Obstetric iatrogenesis in the United States: the spectrum of unintentional harm, disrespect, violence, and abuse

Textbook typologies: Challenging the myth of the perfect obstetric pelvis

“…Since clinical pelvimetry cannot accurately predict shoulder dystocia (Schmitz, 2015), clinicians may be using clinical pelvimetry either based on a false understanding of its effectiveness or as a means to preempt litigation. More broadly, the link between normal pelvic inlet variation and birth outcomes is tenuous due to lack of evidence, especially given the many factors involved in the complex biocultural process of birth (Davis-Floyd, 1994;Liese et al, 2021;Rutherford et al, 2019). Moloy (1933, 1938) used their limited dataset to identify four pelvic types based on the size and shape of the pelvic inlet; this typology is still in use today.…”

“…If clinicians are taught during training that there are reliably predictive typologies and methods for measuring the obstetric pelvis, they are likely to remember that information during clinical practice and consider it important and practicable, even if they cannot remember the specifics. In this manner, flawed information has the potential to shape obstetric iatrogenesis, i.e., injuries resulting from medical interventions (Liese et al, 2021 ).…”

Dignity and respect in maternity care

“…Central to advancing respectful care is the need to recognise and address inherent power hierarchies, 2 as well as the cultural patterns of behaviour, which can drive mistreatment. Influence and direction of community leaders, midwives and doctors, policy-makers and champions are already showing progress in tackling the entrenched obstacles to promoting human rights, dignity and respect for all childbearing persons.…”

“… 1 Anecdotal reports and research evidence collected in maternity care systems from the wealthiest to poorest nations worldwide, irrespective of the state of the health systems, paint a disturbing picture. In fact, mistreatment of persons seeking maternity care, whether subtle or overt, intentional or unintentional, 2 is being recognised as an urgent problem and a growing global movement has been created that spans the domains of healthcare research, quality and education; human rights; and civil rights advocacy. 3…”

New life, new feelings of loss: Journaling new motherhood during Covid-19

“…Existing inequities in obstetric care for historically marginalized groups are also deepening, resulting in a greater likelihood of negative birth experiences and outcomes, which can lead to postpartum mental distress ( Davis et al, 2021 ; Norton et al, 2020 ; Obinna, 2021 ; Oparah et al, 2021 ). Anxieties about contagion, isolation, and quarantine, being separated from one's newborn at birth, or not being allowed birth companions during labor may be associated with a higher incidence for mothers of complications during labor and greater likelihood of medical interventions ( Friesen et al, 2021 ; Liese et al, 2021 ; Searcy and Castañeda, 2021 ). Increased episodes of obstetric violence have been reported in relation to these trends ( Sadler et al, 2020 ).…”