Obstetric violence

Obstetric violence-violence in the labor room-has been described in terms not only of violence in general but specifically of gender violence. We offer a philosophical analysis of obstetric violence, focused on the central role of gendered shame for construing and perpetuating such violence. Gendered shame in labor derives both from the reifying gaze that transforms women's laboring bodies into dirty, overly sexual, and "not-feminine-enough" dysfunctional bodies and from a structural tendency to relate to laboring women mainly as mothers-to-be, from whom "good motherhood" is demanded. We show that women who desire a humane birth are thus easily made to feel ashamed of wanting to be respected and cared for as subjects, rather than caring exclusively for the baby's well-being as a good altruistic mother supposedly should. We explore how obstetric violence is perpetuated and expanded through shaming mechanisms that paralyze women, rendering them passive and barely able to face and fight against this violence. Gendered shame has a crucial role in returning women to "femininity" and construing them as "fit mothers." To stand against gendered shame, to resist it, on the other hand, is to clearly challenge obstetric violence and its oppressive power. SHAMING AND GENDER VIOLENCE Obstetric violence-psychological and physical violence by medical staff toward laboring women<1>-has been described specifically as gender violence: violence directed at women because they are women.<2> The insights of feminist theory are crucial for explaining how this phenomenon differs from other types of medical violence, objectification, and reification and for accounting for the feelings many of its victims report, including loss of control, diminishment of self, physical and emotional infantilization, and, especially, shame. We offer here a philosophical analysis of obstetric violence, focused on the central role of shame in constituting and perpetuating such violence. The kind of shame discussed here is mainly gendered shame, a pervasive emotion that can affect women to their very core. Gendered shame, we show, tends to be paralyzing, making women's most intimate embodied selves insecure. Thus shame in this form not only perpetuates obstetric violence but is itself violent, confining, restricting, and diminishing laboring women. We base our discussion of gendered shame mainly on Sandra Bartky's analysis of the "shame of the oppressed" (Bartky 1990, 97). According to Bartky, in addition to the shame that all subjects necessarily experience when existing as social and moral persons, oppressed people-such as women-also experience pervasive shame, a product of the continuous and persistent disciplining of their embodied selves by different forms of structural oppression (such as sexism and racism). As she notes (regarding women in her classroom): "The shame of some of these women was not a discrete occurrence, but a

The COVID-19 pandemic has made the highly medicalized and interventionist approach in which facility-based birth was happening in Portugal before the outbreak more acute. In a system where personal choice and self-determination are not well established, their possibility is easily overridden in the face of what is perceived as a dramatic threat to life. This piece considers both women’s voiced concern of the impact of the COVID-19 containment measures readily implemented in MNH care provision, which focus exclusively on control and minimization of risk of contagion at all costs to the detriment of positive perinatal experiences, and the role of civil society organizations in denouncing and struggling for the reinstatement of childbirth rights at health facilities.

Temos como objetivo, no presente artigo, apontar aspectos epistêmicos presentes na violência obstétrica. Para isso, apresentaremos o conceito de injustiça epistêmica proposto por Miranda Fricker e como tem sido utilizado para reflexões sobre as práticas de saúde na literatura de epistemologia social. Posteriormente, nos deteremos em analisar relatos de casos de violência obstétrica bem como um caso de esterilização forçada, examinando o Relatório Final da CPMI acerca da incidência de esterilização em massa de mulheres no Brasil e artigos científicos que descrevem casos de violência obstétrica. Com isso, buscamos apontar que há um aspecto epistêmico em tais violações e que uma mudança na distribuição de credibilidade pode ser relevante para o enfrentamento à violência obstétrica.