When Laura gave birth to her son, the experience was violently traumatic. “It was so bad, I thought I was going to die of pain,” she said.
To deliver the baby, the gynaecologist pushed on Laura’s stomach using her full bodyweight , refusing the medical team’s recommendation of a caesarean. During the process, the gynaecologist broke her baby's collarbone.
After the delivery, the doctor sewed up Laura’s vagina before the local anaesthetic kicked in.
“She gave me eight stitches inside and eight outside. I screamed so much, they asked the orderly that was in the room to hold my feet to the table,” Laura said, speaking on the condition of anonymity to protect her and her family’s privacy. “I still have nightmares.”
Laura’s horrific experience becomes even more shocking when you consider that this took place just last year in France, one of the wealthiest countries in the world, which spends 11.3 percent of GDP on healthcare – the second largest share in the EU, closely behind Germany. France was praised by the World Health Organisation in 2000 for providing the best overall healthcare in the world. And just last week, President Emmanuel Macron announced that France is investing €7 billion (about £6 billion) in public funding to further improve its healthcare system following the COVID pandemic.
“It is as if as soon as you get pregnant, you have no rights, no brain.”
But despite its universal health care system being widely lauded, many women in France experience obstetric violence during pregnancy and childbirth. Although conditions have improved in the past decade, experts and activists say the patriarchal culture of medicine in France leads to systemic mistreatment. Men represent 74 percent of board members of the French National College of gynaecologists and obstetricians but only 49 percent of OB-GYN practitioners. The practice of pushing on a woman’s stomach to aid childbirth, as experienced by Laura, had supposedly been banned by France’s national health authority (HAS) in 2007.
Experts and women who had recently given birth told VICE World News that “ordinary sexism” had crept into obstetrics in France, and that it was difficult to counter.
“We have a medical field that is very powerful, very difficult to question,” said Sonia Bisch founder of Stop Violences Obstétricales et Gynécologiques (StopVOG), a French association working to end obstetric violence and improve medical practices. The group collects and maps women’s testimonies.
As one paediatric nurse with 10 years experience working in France, who spoke on the condition of anonymity to protect her professional practice, said: “It is as if as soon as you get pregnant, you have no rights, no brain.”
The first time Danielle experienced this “ordinary sexism” was during a routine checkup in 2012 when she was about six months pregnant. In France, doctors often request that patients fully undress for most medical exams.
“I was lying completely naked on the bed, and he said to me, ‘Oh, wow, you look like a pinup’,” Danielle said. “I felt dirty and violated.”
Danielle had been seeing this same OB-GYN for two years, who had been recommended by a friend, and he had delivered her first child. But when Danielle said she wanted her mother to be present for the delivery, the doctor called Danielle “a little girl” who was “afraid to deliver.”
“At this point I am screaming, ‘I am going to die.’”
During a checkup exam, the same doctor examined Danielle vaginally without her permission, despite French law requiring informed consent. The Kouchner law, named for French doctor and politician Bernard Kouchner, is intended to protect patients rights, including asking for consent before a medical procedure.
The vaginal examination set off contractions. Danielle went to the hospital and contacted her midwife, who told Danielle that the doctor had stretched her cervix during the exam. Although the contractions subsided, the same thing happened in a later checkup, again without her permission. This time, she was only two weeks away from her due date, and she went into labour.
While waiting at the hospital, her doctor called, telling her that “if I say that you have to be strapped down to the table, then you have to be strapped down the table,” Danielle recalled.
Shaking, Danielle returned to the delivery room, where the midwife said Danielle’s doctor had ordered her to forcibly break Danielle’s water using a long needle. The pain was immediate, and excruciating.
“My whole entire body felt like it was shattering because my child started slamming against my pelvis instantaneously,” Danielle said.
“At this point I am screaming, ‘I am going to die.’ And I'm gripped onto this midwife, who was actually also pregnant, and I am holding on to her face. I've got my arms wrapped around her neck. I’m just holding on for dear life.”
Danielle’s doctor finally arrived and started an IV drip with Pitocin, a synthetic version of the hormone oxytocin, which accelerates contractions. The birth happened quickly, but Danielle bled heavily.
After her child was born, the physician only came to check in once, while Danielle’s mother was visiting the hospital. During this visit, Danielle recalled that he turned to her mother and said, “I’m very macho. And madame, your daughter is very stubborn.” VICE World News isn’t publishing Danielle’s surname in order to protect her identity. She said she never filed a complaint against the doctor in question because she thought she would never be believed, and it was her word against his. She doesn’t want to go through the formal complaint process now, because she doesn’t want to be forced to relive the trauma she endured in an official capacity.
Although the practice has decreased, France still has a high rate of episiotomies, which is when a medical practitioner creates an incision in the perineum to make the vaginal opening wider for childbirth. France has an episiotomy rate of 20 percent for vaginal deliveries; WHO recommends aiming for a rate of 10 percent. In 2020, 71 percent of surveyed women who had an episiotomy in France did not consent to having one done.
Contributing to the problem is a phenomenon called le point du mari, or the “husband’s stitch,” which is when the medical practitioner adds an extra stitch when sewing up the woman after childbirth.
“It’s a sexist practice of tightening the vagina a little bit more for the pleasure of the spouse,” said Bisch, of StopVOG.
“Le point du mari, unfortunately, is still a reality. This is mainly due to sexism in medicine and a lack of regulations and sanctions.”
“France is the country of human rights. But it is also a country of no rights in the delivery room.”
When Lara, who spoke on condition of anonymity because of the details of the trauma she shared, gave birth at the Port-Royal Hospital in Paris in 2019, she was given a point du mari without informed consent and without a sufficiently-strong anaesthetic.
“The last few stitches I felt raw because my anaesthesia was gone. After, the stitches pulled all over,” Lara said. “I continued to bleed for 3 months after the delivery.”
She was in excruciating pain for two months and had to return to be reexamined several times. Lara had another operation nine months after her delivery and is going through post-operational rehabilitation. She sees a psychologist today too.
“Of course, France is the country of human rights. But it is also a country of no rights in the delivery room,” Lara said.
After experiencing excruciating pain, Lara went several times to be reexamined. Even when she went to a different practitioner, she was told that she was fine.
“Instead of admitting that something had gone wrong, he excused his colleague. He said, ‘No this is a very good obstetrician. It's a very well-run hospital. I have colleagues who work there. He didn’t even talk about me, just his colleagues,” Lara said. “It's dramatic, this brotherhood.”
The complicity is evident even when a complaint is filed, experts and activists say. When a case comes before a judge, the judge defers to an expert to submit a report detailing the technicalities of the case, Marie-Hélène Lahaye, a lawyer and author who helped popularize the term violences obstétricales in France, said.
“In the case of childbirth, this expert is a doctor. Therefore, the report submitted by the doctor is very often in the interest of his colleagues and not in the interest of the woman or the midwife,” she said.
Because of this, medical professionals are rarely disciplined. “There is such impunity, such medical power in France,” Bisch said.
In France, suicide is one of the two leading causes of death for women in the first year after they give birth (the other being cardiovascular disease), according to the most recent report by the French National Institute of Health and Medical Research (INREM), which analysed data from 2013-2015.
“In my opinion, obstetrical violence is a major cause of suicide because a primary cause of suicide is trauma. Obstetric violence is highly traumatising,” Bisch said.
Laura, who gave birth in 2020 and whose doctor pushed on her stomach, cannot fully remember what happened during the delivery but she still has flashes of the trauma that trigger panic and pain. She has post-traumatic stress disorder, suicidal thoughts and recurring nightmares of the birth. Both she and her husband see psychologists today. Laura had wanted a second child, but now she is afraid of being subjected to obstetric violence again. The trauma also made it difficult to bond with her baby.
“The birth is supposed to be the most beautiful day but for me, it was a day of suffering. It destroyed me.”
Danielle had a similar experience in the first year after her daughter’s birth because of the trauma. “I struggled to bond with my second child in the first six months to a year,” she said.
For Lara, the trauma from the birth affected her relationship with her husband.
“It was my first birth, and it entirely transformed my relationship with my spouse. It did a lot of damage,” she said.
These long term effects are often ignored by many medical practitioners.
“This trauma is something a lot of doctors and midwives deny,” said a nurse with 10 years of experience in paediatrics. “They say that if the baby is healthy, that’s all that matters.”
Over the past few years, the French government has begun to pay attention to the conditions of births and pregnancies in France. In 2017, Marlène Schiappa, then-secretary for equality in France, called on the High Council of Equality to conduct a report on obstetric and gynaecological mistreatment in France which was published in June 2018.
“The most important thing is to listen to our pain, to take into account when we are in pain.”
“It is a taboo subject, and the goal of this report is to address those subjects concretely, to carry out hearings and in-depth hearings,” Schiappa said in an interview at the time.
Bisch applauded the report, but says not enough has been done with the findings.
“The reflection period was very important, but it's time to move on to concrete action,” she said.
The Sorbonne Institute of Legal and Philosophical Studies launched a recent project that aims to identify avenues in the field of law to protect women from obstetric violence, or to seek recourse.
Some hospitals in France are changing their practices. Danielle’s third pregnancy was a very different experience. She went to a special clinic in eastern Paris. There are birthing pools and a birthing center attached to the hospital for those who don’t want to give birth in a hospital.
When Danielle went in for her first exam, the midwife only used an ultrasound machine, rather than examining Danielle vaginally, explaining that they know physical examinations can set off contractions, as had happened with Danielle.
“I felt a lot more empowered,” she said.
Most importantly, medical professionals and the general public need to listen to women.
“We need to talk about it. You feel guilty talking about yourself because when you give birth to a child, the mother is relegated to the background. Of course it’s important that the child is well, but we aren’t sufficiently warned that this [trauma] can happen,” said Laura.
“The most important thing is to listen to our pain, to take into account when we are in pain.”