Autonomy, Violence, and Consent in the Obstetric Field

Abstract

Obstetric violence is a structural form of gender, medical, and sexual violence perpetrated by health providers and institutions during pregnancy, birth, and postpartum. It can produce physical, psychological, and symbolic harm to pregnant/birthing people and their families. Obstetric violence results from structural conditions in the technocratic model of birth and the acceptance of biomedicine as the authoritative knowledge in health care. This phenomenon produces patients’ loss of autonomy and capacity to provide informed consent, which increases their vulnerability to unjustified medical procedures, resulting in negative birth experiences. In this paper, I argue that individual autonomy is necessary but not sufficient for legitimately consenting to obstetric care and preventing violence. The liberal framework of individual autonomy often ignores that childbirth is a social event where multiple individuals and cultural factors influence the consent process. Consequently, I discuss the role of relational autonomy in obstetric decision-making and describe some structural barriers that negatively intervene in this process. Finally, I propose that doulas and midwives can help nurture autonomy and caregiving skills in obstetric patients and health providers. This strategy protects the informed consent process, prevents obstetric violence, and can be effective in recentering childbirth in pregnant people and their families.