BackgroundResearch into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff.MethodsIn order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy.ResultsFrom our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers.ConclusionsSilence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide.

With the growing concern of human rights in health, the word “violence” is being used to describe apparent disrespectful treatment received by women by either health care practitioners or health care systems. As the definition of violence in health care settings broadens, questions arise over the impact of the term in describing objective reality. Specifically, does use of the term “violence” inadvertently disempower the women that it is meant to empower? This article explores the changing use of the term “violence” and specifically draws on evidence in a South African labor ward, where phenomena such as silence and limited social support have cultural underpinnings that contradict labels of structural or obstetric violence. As global research on obstetric violence in disadvantaged communities grows, choice of terminology will become more important in filtering results into medical policy and practice.

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This article explores the way in which nurses working in a high‐risk and dangerous environment understand and speak about their work caring for mothers following stillbirths. As far as we are aware, it is the first study of its kind from a low‐ or middle‐income country, and the first on this topic to apply the theoretical insights of Menzies Lyth in such contexts. In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was interviews with nurses about their practices with women who have stillbirths. Reflecting on the findings from these interviews, we believe that the nurses’ disclosures followed an overarching narrative that connected their cultural identity and personal suffering to the care that they administer. These connections between identity and profession perpetuate a healthcare system where the nurse often gives, not only out of duty and selflessness, but also out of her own sense of vulnerability. As hospitals in low‐income countries seek to improve their capacity to heal and support those in need of medical attention, nurses should be a focus of research. While their role is generally seen as a support to the doctors, in the case of stillbirths, they are far more central and often ill‐equipped for their role as grieving partner. Nurses need to be acknowledged and adequately supported.

This brief commentary is a response to the helpful responses to our article on the problem of the concept of gentle violence in obstetric care. We find ourselves in substantial agreement with our interlocutors. We suggest that naming individual actions on the part of health care personnel as violent may not be necessary for changing the behavior of these personnel and may in fact impede change. We suggest further that requiring health care personnel to accept our definitions of violence may in itself be an oppressive or epistemically violent act, probably less likely to lead to desired change than other approaches. We emphasize the need for more dialogue on victimology and the discursive complexities of trying to intervene in situations of structural violence.