Table of Contents:

• Why This Article?
• What Constitutes Abusive Treatment?
• How Common Is Abusive Treatment in the United States?
• How Can You Protect Yourself?
• What if Abusive Treatment Happened to You?
• Some Final Words
• Resources

Why This Article?

Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care. — World Health Organization (2014)¹⁶

For the most part, Taking Charge of Your Birth’s Resource Library and my books address the failure of the medical system to promote care practices and policies that produce the best outcomes. But there’s another arena in which maternity care systems may fail you, this one having to do with how you are treated in labor. Just as you are entitled to care that best promotes your and your baby’s physical health and well-being, you are equally entitled to care that is respectful, kind, and, most importantly, acknowledges your right to have the ultimate say about your care, which by definition includes the right to say “no” or “not now” as well as “yes” to what your care provider proposes. Here, too, there is a gap between what you are entitled to and what you may receive.

It is this gap and what you can do about it that I will address in this article—and if you’re thinking, this won’t be a concern for you, I will document below that while subgroups in the birthing population are more subject to the prejudices that fuel abusive treatment in labor, no one is immune. Furthermore, the probability of abusive treatment increases markedly if your birth choices don’t conform with what medical staff think you should be choosing, and that makes the content of this article especially important since what you learn at TCOYB about the pros and cons of your birth options may lead you to do exactly that. I realize this is a scary thought, but knowing this can occur is better than being blindsided, and this article will provide strategies both to minimize the possibility of it happening to you and to deal with it in the moment and in the aftermath if it does.

My plan for this article is to take the same approach as I do in my articles on content of care. That is, I’m going to present the research documenting the problem plus provide you strategies both for averting it and, in the case of this article, for dealing with its aftermath should it happen to you. Accordingly, this article will ask and answer:

• What are your rights in childbirth?
• What constitutes abusive treatment?
• How common is abusive treatment in the United States?
• How can you protect yourself?
• What if abusive treatment happened to you?

You’ll also find a list of selected resources at the end.

Note: I’m going to focus on the United States, but if that’s not where you live, I will be including multinational documents and data, and the strategies I suggest for averting and dealing with abusive treatment are mostly, I think, universally applicable.

What Are Your Rights in Childbirth?

Abusive treatment during childbirth centers around power and control by those who are in charge, which means it’s about consent and lack thereof, what actions are taken to enforce compliance, and what punishments are inflicted on those who resist. And because its victims are solely women and people capable of pregnancy, the issue is rooted in sexism and carried out as a means of reproductive control.

Let’s start, then, by reviewing what a couple of authoritative US organizations have to say about your rights in pregnancy and childbirth that address this imbalance of power:

“Speak Up for Your Rights,” an infographic published by the Joint Commission, a non-government agency that evaluates and accredits hospitals, has this to say about the rights of hospital patients:¹⁴

As a patient, you have the right to . . .[1]

• • Be informed about your care.
  • Make decisions about your care.
  • Refuse care.
  • Be treated with courtesy and respect.
  • Be listened to by your caregivers. . .
  • Care that is free from discrimination.

The American College of Obstetricians and Gynecologists (ACOG), the US professional organization for obstetricians, has two documents that address pregnant patients’ rights: Informed Consent and Shared Decision Making in Obstetrics and Gynecology and Refusal of Medically Recommended Treatment During Pregnancy.^{3, 4} Here is what ACOG says about the requirements of informed consent:⁴

Meeting the ethical obligations of informed consent requires that an obstetrician-gynecologist gives the patient adequate, accurate, and understandable information and requires that the patient . . . is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment.

We have evidence that obstetricians don’t always adhere to the requirement that they provide adequate and accurate information,⁷ but more to the point for this article, here’s what ACOG has to say about your right to decline recommended treatment and also on the motivations behind why obstetricians may disrespect that right:³

• “Pregnancy is not an exception to the principle that a . . . patient has the right to refuse treatment.”
• “It is never acceptable for obstetrician–gynecologists to attempt to influence patients toward a clinical decision using coercion. Obstetrician–gynecologists are discouraged in the strongest possible terms from the use of duress, manipulation, coercion, physical force, or threats, including threats to involve the courts or child protective services, to motivate women toward a specific clinical decision.”
• “[ACOG] opposes the use of coerced medical interventions for pregnant women, including the use of the courts to mandate medical interventions for unwilling patients.”
• “[The] ethical approach recognizes that the obstetrician–gynecologist’s primary duty is to the pregnant woman. This duty most often also benefits the fetus. However, circumstances may arise during pregnancy in which the interests of the pregnant woman and those of the fetus diverge. These circumstances demonstrate the primacy of the obstetrician–gynecologist’s duties to the pregnant woman.”
• “Interventions recommended during pregnancy and childbirth may reflect distortions of risk based on concerns about failure to intervene rather than robust considerations of risks associated with those interventions.”

Two other US childbirth rights statements are:

1. The National Partnership for Women & Families’ The Rights of Childbearing Women
2. The Birth Rights Bar Association’s Birth Rights

Both cite legal sources for their list of rights.

Two multinational sources are:

1. The International Federation of Gynecology and Obstetrics’ (FIGO’s) Ethical Framework for Respectful Maternity Care During Pregnancy and Childbirth
2. The White Ribbon Alliance’s Respectful Maternity Care: The Universal Rights of Women & Newborns

The former, similar to the ACOG’s childbirth rights documents, is published by the international professional organization for obstetricians and gynecologists, and the latter cites international and regional laws as its sources.

The following excerpts from each of these four sources pertain to your right to make decisions for yourself and your baby and to receive dignified, respectful care.

The Rights of Childbearing Women states that every woman has the right to:[2]

• “leave her maternity caregiver and select another if she becomes dissatisfied with her care.”
• “communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.”
• “full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.”
• “accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.”
• “receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.”
• “have family members and friends of her choice present during all aspects of her maternity care.”
• “receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.”
• “freedom of movement during labor . . . [and] the right to give birth in the position of her choice.”
• “virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.”

Birth Rights is a manifesto that declares:  

• “I have the right to decide how, where, and with whom I give birth. . . . This means that it is completely up to you whether you give birth at home, in a birth center, in a hospital, or any other place you wish—and you should not feel pressured about any one of those choices. . . . You may choose who is in the room and what you do during labor—including, but not limited to, walking around, eating and drinking, and positioning yourself however you feel comfortable.”
• “I have the right to informed consent. Your provider must explain to you the risks, benefits, and alternatives for any and all medical procedures. If you are not aware, do not understand, or do not agree, the provider may not perform a procedure on you. No one can legally do anything to your body, or your baby, without your consent. If they do, they are violating their ethical duties and standard of care.”
• “I have the right to refuse surgery or medical procedures. . . . You can always say ‘No’ to any procedure, test, or drug, even if it is life-saving. You do not have to give a reason, and you do not have to sign a form to make it official.”
• “I have the right to receive treatment when in labor or experiencing a medical emergency. . . . If you are fearful about laboring at a particular facility for any reason, you have the option to leave and go elsewhere at any time. Even if you have never been to that other facility . . . they must admit you for treatment if it is determined that you are having a medical emergency or are in active labor.”

Ethical Framework for Respectful Maternity Care During Pregnancy and Childbirth identifies key principles of ethical practice, among which are:

• Principle of nonmaleficence: “Health care practitioners should avoid disrespect and abuse—they must devote attention to defining, identifying and eliminating disrespect and the abuse of mothers and newborns.”
• Principle of justice: “Provide respect, dignity and informed choice—maternity care incorporates a rights-based approach, preventing exclusion and maltreatment of individuals that are marginalized and socioeconomically disadvantaged. Under no circumstances is physical, verbal or emotional abuse of women, their newborns and their families ever allowed.”
• Principle of autonomy: “Health care practitioners should always provide respectful and dignified care—clinicians should treat every woman and newborn with respect and dignity. They should fully inform and communicate with the woman and her family in decision making about care for herself and her baby, ensuring her the right to informed consent and refusal.”

Respectful Maternity Care: The Universal Rights of Women & Newborns states that everyone has the right to:

• “freedom from harm and ill-treatment.”
• “information, informed consent, and respect for their choices and preferences, including companion of choice during maternity care and refusal of medical procedures.”
• “privacy and confidentiality.”
• “be treated with dignity and respect.”
• “equality, freedom from discrimination[,] and equitable care.”
• “liberty, autonomy, [and] self-determination.”

You may be entitled to these rights, but as I said, there’s a gap between what you’re entitled to and what may happen in the real world with, I should add, no consequences for even the most egregious violations. Before we get to that, though, let me be more explicit about what defines abusive treatment.

What Constitutes Abusive Treatment?

One study uses these definitions (taken from a different study) for “disrespectful care”:¹⁰ 

Definitions of abusive treatment vary, but this one pretty much covers the gamut and gives you an idea of the broad range of categories under which abusive treatment falls.

How Common Is Abusive Treatment in the United States?

Now that you know what defines abusive treatment, let’s look at how often it occurs and how that varies according to the characteristics of the pregnant woman or birthing person.

As we shall see in these studies, most instances of abusive treatment don’t rise to the level of “egregious,” as, for example, instances of forced cesarean surgery. Nevertheless, as with abuse in the workplace or home, whether subtle or blatant, the damage to the victim is done.

Notes:

• These studies all collected data from births occurring outside of the COVID-19 pandemic years, which would have been a confounding factor for quality of care.
• While I confined the studies I discuss in this section to US studies, for those of you living in Canada, the UK, or Australia, I have studies in my files finding similar results to the US studies I report on here.

In one study, 2,781 United States and Canadian doulas and nurses responded to a survey regarding their observations of disrespectful care during childbirth.¹⁰ The following percentages responded “occasionally” or “often” to these questions:

• 65%: “Have you witnessed a care provider engage in procedures without giving the woman a choice or time to consider the procedure?”
• 33%: “Have you ever witnessed a care provider tell a woman that her baby might die if she does not agree to a proposed procedure?”
• 22%: “Have you observed a laboring woman receive more procedures because of her racial or ethnic background?”
• 18%: “Have you witnessed a care provider engage in procedures explicitly against the wishes of the woman?”
• 11%: “Have you ever heard a care provider mention a laboring woman’s racial or ethnic background in a way that was demeaning?”
• 9%: “Have you witnessed a care provider use sexually degrading language with a laboring woman?”

In a second study, 2,138 mothers responded to a survey regarding their experiences of inequity and mistreatment during childbirth in the United States.¹⁵ The following percentages responded “yes” to these statements:

• 9%: “Health care providers (doctors, midwives, or nurses) shouted at or scolded you.”
• 8%: “Health care providers ignored you, refused your request for help, or failed to respond to requests for help in a reasonable amount of time.”
• 6%: “Your physical privacy was violated (i.e., being uncovered or having people in the delivery room without your consent).”
• 5%: “Health care providers threatened to withhold treatment or to force you to accept treatment you did not want.”
• 2%: “Health care providers threatened you in any other way.”
• 1%: “You experienced physical abuse (including aggressive physical contact, inappropriate sexual contact, refusal to provide anesthesia for an episiotomy, etc.).”
• 1%: “Your private or personal information was shared without your consent.”

Total: 17 percent experienced one or more of the above.

The study also found that these factors increased the likelihood of mistreatment:

• Being a person of color
• Young age
• Low socioeconomic status
• Pregnancy complications
• Elevated social risk, i.e., substance use or incarceration
• Having a hospital as the place of birth (vs. free-standing birth center or home)
• Being transferred from a birth center or home into the hospital
• Having an unplanned cesarean or instrumental vaginal birth
• Having a difference of opinion with their care provider

Of note, having a difference of opinion with the care provider resulted in the highest rates of experiencing mistreatment: 79 percent.

In addition, for many of these factors, respondents of color were more likely to experience mistreatment compared with respondents having these same factors who were white.

Finally, a third study analyzed data from a survey of 2,402 US mothers conducted in 2023.⁹ The following percentages responded “yes” to these statements:

• 10%: “Health care providers ignored you, refused your request for help, or failed to respond to requests for help in a reasonable amount of time.”
• 7%: “Health care providers (doctors, midwives, or nurses) shouted at or scolded you.”
• 5%: “Your physical privacy was violated (i.e., being uncovered or having people in the delivery room without your consent).”
• 5%: “Health care providers threatened to withhold treatment or to force you to accept treatment you did not want.”
• 4%: “Your private or personal information was shared without your consent.”
• 4%: “Health care providers threatened you in any other way.”
• 4%: “You experienced physical abuse (including aggressive physical contact, inappropriate sexual contact, refusal to provide anesthesia for an episiotomy, etc.)”

Total: 20 percent experienced one or more of the above.

Overall, 29 percent of respondents reported experiencing discrimination for one or more of these reasons:

• Race, ethnicity, or skin color
• Disability status
• Immigration status
• Age
• Weight
• Income
• Sexual orientation
• Religion
• Language or accent
• Type or lack of health insurance
• Difference of opinion with caregivers about the right care for themselves or their baby
• Use of substances (alcohol, tobacco, or other drugs)
• Involvement with the justice system (jail or prison)

As with the second study, respondents of color were more likely to report discrimination for these reasons than respondents who were white. For example, only 2 percent of white respondents reported experiencing discrimination because of their race, ethnicity, or skin color compared with 13 percent of Black respondents, 11 percent of multiracial respondents, 9 percent of Indigenous American / First Nations respondents, 7 percent of Hispanic respondents, and 6 percent of Asian respondents.

So, in confirmation of what I wrote in my introduction, a long list of factors affects the probability of experiencing abusive treatment, and everyone is at risk for it to more or less of a degree. As to the magnitude of the risk, perhaps the most telling of these studies is the survey of doulas and nurses.  People are more likely to respond to a survey if they have strong feelings about the topic, which means respondents to a survey about their birth experience are more likely to be upset or angry about it than the general population. That bias, however, doesn’t apply to a survey of witnesses who, in the aggregate, are documenting their experiences at large numbers of births. Still, even assuming the true percentages of abusive treatment coming from survey respondents are lower than in the population at large, the relationship between certain characteristics and the probability of abusive treatment holds, and abusive treatment in labor is clearly far from rare.

How Can You Protect Yourself?

This brings us to what you can do to protect yourself. Let’s start with your care providers and your planned place of birth. If any responses are unsatisfactory, don’t make the mistake of thinking that it will be okay at the birth. If at all possible, look elsewhere for care.

During Pregnancy

• Choose care providers (or confirm that you have chosen care providers) who will respect your right to informed refusal:
  • Ask your doctor or midwife what happens if, after discussion, you turn down a recommendation.
  • Because doctors and midwives generally work in groups, if the answer is satisfactory, ask how you can ensure that whoever attends the birth takes the same approach.
• Choose care providers (or confirm that you have chosen care providers) who respect your autonomy:
  • Ask your care provider their opinion of doulas. Discouraging having a doula is a sign your care provider wants to control your access to outside influence.
  • Ask your care provider their opinion of birth plans. Discouraging a birth plan indicates that your care provider doesn’t recognize your right to participate in decisions about your care.
  • Regarding birth plans, if the care provider’s response is satisfactory, ask: “How can I ensure that the person who attends me in labor will go along with any agreements that you and I may make?”
• Evaluate interactions during your prenatal visits. Ask yourself:
  • Do I feel rushed?
  • Do I feel listened to?
  • Does this person respect my right to make the ultimate decisions about my care?
  • Were there any red flag responses? Did they . . .
    • use scare tactics: “I want to induce labor when you reach 39 weeks. There’s no reason not to, and even though you’re healthy, you never know what might happen if we wait.”
    • bully you: “Decisions will be made by me and are not negotiable.”
    • give you only vague answers: “I only do cesareans when it’s necessary.”
    • get angry: “And what medical school did you go to?”
    • patronize you: “Don’t worry; just relax and let me take care of everything.”
    • ridicule you: “Natural childbirth? Why would you want to suffer in this day and age?”
• Choose a birth setting (or confirm that you have chosen a birth setting) where your right to informed refusal will be respected:
  • Request a copy of the hospital’s admission consent form. Some forms give blanket permission to perform any treatment or procedure, including cesarean surgery, without seeking further permission. If your hospital’s form is one of those, ask if the form can be modified to stipulate that barring emergency circumstances that deprive you of the capacity to make decisions, you will give consent or refusal on a case-by-case basis for any proposed medications, treatments, tests, or restrictions.
  • On your hospital tour, ask, “What is the general opinion of doulas?” As with your care provider, a negative opinion is a red flag.

Tips:

• If you have already engaged a doula, ask what their experience has been at the hospital where you plan to have your baby.
• Consider a home birth or birth at a freestanding—that is, not inside a hospital—birth center. As you saw above, you are less likely to experience abusive treatment in these settings.¹⁵ The downside, though, is that the same study found that should transfer to a hospital become necessary, the probability of abusive treatment by hospital staff is increased.

During Labor

Preventive measures

• Exercise your right to make informed decisions about your care. Use the BRAIN acronym to help you do this:

Benefits

Risks

Alternatives

Intuition/instinct

No or not now

As we saw above, if a test, procedure, medication, or restriction is proposed to you, you have the right to know its benefits, in other words, why it is being recommended, and its risks, that is, the potential harms. You are also entitled to know your alternatives, including doing nothing for now, and the benefits and risks of your alternatives. After you have taken in the information, pay attention to what your intuition/instinct is telling you because your gut feelings are important too. Finally, as we also saw above, you have the right to say “no” or “not now.” When declining treatment, it may help avoid confrontation if you discuss what would lead you to consider changing your mind rather than giving a flat “no.”

• Slow down the decision-making process. If a cesarean or a vacuum extraction or forceps delivery is being recommended, ask why it’s being recommended and how urgent is it that you make the decision right away. If the situation isn’t an emergency, you have time to run through the BRAIN acronym. Then, once you have the information, ask for time alone to think it over. That will give you the opportunity to discuss it with your intimate partner and your doula if you have one. The conversation may also generate additional questions or concerns you wish to raise with your care provider or alternatives you wish to discuss before making up your mind.
• Maintain a united front. One not uncommon strategy is an attempt to co-opt your intimate partner to assist in getting you to change your mind.
• Request a different nurse. Don’t be drawn into an argument. Just keep politely repeating your request. Depending on how labor care is organized at this hospital, you may be able to request a different doctor.

Response strategies

I can’t do better here than to excerpt the advice given in Birth Rights. The section on “What You Can Do During a Violation” begins with:

There is no definitive strategy that works every time in every situation, and some strategies come with risks. In particular, some people . . . may face harsher consequences for their resistance to authorities or may be targeted as a result of their being identified as part of one of those groups. Each individual should weigh their options based on their individual circumstances.

The authors then continue with a list of strategies that can be undertaken either by you or someone with you, expanding in greater detail on each one than what I can quote here. I recommend downloading the booklet on the principle that it’s better to have a plan and not need it than not to have a plan.

• “Delay and try to buy time. This can be done by repeatedly asserting that more time is needed, by asking the staff to answer questions, by asking the staff to involve more/other staff, by leaving, by calling in advocates to either physically be present, waiting in the hall, or making calls on their own.”
• “Document what is happening. Take pictures of whatever you can: forms, signs, badges. . . . Taking notes while things are happening is also a good idea.”
• “Restate your needs and wishes aloud. Having someone restate what you are saying, even just to you, can help.”
• “Make eye contact or hold someone’s hand. Whether you are experiencing the violation directly or supporting someone else through it, feeling connection can reduce trauma.”
• “Get more information. Ask to see whatever is relevant (the fetal heart rate tracings, or the test results, or the ultrasound for example).”
• “Focus on what I have the power to do. Having a sense of control even in the face of trauma can improve recovery.”

The suggestions in this section can help prevent or stop abusive treatment, but nothing is foolproof. At least now, though, you’ll be able to recognize when it is happening. That recognition can help you decide what’s best to do, given your circumstances, and that agency matters, even if it is no more than the ability to choose your least-worst option.

What if Abusive Treatment Happened to You?

Psychological Consequences

One obvious psychological consequence of abusive treatment in labor is negative feelings about the birth. This is bad enough because those memories are powerful and permanent,¹³ but this isn’t the worst of it. Abusive treatment also heightens the risk of experiencing symptoms of posttraumatic distress or even full-blown posttraumatic stress disorder (PTSD).

PTSD is triggered by experiences in which a person feels that they or someone they love is under threat, and they are helpless in the face of it.⁸ This is typically thought of as being situations of physical danger, including war, assault, or natural disaster.¹¹ Childbirth events such as emergency cesarean, hemorrhage, or a baby needing admittance to intensive care are accepted sources of childbirth-related PTSD in maternity care, but abusive treatment is not, although you can readily see that abusive treatment in labor could have this effect, especially considering that it almost always involves forcing unwanted procedures on someone who is resisting them and often involves accusations that refusal will put the baby at risk. Abusive treatment is, however, a much more significant factor in predisposing to PTSD than physical threat. In evidence of this, among 748 survey respondents who described their birth as traumatic, one third attributed it to events during the birth and two thirds to abusive treatment.¹² Systematic reviews (studies pooling data from multiple studies of the same topic) report that experiencing the birth negatively is the factor most strongly associated with developing childbirth-related PTSD.^{5, 8} One systematic review also found the reverse is true: good support by medical staff and having agency act as buffers against it.⁸

One consequence of being the major precipitant of childbirth-related trauma is that unlike physical danger or harm—which no one disputes can cause psychological trauma—abusive treatment is subjective. That’s important to know for a couple of reasons. For one thing, it enables you to push back against—or at least not internalize—a common, unintentionally hurtful thing people say in dismissal of those whose births were difficult or disappointing: “Of course, the most important thing is a healthy baby.” A healthy baby is important, but it isn’t the only thing that’s important. And for another, the fact that abusive treatment is an internal perception makes it easy for the medical community to ignore the issue, which they would be motivated to do since it indicts actions of its members as causing psychological trauma. That’s important because one consequence is that unlike postpartum depression, little attention is paid to identifying people with PTSD symptoms, which means most sufferers aren’t being diagnosed at all and others—because some symptoms overlap and depression can be concurrent with PTSD⁵—are being misdiagnosed as solely having depression. (Depression in conjunction with PTSD is understandable considering how difficult life as a new mother becomes when experiencing symptoms of posttraumatic distress.) The upshot of that blind spot is that you may need to diagnose yourself. In furtherance of that, the rest of this section will cover symptoms specific to PTSD, symptoms of PTSD that overlap with symptoms of depression, and treatment modalities specific to PTSD.

PTSD symptoms include:^{1, 2, 6}

• Unwanted memories
  • reexperiencing memories of the trauma
  • having flashbacks
  • having nightmares
  • reacting emotionally or physically when something triggers a memory
• Avoidance
  • being unable to recall the details of what happened
  • trying to avoid thinking or talking about what happened
  • avoiding people, places, or situations that recall the trauma
  • having to keep busy
• Negative thoughts and moods
  • feeling negative about yourself, others, the world
  • detaching from others, feeling hopeless and numb
  • blaming yourself for what happened
• Difficult feelings
  • feeling you can’t trust anyone
  • feeling nowhere is safe
  • feeling nobody understands
  • feeling overwhelmed by anger, sadness, guilt, or shame
• Changes in emotional and physical reactions
  • becoming easily upset, irritable, or angry
  • being easily startled or frightened
  • experiencing hypervigilance
  • having increased anxiety or panic attacks
  • engaging in self-destructive behavior
  • struggling to sleep or concentrate

Overlapping symptoms with depression include:^{2, 6}

• Struggling to sleep or concentrate
• Lacking interest or pleasure in life
• Becoming irritable or angry
• Having increased anxiety
• Feeling negative about yourself or your ability to care for the child
• Feeling detached from others

Treatment specific to PTSD may include:¹¹

• Cognitive processing therapy (CPT)
• Prolonged exposure therapy
• Eye movement desensitization and reprocessing (EMDR) therapy
• Medications to treat PTSD symptoms

For a brief description of each treatment, follow the link above, scroll down the page, and click on “How Is PTSD Treated?”

Finally, while I’ve focused on you in this section, traumatic events can also affect witnesses,¹¹ which means your intimate partner or others who were with you may experience PTSD symptoms as well, and because psychological trauma is subjective, they may experience posttraumatic distress even when you don’t.

Seeking Redress

As with responses in the moment, I can’t do better than to refer you to the Birth Rights document. In the section “How to Say: ‘What Happened to Me Was Not Okay,’” the document lists nine strategies and describes “Action Steps,” “Costs” (not just monetary), and “Benefits” for each one. The strategies are:

• “Talk about what happened.”
• “Write your narrative.”
• “Give direct feedback.”
• “File a formal complaint.”
• “Work the system, be creative.”
• “Contact a State representative.”
• “Contact the media.”
• “Take direct action.”
• “File a lawsuit.”

A word of warning, though. I recommend that any actions you undertake be because you feel it’s something you need to do for your own sake, not because you hope to achieve acknowledgment or amends or effect change. If those are your goals, you are almost certain to be disappointed. Abusive treatment is entrenched in maternity care systems worldwide, which makes achieving any of the above unlikely.

Some Final Words

If we lived in a perfect world, you wouldn’t need this article, but we don’t. Forewarned is forearmed, however, and now you are both. You know the score, and you have prevention strategies and coping strategies should worst come to worst. Now that you do, put your prevention strategies into practice and then let go, knowing that you have prepared as best you can, and even in an imperfect world, you’re probably not going to need them.

Resources

Childbirth Rights Statements

“Speak Up for Your Rights”

Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy. Revised 1/22 

Committee Opinion, Number 819: Informed Consent and Shared Decision Making in Obstetrics and Gynecology

The Rights of Childbearing Women

Birth Rights. A Resource for Everyday People to Defend Human Rights During Labor and Birth

Ethical Framework for Respectful Maternity Care During Pregnancy and Childbirth

Respectful Maternity Care. The Universal Rights of Women & Newborns

Miscellaneous

Choices in Childbirth

Take Charge of Your Birth Resource Library

References

1. Birth Trauma and Postnatal PTSD. Mind, 2024. (Accessed Jan 6, 2025, at https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/ptsd-and-birth-trauma/#SignsAndSymptomsOfPostnatalPTSD.)
2. How to Recognize and Recover from Childbirth Trauma. University of Utah, 2022. (Accessed Dec 12, 2024, at https://healthcare.utah.edu/healthfeed/2022/02/how-recognize-and-recover-childbirth-trauma.)
3. Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy. Revised 1/22., 2022. (Accessed Jan 18, 2025, at https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/06/refusal-of-medically-recommended-treatment-during-pregnancy.)
4. ACOG. Informed Consent and Shared Decision Making in Obstetrics and Gynecology: ACOG Committee Opinion, Number 819. Obstet Gynecol 2021;137(2):e34-e41.
5. Ayers S, Bond R, Bertullies S, et al. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med 2016;46(6):1121-34.
6. Is It PTSD, Depression, or Both? WebMD, 2024. (Accessed Dec 22, 2024, at https://www.webmd.com/depression/depression-ptsd-vs-depression.)
7. Declercq ER, Cheng ER, Sakala C. Does maternity care decision-making conform to shared decision- making standards for repeat cesarean and labor induction after suspected macrosomia? Birth 2018;45(3):236-44.
8. Dekel S, Stuebe C, Dishy G. Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors. Front Psychol 2017;8:560.
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[1] Ellipses appear here in the original source.

[2] The source states that, at the time of its writing, “childbearing women are legally entitled” to all but two of these rights. They also state that the two exceptions—the right to have family members and friends present and the right to uninterrupted contact with the newborn—are nevertheless likely to be upheld by the legal system.