"Lady I can deliver your baby but first let me take a selfie," said smooth-talking Venezuelan student obstetrician Daniel Sanchez on his Instagram page last week. In the accompanying picture he smirks at the camera while a woman, naked from the waist down, gives birth behind him. Another obstetrician's fingers are still in, or around, her vagina as the baby's head is born.
Sanchez (who has since set his Instagram account to private) went on to boast that his team "bring kids into the world and reconstruct pussies", claiming their skills are such that women (and implicitly their partners) can look forward to being "brand new, like a car with zero kilometres on the clock". How splendid, say the image's 31 likers. Unfortunately for Sanchez more than 4,000 people, who've signed a petition calling for disciplinary action to be taken against him, think it's less acceptable.
In an email exchange with the petition's creator (Jesusa Ricoy of the Roses Revolution, a global movement against obstetric violence) Sanchez has apologised for any offence while denying taking the picture himself. He carefully mansplains to us all that the woman in question is respected because "you cannot see her genitals or her face" and assures that she gave consent. He's also keen to make it known that he is one of the most empathetic students in the team and that women often request that he specifically performs their vaginal examinations, saying, "doctor hagame el tacto usted que es mas delicado" ("doctor you touch me because you are more gentle").
Even if Sanchez did gain the unidentified woman's consent before displaying an intensely private and vulnerable moment to the world, his priorities were skewed. She was busy pushing a small human out of her body. Having done that a couple of times myself I'm confident that being a photographic model wasn't at the top of her to-do list.
But that's only part of the problem with this photo. Most shocking to me is that the power in it is in completely the wrong place. The woman is surrounded. She's on her back and at a moment of birth where she can't move even if she wants to. The others are standing, uniformed against her nudity. They have faces, feelings and agency. She has been reduced to a torso. A reproductive channel to be rooted around in without regard.
Jesusa Ricoy started the online protest against the image to "tackle the culture in which this kind of thing is permitted and accepted". Her movement was founded in response to a series of cartoons in the Spanish Society of Obstetricians and Gynaecologists journal that shamed, mocked and sexualised women. With oversized breasts matching their inane questions, reduced to splayed legs and genitals in stirrups or running with a vaginal prolapse dragging on the ground to the delight of chasing dogs; it was clear how these doctors viewed the women they were supposed to care for. Despite protests, the Society has never apologised for the cartoons.
Sanchez's photo isn't a lone example. This image of an apparently unconscious, naked woman after a caesarean section was again posted online by doctors. Over this weekend Ricoy found another medic instagramming dubious birth images. Nurse Francisco Salgado has now deleted his photo showing the post-birth stitching of a woman's perineum. A tastefully blurred and bloodied vagina and thighs is the background of an in-focus head attending to her. Salgado has added a caption that reads; "someone will be in my eternal debt #thankfulhusbandsstich". The "husband stitch" refers to the practice of painfully suturing a woman's vaginal opening to be smaller and tighter than before birth.
Of course the images in and of themselves aren't the real problem. They are simply hieroglyphics for much of what's wrong with the way women are treated in childbirth and, more broadly, throughout their reproductive lives. Away from the filtered reality of Instagram, the power is still usually in the wrong place.
Venezuela was the first country to legally recognise the term " obstetric violence". The law forbids abusive practices and anything that brings with it "loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women". The legal definition has provided hope around the world, but the reality in many Venezuelan hospitals is still grim.
In Brazil last year Adelir Carmen Lemos de Góes was taken from her home by police and forced against her will to have a caesarean section because doctors didn't agree with her birth choices. Routinely, according to the recent Birth in Brazil study, vaginal birth is a lonely world of pain. Women are denied the opportunity to have a companion, access pain relief or the freedom to move around in labour. The caesarean section rate is out of step with women's preferred choice of labour with a recent study showing that while 73 percent of women want a vaginal birth, 50-80 percent of them end up with caesarean sections.
This isn't a problem unique to South America. It's so endemic that the World Health Organisation has launched a campaign explaining that "across the world many women experience disrespectful, abusive, or neglectful treatment during childbirth in facilities. These practices can violate women's rights, deter women from seeking and using maternal health care services and can have implications for their health and well-being."
While those in the developing world are often hit hardest by abusive practices and a culture that dehumanises childbearing women, it would be naive to think this doesn't impact on women closer to home. Activists Cristen Pascucci and Lindsay Atkins' newly launched "Exposing the Silence" photo project documents women in the US who have experienced obstetric violence. There are equally shocking forced caesarean cases in the US and a rising culture of punitive measures against pregnant women who seek to restrict their reproductive freedoms more broadly.
The UK does better, but women still report intimate, surgical procedures being performed without their consent. A lack of dignity and compassion is cited time and again in investigations into failing maternity units and tragic, avoidable deaths. Women say that they are made to feel like vessels, not human beings, in birth.
Humanity is the key to breaking down acceptance of practices that not only humiliate, imprison, endanger and abuse women, but eat away at their basic rights. In South America the extent of the problem has provoked a revolutionary solution. The humanising birth movement (resulting in government-sponsored programmes like the Stork Network in Brazil) pushes for safe and quality care with a woman-centred, respectful approach at all times. Putting basic human dignity back in to childbirth and reversing the power balance is an approach now being watched and emulated around the world.
Forced caesareans, obstetric violence and dehumanised care can seem a world away from an arrogant junior doctor with a selfie-stick. But women are shamed and dehumanised in the birth room every day. Their heads may as well be cropped out, as in Sanchez's photo, as they lie stranded, just identity-less vaginas awaiting rescue or pillage; the balance of power tipped entirely in the wrong direction. It's women, not doctors, who "bring kids into the world". Let's start with getting that on the first page of the obstetric text book.
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