Author on violence during childbirth: “Have children and keep your mouth shut”

Verbal attacks and physical violence: Women giving birth have stressful experiences in the delivery room, says Lena Högemann. Why is this so and what needs to change.

At the Still Lab, aspiring midwives use full-body simulators to train during childbirth, both at home and in the delivery room. Photo: Friso Gentsch/Picture Alliance

taz: Mrs Högemann, the first sentence of your book is: “The day I became a mother was the worst day of my life.”

Lena Hogemann: Women are expected to live the day of our child's birth as a happy day. But on no other day have I experienced so much heteronomy, attacks and humiliation as the day I became a mother.

You can be more specific?

Mentally it was terrible. The midwife told me from the beginning: what I'm doing is not enough, it won't work. When I cried, she said that wouldn't help me now either. Physically it began with a contraction drip and epidural, that is, anesthesia through the spinal cord. Both procedures were not medically necessary and were not explained to me at all. But I only understood it when I read my file later.

Obviously, the midwife and doctors wanted me to have my child faster – the delivery rooms were full. They didn't even talk to me about an episiotomy. My daughter was finally born via vacuum. It was a nightmare.

Isn't that an experience that many women have?

Yes, that's exactly the problem. I spoke to about 30 other mothers and fathers for my book. All of these women suffered psychological, verbal and physical violence during childbirth. Some particularly egregious cases: a woman recounts how the entrance to her uterus was violently dilated.

In another, the anesthesia for the cesarean section did not work, but it was not heard. During the so-called Kristeller maneuver, in which doctors apply strong pressure to the stomach of the giving birth woman, the woman's spleen is likely to rupture. Several women who gave birth have reported that they felt like cattle during childbirth. It should not be like that.

They extrapolated estimates from the Mother Hood association about how many women consider giving birth a burden. This applies each year to between 130,000 and 280,000 women, with between 680,000 and 700,000 births each year. Why is this hardly a problem in society?

We quickly get to the point of patriarchy: having children and keeping your mouth shut. Women should not complain that care work is distributed unfairly. In many areas we are not allowed to address or change injustices. This becomes particularly clear during births. We find ourselves in very vulnerable situations when we have children.

Many women do not dare to respond during childbirth or wonder afterwards what they did wrong. For months I wondered if I had provoked my midwife's behavior with something. Her statements stayed with me for years.

Can self-determined births ultimately exist? After all, women who give birth usually have no medical experience.

Of course, there is a power imbalance between doctors, midwives and those who give birth. Furthermore, a birth always carries the threat that something could happen to the child. Of course, you have to do what is necessary afterwards. This is exactly what puts pressure on women because they don't want to put their children in danger. But these highly dangerous situations affect far fewer women than those who experience childbirth as violent. This is not just the case in obstetrics, but here it seems especially true to me that those affected by violence are not allowed to be affected.

What would help?

For example, you can influence the birthplace you choose and whether you feel comfortable there. Clinics are service providers and I can go somewhere else if I want. There is also a guideline for vaginal delivery at term. This describes the highest level of science, but unfortunately it is often not applied. If you've at least read them beforehand, you'll have a say if things happen that you don't want, or your partner can have a say.

The goal during childbirth is to make the decision together about what happens next. For example, many women say they felt a certain position didn't work for them. But the doctor or midwife simply acted against your will.

So are midwives and doctors the problem?

Long after my daughter was born, I spoke to the head doctor of the clinic at the time, who basically told me: It was a good birth and now you should look on the bright side. I laughed at him, but in the end the conversation was very healing for me because I understood the system. Of course you can have bad luck with some people.

But in the end the system does not work. It is financed by fixed fees per case and therefore creates completely false incentives for births: the more it intervenes, the more money the clinic makes. A time-consuming natural birth is simply not worth it. In addition, the staff is overwhelmed: some midwives have to care for three women giving birth at the same time. This is crazy, both for the midwife and for the woman giving birth. And finally, for example, there is a phenomenon called cooling: too much stress and too much workload make some people numb and can no longer feel empathy.

The hospital reform aims to end the system of flat-rate payments per case. So will this improve obstetric care?

I don't think we'll get to a system where lump sum payments no longer exist. There is talk of postponing this proportionally so that part of the income is independent of the interventions. That would be an important step. Alternatively, a new flat rate per case could be introduced for a natural birth. The German Association of Midwives has already presented a model in this regard.

The problem with hospital reform is that obstetricians and midwives were not involved at all. And just because at some point there is no longer any financial disincentive for interventions, that does not mean that routines for intervening in childbirth will be broken. Something has to change in the attitude of the doctors and midwives in the clinic. You must learn to see birth as a natural process.

They cite researcher Tina Jung, who writes about the strong internalization and normalization of violence in obstetrics. What does that mean?

That said, this is how we do it here, we always do it this way and you agree, or we can't guarantee anything. Then, in the worst case, violent attacks come as help. And that leads to normalization. I get an incredible amount of messages from people who have experienced violence during childbirth, but haven't been able to put a name to it for years. Very little is said about what those who give birth experience and what it affects them and their children.

They ask for new obstetric care. What would that look like?

Some things could be implemented quickly: Mandatory training in sensitive communication and violence during childbirth, especially for midwives and doctors. The youngest have recently stopped taking any training and are studying dual. They learn to accompany birth at eye level. They recognize the violence and do not want to accompany births in such a controlled way from abroad, but, of course, old structures and hierarchies still exist. Breaking this down would mean that we as a society would ask ourselves: How do we want to accompany the birth?

As?

There should be no flat case rates for births and clinics need more money for staff. The coalition agreement even includes personalized care for women giving birth, but it has not yet been implemented. This is absurd.

You write that you have received a lot of rejection for your book. How do you explain that?

I can understand that doctors and midwives get upset because a journalist and a mother come and tell them how many people live their work. This is a normal defensive posture.

You write that there are also mothers whose children know nothing about traumatic births and who accuse you of spreading fear and terror.

There are many women who write to me saying they have had similar experiences, seeking information and demanding that something change. But there are also those who say that their child should not know anything about their experiences because then they may think that the birth was terrible means that they are not loved. One has nothing to do with the other. My daughter knows her story and knows that we both suffered during childbirth. We couldn't help but have experienced that. I am very happy to have found a completely different place for my second birth and to have been accompanied there by a very supportive midwife.