Merette Khalil, an Egyptian doula, has spoken out regarding an epidemic of obstetric violence in Egypt’s maternal health system. Khalil cites existing scientific literature which describes obstetric violence as ranging “from the denial of the comfort of a companion of choice, to lack of information about the different procedures performed during care; unnecessary cesarean sections; deprivation of the right to food and walking; routine and repetitive vaginal exams without justification; frequent use of oxytocin to accelerate labor and cutting episiotomies without consent. All these events can ultimately lead to permanent physical, mental and emotional damage.”

Khalil describes her observations of obstetric violence she has witnessed over the years as a doula.

As a doula, I have witnessed almost all of these examples during births, from pushing hard on mama’s abdomen after the baby is born, to mamas being subjected to unnecessary and unannounced vaginal cuts, to being coerced into epidurals or given medication to accelerate labor, without being informed or consenting.

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Obstetric violence begins with a lack of education. It begins with telling women that their voices do not have weight during their births compared to the voice of a medical professional.

Obstetric violence starts much earlier in Egypt and in the Region, it starts with the rampant female genital mutilation (FGM) of young girls, to the silencing of adolescents about their sexual reproductive health and rights, to a medical system that continues to see pregnant women as “sick patients” who are not able to make decisions and are not entitled to preferences or information.

Violence can be simple acts of coercion and humiliation- being too intimidated to ask a question out of fear of being shamed, dismissed, or being made to feel stupid for not knowing the answer to a medical question as a first-time-pregnant mom. All too often, many mothers don’t know what questions to ask, or how to get access to the information they need; they just listen to their friends’ or their mothers’ experiences or horror stories, praying it will not happen to them.

Khalil goes on regarding Egyptian hospital policies which require women to give birth in operating rooms, laying on their backs to push. Egypt does not use midwives in hospitals, so health care staff are not trained to deliver babies in any laboring position the woman chooses. Doctors often advise women in advance that they can’t handle the pain of labor and recommend epidurals. Not being able to walk or move while laboring leads to an increase in episiotomies, the use of vacuums or forceps, and c-sections. In fact, Egypt has a c-section rate almost 6x higher than the global recommendation

While women’s labor and delivery choices should be respected, it is important for the ethical principle of autonomy that women have full understanding of all their options. They also must be offered the opportunity to labor in different positions and for labor to progress naturally if that is their choice. This is an international problem as women worldwide often feel pressured in their birthing choices.