What is Obstetric Violence and How Can We Prevent It?

By Ana V. Soto-Sánchez, Ph.D.

The following excerpt is an illustrative example of obstetric violence and may be triggering for parents who have experienced medical or birth trauma:

Unfortunately, this is a common occurrence for birthing parents worldwide. Even more unfortunate is the perception among obstetric providers and parents that this is a normal delivery experience. In reality, some of the actions described above are forms of obstetric violence. And Elena’s reaction represents just a fraction of its consequences.

What is Obstetric Violence?

Obstetric violence, a term that originated in Latin America, refers to a range of violent practices against birthing individuals during childbirth, such as mistreatment, disrespect, or various forms of abuse. This includes forced medical procedures, disrespectful language, neglect, sharing private information with people who are not involved in the birthing parent’s care without their permission, and discrimination based on socioeconomic status, ethnicity, race, or gender identity (Hakimi et al., 2025). Some examples of these forms of mistreatment are:

• Threatening the birthing parent with physical harm if they don’t comply with orders.
• Performing an episiotomy without informing the birthing parent of the benefits and risks and without confirming consent.
• Performing a C-section without medical necessity.
• Forcing the birthing parent to stay in a specific birthing position.
• Ignoring pain complaints or requests for pain relief medication.
• Shaming or humiliating the birthing parent during childbirth.
• Not providing lactation support after childbirth.
• Making comments or gestures of a sexual nature during childbirth.

In their research, Hakimi and colleagues (2025) calculated a pooled global prevalence of 59% for obstetric violence, with medical procedures performed without the birthing parent’s permission at a rate of 37%. This means that approximately 6 out of 10 people who have given birth across the globe have experienced some form of obstetric violence. In some cases, spontaneous changes to the birth plan and addition or modification of medical procedures are necessary to ensure the safety of both the birthing parent and the baby, which can be stressful for the parents and the providers. Two key factors differentiate this from obstetric violence: informed consent and justification by medical necessity.

This means that providers must explain all medical procedures, the reason for recommending such procedures, along with the risks and benefits of the procedure and of choosing not to have the procedure. Providers must also confirm that the birthing parent agrees to such procedures. Clear communication regarding potential changes to the birth plan ensures that the providers respect the birthing parent’s autonomy in unexpected situations. According to the American College of Obstetrics & Gynecology (2021; pg. e39), providers are still expected to initiate and maintain shared-decision making with birthing parents about potential changes to delivery plans and “initiate as full an informed consent process as possible in time-limited scenarios.” 

Why Does It Matter?

Obstetric violence is associated with a higher risk of postpartum depression and posttraumatic stress, difficulties with breastfeeding, injuries related to childbirth, difficulty adapting to parenting, poorer self-esteem, and decreased desire to have more children (Church, 2024; Hakimi et al., 2025; Kohan et al., 2025). People who have faced racial discrimination in medical settings may be more likely to experience obstetric violence (Church, 2024), which can lead to worse health outcomes. For example, neglecting or delaying treatment for Black birthing parents during pregnancy due to racial stereotypes might contribute to higher rates of complications during childbirth and stillbirth among this population (March of Dimes, 2021). These experiences can lead to posttraumatic stress or birth trauma, in which a stressful or life-threatening birthing experience results in symptoms that impact wellbeing and functioning.

On the other hand, parents who perceive that they are supported, their birth plan is respected, and that their healthcare provider communicates with them respectfully are more likely to report positive childbirth experiences and fewer mental health symptoms (Silva-Fernández et al., 2023). The quality of communication between birthing parents and healthcare providers is a tool to preserve the life of both the birthing parent and the newborn and can either strengthen the parent’s self-confidence or result in emotional harm (Kohan et al., 2025). 

What Can Expecting Parents Do?

Many parents have safe and positive childbirth experiences. If you are anxious about giving birth, the following are some ways you can get support and feel comfortable with your medical team:

• Discuss your concerns and values during your prenatal care with your healthcare providers.
• Have a companion (e.g., doula, coparent, close friend or family member) with you during your prenatal visits and the birthing process. Ask them to take notes on the topics discussed for you to review later.
• Know your rights as a patient! According to the U.S. Patient’s Bill of Rights and Responsibilities, you have the right to:
  • Respectful, dignified, and responsive care.
  • Receive information that is easy to understand about the benefits, risks, and costs of medical interventions and treatments.
  • Have your decisions regarding medical interventions and treatments respected.
  • Other rights and responsibilities.

Complications during childbirth can be frightening, especially when you feel a loss of control and autonomy over the birth while also worrying about your baby’s wellbeing. If you’ve experienced obstetric violence or mistreatment and are struggling with mental health or would like further support, seek help from a mental health professional and join parent groups such as PSI’s Birth Trauma Support Group or the Birth Trauma Support for Black, Indigenous, People of Color (BIPOC) Birthing People for emotional support and connection. You deserve to be heard, validated, and valued. Many medical and mental health providers are committed to ensuring respectful and dignified childbirth experiences and to supporting those who have experienced obstetric violence or birth trauma.

How Can Providers Advocate Against Obstetric Violence Within Their Institutions?

Obstetric violence is a public health issue, a human rights issue, and a women’s rights issue. The World Health Organization (WHO) encourages an individualized approach to maternal care that respects the birthing person’s autonomy. According to WHO (2025), adequate maternity care prioritizes both physical and emotional safety, including:

• Ensuring adequate conditions at institutions.
• Ensuring the birthing parent’s information is private and confidential.
• Engaging in clear and empathetic communication.
• Providing emotional support.
• Involving family members or companions in the birthing process.
• Ensuring the birthing parent’s active participation and informed consent.
• Respecting the birthing parent’s decisions regarding their body.
• Providing timely pain relief.

Certainly, obstetric violence can also be stressful for healthcare providers, particularly when they are limited by a lack of resources within their institutions, which can enable harmful practices. The following are some recommendations to encourage respectful maternity care:

• Some obstetric violence practices have become normalized in healthcare settings. Ask yourself: Is my approach communicating respect for this person’s autonomy? What is the reasoning behind the medical interventions I am recommending, and what does the latest literature say?
• Identify the enablers of obstetric violence practices. According to WHO (2025), these can be individual factors (e.g., burnout), organizational factors (e.g., inadequate training), cultural factors (e.g., gender norms), or policy-related factors (e.g., lack of laws against obstetric violence in some countries).
• Encourage the use of trauma-informed approaches in your institution.
• Invite speakers to case conferences and share educational content among colleagues.
• Familiarize yourself with the WHO’s strategies to improve the maternity care experience of pregnant and birthing people as well as their Compendium on Respectful Maternal and Newborn Care for clinic directors.
• Advocate for incorporating reporting systems and observances for obstetric violence practices (Sadler et al., 2016).
• Join the conversation! Obstetric violence has been a topic of international debate and research for the past decade. There are still many aspects left to define to determine the most appropriate solutions for this issue.

Elena’s Story

Let’s consider Elena’s experience. Her birth plan included a vaginal delivery, which had been important to her. Elena experienced complications that challenged those expectations, resulting in feelings of fear. Initiating an ongoing discussion about her birth plan, including potential complications and medical procedures, and being transparent about changes to the plan during childbirth may have helped prevent negative aspects of Elena’s experience. For example, “We planned for a vaginal delivery, and everything looks good so far. I want to make sure we take time to discuss the emergency medical procedures that may be needed to ensure both your safety and your baby’s safety in case we experience unexpected complications.”

It’s important to always check the birthing parent’s understanding of the information provided. Healthcare providers can also strive to be curious about what birthing parents are willing to be flexible on and be mindful of potential factors that increase a parent’s risk of birth trauma (e.g., Elena’s two-year journey to conceive and any past losses). In some cases, quick decision-making might be key to saving a life. In this case, sharing what is happening in simple terms (e.g., “You are bleeding heavily, we need to give you blood.”) can go a long way to ensure parents are dignified, informed, and remain active participants in their treatment.

Elena’s family felt neglected and uninformed about the severity of her condition due to learning about her childbirth experience and treatment from her rather than from her care providers. Family members and companions also deserve clear and respectful communication about the interventions performed and their medical justification as soon as possible (e.g., “There was an unexpected hemorrhage during Elena’s delivery. She received a blood transfusion and is now stable. She and the baby are doing well and resting in the ICU.”).

Part of what contributed to Elena’s negative experience was witnessing her medical team arguing among themselves when she requested pain relief— a request that was shamed and ignored by the attending provider, leaving her feeling betrayed, fearful, and helpless. Clear and respectful communication among team members is crucial during unexpected medical interventions (e.g., “Please prioritize pain relief while we manage hemorrhage.”). For team members witnessing mistreatment, a reporting protocol would allow the reporting of obstetric violence practices and support the birthing parent.

Elena experienced postpartum posttraumatic stress symptoms, such as flashbacks, intrusive memories, tearfulness, rumination, avoidance, and anxiety. Ensuring follow-up and emotional support after the birth may have helped prevent Elena’s worsening mood symptoms and contributed to adequate postpartum adjustment and quality of life.

Conclusion

Parents, remember you have power. You have autonomy and the right to transparency, informed consent, and respectful care. Obstetric violence has become normalized and can have serious consequences for birthing parents, their family members, and the medical team caring for their patients. This matter is not solely the responsibility of healthcare providers— it requires collaboration between professionals across disciplines, parents, and people in the community.

Note: Special thanks to Dr. Lindsay Sycz, Dr. Victoria Atzl and Dr. Keisha Bell for their valuable input and thoughtful contributions that strengthened this piece.

---

References:

American College of Obstetricians and Gynecologists. (2021, February). Informed consent and shared decision making in obstetrics and gynecology (Committee Opinion No. 819). Obstetrics & Gynecology, 137(e34–e41). https://doi.org/10.1097/AOG.0000000000004247

Church, A.C. (2024). “Don’t push!”: Experiences of obstetric violence in U.S. hospital settings. Social Sciences & Medicine, 363. https://doi.org/10.1016/j.socscimed.2024.117497

Hakimi, S. Allahqoli L, Alizadeh M., Ozdemir, M., Soori, H., Veber Turfan, E. Sogukinar, N. Alkatout, I. (2025). Global prevalence and risk factors of obstetric violence: A systematic review and meta-analysis. International Journal of Gynecology and Obstetrics. 169, 1012-1024. https://doi.org/10.1002./ijgo.16145

Kohan, S., Mena-Tudela, D., & Youseflu, S. (2025). The impact of obstetric violence on postpartum quality of life through psychological pathways. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-88708-8

March of Dimes. (2021, October 15). Health disparities contribute to pregnancy and infant loss. March of Dimes. https://www.marchofdimes.org/find-support/blog/health-disparities-contribute-to-pregnancy-and-infant-loss

Sadler, M., Santos, M. J. D. S., Ruiz-Berdún, D., Leiva Rojas, G., Skoko, E., Guillen P. & Clause, J. A. (2016). Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence. Reproductive Health Matters, 24(47), 47-55. https://doi.org/10.1016/j.rhm.2016.04.002  

Silva-Fernandez, C. S., De la Calle, M., Arribas, S. M., Garrosa, E., & Ramiro-Cortijo, D. (2023). Factors associated with obstetric violence implicated in the development of postpartum depression and post-traumatic stress disorder: A systematic review. Nursing Reports, 13(4), 1553-1576. https://doi.org/10.3390/nursrep13040130

U.S. Department of State. (2025, August). Patient Bill of Rights and Responsibilities, Rev. 08.2025 [PDF]. U.S. Department of State. https://www.state.gov/wp-content/uploads/2025/08/Patient-Bill-of-Rights-and-Responsibilities-Rev-08.2025-Accessible-8.11.2025.pdf

World Health Organization, Human Reproduction Programme, UNICEF, UNFPA, & Jhpiego. (2025). Compendium on respectful maternal and newborn care (ISBN 978-92-4-011093-9). World Health Organization.

World Health Organization. (2023, October 12). Improving the experience of pregnant and birthing women [Departmental update]. World Health Organization.

---

---

Explore More PSI Resources: 

Postpartum Planning Class
Birth Trauma Support Group
Professional Perinatal Mental Health Trainings
Subscribe to the PSI Blog