Thinking Philosophically (Again) about Obstetric Violence

In the afterword to the Women’s Birthing Bodies and the Law: Unauthorised Intimate Examinations, Power and Vulnerability, I reflect on the problem of consent in the context of sexual ethics and sexual violence, and propose that in the labour room – as in sexual interactions – consent might easily transform into non-consent, especially considering how fragile and dynamic subjectivity can be. Thus, taking into account that we are never ‘completed’, ‘enclosed’, ‘static’ subjects, we should at the very least be much more careful when distinguishing between ‘consensual’ and ‘enforced’ practices in medicalised childbirth, as such dichotomised definitions usually fall short.

Speaking of problematic or unproductive dichotomies, I add that in order to understand what is happening in the (medicalised) labour room in terms of the phenomenon of obstetric violence, we need much more than simple binary structures such as victim/perpetrator, passive/active, subject/object or structural/individual. Hannah Arendt’s idea of the ‘banality of evil’ might be useful in this context, as a way to pose important questions about the role of individuals within systems of violence. I believe that both Arendt and her critics were right: individuals become perpetrators of violence as a part of systems of violence, but there is nevertheless still a sense in which individual responsibility can never be totally erased or diluted. I argue that these structures, along with the individuals who take part in them, need to be addressed and named and their experiences unpacked if we want to really understand and tackle the phenomenon of obstetric violence. Thus, medical practitioners, obstetricians and gynaecologists, midwives and medical residents are themselves treated violently by violent systems and structures, which in turn make them act in violent ways towards patients. For example, a very young woman - a resident in obstetrics - told me a story about being ‘socially compelled’ to perform a vaginal examination on an anaesthetised woman because all of her superiors were watching her, expecting her to do it. This ‘circle of violence’ is, I think, part of what Judith Butler has in mind when she talks about pervasive violence, what has recently pushed her to advocate for a ‘radical politics of non-violence’. I do not mean to say here in any way that the perpetrators of violence suffer from that violence in the same manner as do the victims of that violence (in this case, birthing women), but I do truly believe that just as patriarchy cannot be combatted without also looking at the price that men pay for living in patriarchal systems, nor can obstetric violence be tackled without reflecting on the ways in which the perpetrators of this violence are themselves the victims of violent structures and trauma.

And how do we – women, doctors, midwives – identify violence amid structures that constantly reproduce normalised violence? How can this violence even be recognised as such? I begin to deal with this in my article on vaginal examinations in childbirth, but more research still needs to be done on the myriad philosophical problems surrounding the position of health-care personnel within the problem of obstetric violence.

I believe, for instance, that when we ask how violence can be recognised by a health provider who actually believes her- or himself to be acting in the best interests of the patient, we could deploy the ‘#MeToo narrative’; that is, we could say something about the importance of the subjective perception of violence: ‘I feel that you are harassing me, so this is violence, even if it does not seem that way to you’. This of course cannot be taken lightly, and the argument needs to be rethought and made more complex, since otherwise this could turn into a completely trivialised or relativized approach to the question of what constitutes violence or who is violent. Butler discusses this in her most recent work on ‘the force of non-violence’, when she writes about how ‘the power’ often sees ‘the other’ as the real danger, as no less than the incarnation of violence, in fact. Butler gives the example of the white policeman who murders the – unarmed, innocent – black man because the black man in himself ‘incarnates violence’, before he ever even acts. In such a case, it is a mistake to stand by the policeman and agree that simply ‘because he perceived violence hence there was violence’. We do not want to agree to this purely ‘subjective’ perception of violence. Power relations matter crucially.

This is why it is crucial to give an account of power relations, and the positions in which we find ourselves and each other with regard to these power relations, when we discuss violence in general and in the labour room in particular. There is an important difference between those who use violence (usually the powerful) and those who have the right to complain about or resist violence (usually the disenfranchised). We need to learn to listen to and think about these voices differently, and in relation to their specific position within the relations of power.

Dr Sara Cohen Shabot, Chair of the Women’s and Gender Studies Program, The University of Haifa