law exists in the UK.

7 Jodie says her relationship with James suffered as she was battling PTSD, depression and anxiety Credit: Mother May I/Birth Monopoly Foundation

According to Camilla Pickles at Oxford University, who’s been researching obstetric violence for the past six years, we’re in desperate need of similar legislation.

“Unless it’s happened to you or someone you love, most of us are ignorant to it,” she explains.

“You have to convince people it’s a real issue and when you do, they’re horrified. But while the offence of battery may apply, relating it to obstetric violence is challenging at best. At worst, the argument can always be presented that the procedure had to be carried out in the mother’s best interests.”

Amy Gibbs, chief executive of the women’s rights charity Birthrights, says that they hear from many people who feel they’ve experienced disrespectful or abusive care. “Yet because it’s not formally recognised in the UK, there’s very little data available to give us an idea of the scale of the problem,” she explains.

7 Alabama mum Caroline Malatesta was awarded an unprecedented £13million through a civil case Credit: Mother May I/Birth Monopoly Foundation

For Amy, respectful and safe care is the only way to end obstetric violence. “The sooner that’s realised,” she says, “the safer all women will be.”

Obstetric violence doesn’t just apply to childbirth. It can also occur during terminations or post-miscarriage procedures. In October last year, Croatian MP Ivana Nincevic-Lesandric publicly shared her experience, revealing medical staff tied up her arms and legs during an abortion in February 2018 and started the procedure of curettage – scraping the cervix to remove a growing embryo – without anaesthesia. She described it as “the most painful 30 minutes of my life.”

Soon after, a #MeToo-inspired movement quickly took hold, with women across the country sharing their own stories using the hashtag #BreakTheSilence. “I’ve since learned one in three women in Croatia has endured obstetric violence and yet nothing changes,” says Ivana. “Speaking out is the only way things will change.”

Meanwhile, in America – where obstetric violence is often controversially referred to as “birth rape” – Alabama mum Caroline Malatesta was awarded an unprecedented £13million through a civil case in August 2016. During a harrowing labour four years earlier, she’d been wrestled on to the bed by a midwife who demanded she remained immobile despite her baby showing no signs of distress, while another physically pressed her baby’s crowning head back into her vagina for six minutes.

I was terrified [my partner] wouldn’t stop if I asked him to, even though I trust him completely Jodie

For hairdresser Jodie, her ordeal in February 2017 left her suffering with PTSD, depression and anxiety.

“My two previous births had been faultless,” she says. “the third time, I was induced in hospital at just over 40 weeks, with James by my side. My two midwives were great and every time they needed to do a vaginal exam they asked first.”

After Jodie had been in labour for five hours, a consultant came into the room, but his behaviour left her, James and the midwives feeling uncomfortable. “From completely ignoring me to falling asleep in a chair and then chatting on his phone, none of us really knew what to make of it,” says Jodie, from Somerset. “James and I were unnerved, but I’d practised hypnobirthing so concentrated on my breathing.”

Following a vaginal exam by her midwife, who said Jodie was 5cm dilated, the consultant insisted on doing another one.

“The midwife explained that we’d wait for a contraction to pass, and then I’d give my consent for the examination,” she says.

“If it got too painful, they’d stop.”

However, according to Jodie, he didn’t.

“Within seconds, I was in agony and told him to stop but he continued with such force that he was literally pushing me off the bed,” she recalls.

“I started shouting and kicking at him, then finally the midwife managed to push him away. While we were all in shock, the consultant seemed oblivious, declaring I wasn’t even ‘that far gone’ and walked out. The midwives looked in as much shock as I was.”

7 Mums like Jodie are speaking out to 'convince people obstetric violence is a real issue'

Despite not encountering the consultant again, Jodie was left in such distress that she had an epidural to block any further pain.

“While I was overjoyed to have Frankie in my arms afterwards, I felt so traumatised,” she says.

She was discharged the next day and within a week she had received a call from the hospital telling her that the midwife who’d helped deliver Frankie had put in a formal complaint to the General Medical Council (GMC) about the consultant’s behaviour.

The following week, Jodie made a complaint via the NHS Patient Advice and Liaison Service (PALS).

“PALS opened a case but said they needed more information which involved me filling in so much paperwork,” she says. “It was such a stressful time as I was suffering from flashbacks and anxiety relating to what had happened in the delivery room.”

Her relationship with James suffered, too.

“We weren’t intimate for nearly two years,” she says. “Every time James hugged me I’d move away. I was terrified he wouldn’t stop if I asked him to, even though I trust him completely.”

In January 2018, Jodie went back to her GP. She’d been taking antidepressants before her pregnancy, but her doctor increased her dose and referred her for rape counselling. “But my experience was just so different that even though I went for therapy, I just didn’t feel it applied to me,” she says.

7 Researchers say we’re in desperate need of legislation to stop painful procedures being given to mums without their consent Credit: Plainpicture/Monika Kluza

That same month, Jodie says a senior midwife from the hospital visited and told her she needed to get over it.

“I couldn’t believe what she was saying,” she recalls. “The room started swimming and I had a full-on panic attack. James had to ask her to leave.”

In desperation, Jodie went to the police in June 2018 to see if they could help. However after looking at the files submitted to the GMC they admitted that without intent, sexual assault was impossible to prove. Since then, Jodie has been informed by the GMC that while the case is still pending, their internal investigation found there is no case to answer as it was a one-off and not an issue of fitness to practise or medical negligence.

“It’s so frustrating,” says Jodie. “I could pursue a civil case to seek compensation, but money won’t make a difference. I just want to stop it from happening to someone else, but I’m not sure I have the strength.”

According to Camilla, the majority of victims of obstetric violence rarely question doctors, even when something feels wrong.

“They don’t feel they can complain because they walked out of hospital with a healthy baby, but we need to reframe our thinking,” she says. “A healthy baby isn’t a healthy outcome if you’re left traumatised because you were subjected to a procedure you didn’t consent to.”

7 If a mum refuses to consent to interventions, a doctor 'may have to watch a baby die', says Dr Brooke Vandermolen

However, obstetrician and gynaecologist Dr Brooke Vandermolen argues that sometimes it can be difficult to get consent in an emergency situation.

“In obstetrics, the decisions made are so fast-paced,” she explains.

“If it’s decided that intervention is urgently needed because the mum is tired or the baby could be in distress, it’s our duty to make a split-second call or else we could be considered negligent. Of course, a consultant should always get consent, but the safest way to do that is away from an emergency setting before a woman hits the maternity ward, so it’s clear on both sides.

“While most women will say: ‘Just deliver my baby safely,’ if someone refuses to consent to interventions, such as a forceps delivery or an emergency C-section, it’s the worst moment for a doctor as they may have to watch a baby die, knowing it could have been prevented. The mother is always the priority.”

Brooke also points out that consultants typically look after several mothers at one time.

“In an ideal world, every mum to be should be a doctor’s only priority, but the reality is they’ve got several mums under their care,” she says.

“So they might rush through an examination or be brusque without realising the impact it has on a patient. Admittedly, there are older-generation consultants who still feel that ‘doctor knows best’, but, thankfully, most don’t take that approach.”

7 The majority of victims of obstetric violence rarely question doctors, even when something feels wrong, a researcher says

When first-time mum Sarah* went into labour last July, she was initially pleased with her experience at the Chelsea and Westminster Hospital. She’d been given a birthing pool and gas and air for pain relief as per her birth plan, which stated she wanted a natural delivery without any intervention.

“Things went to plan for the majority of my labour,” Sarah, 32, from London, remembers.

I started shouting and kicking at him Jodie on her consultant

“But when I got to 10cm dilation after four hours and was then pushing for more than two hours, my labour still wasn’t progressing. The consultant said I needed to move on to a labour ward, but didn’t say why or what would happen there. I didn’t ask, because I trusted they knew best.

“My birth plan said I didn’t want an episiotomy, which is where a cut is made between the vagina and anus, as I’d done a lot of research and felt it wasn’t necessary, but they did one anyway without asking me after I reluctantly agreed to an epidural. Then they used forceps to deliver the baby without my consent. My husband was trying to speak up for me, but no explanations were offered. It ended up being the total opposite of what I wanted.”

The experience left Sarah extremely distressed, and two months after the birth she made a complaint to the hospital. A few months later she received a formal letter of apology, and had her notes amended to reflect the fact she hadn’t consented.

What does the GMC say? Professor Colin Melville, medical director and director of education and standards for the GMC said: “Maternity patients should expect to be treated with dignity and respect by their doctors, and to be given the information they want and need in a way they can understand. “It’s important doctors have clear conversations with their patient, putting them at the centre of decision-making. “They must explain the pros and cons of each treatment option, including the option not to treat, and must not pressure the patient to accept their advice. “Patient safety is our top priority and if a doctor seriously or persistently breaches our guidance we won’t hesitate to take action.”

“It was all so traumatic,” says Sarah. “The hospital explained that Ben’s head was in a difficult position, so I accept the episiotomy and forceps may have been necessary, but it doesn’t change the fact that I should have been asked and better informed.

“I feel like I was violated. We’d always wanted a big family, but we’ve agreed not to have any more children as I couldn’t ever face going through that again.”

In January this year, Jodie, who now speaks to patient advocate groups and at conferences of medical professionals to raise awareness of obstetric violence, discovered she was pregnant again.

“It was planned, but I’m too petrified to have another vaginal birth, so I’ll be opting for a C-section,” she says. “We’ve moved since Frankie’s birth and my new hospital has been brilliant. I’m classified as a high-risk birth, so I’ve been assigned a perinatal patient advocate for every appointment with my consultant, who will make sure my consent will be asked for every step of the way.”

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