Meet Hillary Melchiors, PhD, MPH, LCCE, CD(DONA).  Dr. Melchiors is a presenter at the 2022 Lamaze International Conference taking place virtually on October 20, 2022.  Dr. Melchiors will be presenting "Obstetric Violence: The Role of the Childbirth Educator" and speaking to childbirth educators and others working with pregnant, birthing and new families about specific ways that childbirth educators can help students not only recognize obstetric violence but also advocate for themselves. If you have not yet registered for this conference packed with amazing speakers such as Dr. Melchiors, you can do so here on the conference page.  Valuable continuing education hours, updated relevant information and an opportunity to connect live or watch the sessions recorded for a period of time are all part of this year's event. I appreciate the opportunity to interview Dr. Melchiors in advance of her session and share that interview with you here. - Sharon Muza, Community Manager, Connecting the Dots.

Sharon Muza: It seems like it might be hard to capture an accurate assessment of how prevalent obstetric violence is, both in the USA and globally.  Can you share with readers what is obstetric violence, and what those rates might be and how that is assessed? Have there been any trends that have been observed on these numbers?

Hillary Melchiors: Globally around 30% of maternity care patients and families have feel theyir experienced at least one incident that falls under the definition of obstetric violence, which is defined as excessive medical intervention, disrespect, or abuse; this rate that is holds true here in the United States too. The studies that have looked at these rates have used a variety of methods to determine patterns and prevalence of obstetric violence including surveys, qualitative interviews, and more. I think we’ll continue to see this trend rising as awareness of obstetric violence increases and families who have experienced trauma find their voices and speak up about their experiences. 

SM: At times, childbirth educators are hesitant to discuss very difficult and heavy topics, such as infant loss for example) in their classes.  This hesitancy may come from a fear of “scaring” families and increasing their anxiety.  As a result, these topics may be excluded or glossed over. Why is it important for educators to inform families about what obstetric violence is and how can educators do that in a sensitive manner that does not increase fear in birthing families.

HM: I completely sympathize with educators not wanting to scare families, especially because I live in an area with very limited maternity care options. My idea, which I’m really excited to present at the Lamaze Virtual One-Day Conference this month, is for educators to focus on setting up families’ expectations for what great care is supposed to look like. When families know what the standard of care to expect looks like, then educators can set them up to better understand when those standards are not being met. That doesn’t mean we shouldn’t discuss the other side of it, but by building that foundation with them and then practicing potential interactions, we help families increase their confidence to deal with incidences of potential obstetric violence that they may encounter. 

SM: Is there a subset of the population that is at higher risk of receiving care that includes components of obstetrical violence? If so, why do you believe that is the case?

HM: What we see in the data isn’t really surprising, as all the” -isms” seem to play a role in obstetric violence: racism, classism, sexism, etc. People who are members of marginalized populations around the world seem most likely to experience obstetric violence. Why is a very big question to answer, but my more optimistic opinion is that the more strained our medical systems become, the more stress the people who work within those systems experience, and the more we see power flexed in the form of shortcuts to excellence in care often result in episodes of obstetric violence. The culture of medicines and the varying iterations around the world of this culture are problematic, and the history of gynecology especially has violence at its roots that needs to continue to be investigated. 

SM: There are many types of health care providers who catch babies - obstetricians, family practice doctors, certified nurse-midwives and community midwives. Nurses also provide care and are supporting growing families. Are the rates of obstetrical violence more prevalent amongst a certain type of provider when you compare rates across provider types?

HM: I haven’t seen any studies that compare across provider types specifically. In my experience as a doula, I can say that I have observed obstetric violence occur with every single one of these types of practitioners, but that’s just my very limited anecdotal data. 

SM: How does an experience(s) of obstetrical violence impact the birthing person both in the moment and after the event has passed, in early parenting, postpartum and beyond? 

HM: Reactions to obstetric violence vary from trauma reactions to no reaction at all. Part of the issue is that families are being told that the care that they are receiving is normal and expected both by the systems where they are birthing and from their families and friends. For example, I’ve supported people who didn’t even know that they had gotten an episiotomy until our in-home postpartum  visit where we debrief their birth as part of my client-doula relationship for example. That is a wholly different type of traumatic reaction than those who realize what is happening in the moment. This is why I think childbirth educators need to help families know what to expect and how to communicate their expectations to their care providers. We know that traumatic experiences can have long lasting effects, and honestly I’ve been really excited to see some excellent research coming out about early interventions to prevent PTSD after traumatic events. I also hope that increased recognition of obstetric violence will raise the bar for mental health practitioners to focus on helping birthing people heal from these experiences. We know that birth experiences stay with most people for the rest of their lives, and the impact of obstetric violence can as well. 

SM: How would you answer this question: “My session at the 2022 Lamaze Virtual One-Day Conference will be a success if…”

HM: If attendees are excited to teach their students about standards of care and what to do if they experience obstetric violence. Childbirth educators help families know what to expect and are in a unique position to help raise their expectations to receive care that is free of obstetric violence. 

About Hillary Melchiors PhD, MPH, LCCE, CD(DONA)

Hillary Melchiors is a birth doula and childbirth educator who holds a PhD in Medical Anthropology and a Masters in Public Health both from Case Western Reserve University. She manages Doula Group of Evansville, a doula agency in southwest Indiana with 11 birth and postpartum doulas. She co-founded The Birth Geeks podcast with Robin Elise Weiss in 2019, and is the current president-elect of DONA International (2022). Her most recent publication is a chapter titled "Doulas as Witnesses to Obstetric Violence" which she co-authored with Dr. Angela Castaneda for the edited volume Obstetric Violence: Realities and Resistance from Around the World (2021). She lives in southwest Indiana with her partner and two children. You can find Dr. Melchiors on Twitter: @HillaryMelch or their website.

https://HillaryMelchiors.com

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