Victims of violence are more likely to be mistreated by the maternity system.

I’ve read thousands of documents that address the issue of obstetric violence and mistreatment in the maternity services industry. I’m always interested in papers that centre the woman and ask her about her experience.

A recently published study (September 1, 2025) called The Perinatal Experience of Women With a History of Intimate Partner Violence: The Birth Experience Study (BESt) by Keedle, et al., examined the experiences of women who were victims of intimate partner violence (IPV) during their institutionalised births in Australia between 2016 and 2021.

Although this study is specific to Australia, there’s enough research to indicate that maternity services are pretty much the same around the world and women’s experiences are pretty consistent when it comes to non-consenting, non-evidence-based, and dehumanising interactions.

In a nutshell, women with a history of IPV experience less autonomy over their bodies, more disrespect and mistreatment compared to women who are not victims, and more re-traumatisation and PTSD, often as a result of negative interactions with health care providers.

None of this surprised me. Profoundly saddened, somewhat enraged, but not surprised.

At first glance, this should be a no-brainer. Maternity practitioners should have extensive training in trauma-informed care and they should generally be very nice people who give a damn. But it’s more complex than that.

Firstly, this industry was not built on benevolence despite the fact that there are many benevolent people involved. Its origins come from the desire to control and co-opt women’s physiology for power and profit by the male physician who was looking at women as cash cows. Over time it morphed into our current technocratic model of management, control, and risk-management – the risk being to themselves.

We know that IPV doesn’t happen randomly or in a vacuum. Abusive people have generally been conditioned to abuse their victims, often because they themselves have been abused or they learnt it from their caregivers as children. Our “entertainment” culture also programmes us into a degree of conditioned dehumanisation and tolerance for extreme violence.

Many of the victims of IPV have also often been conditioned to accept abuse, perhaps as survivors of adverse childhood experiences. (Zhu, et al., 2022)

Women who have endured adversity as children, specifically, family dysfunction such as death of a parent, parent mental illness, substance use, incarceration, and/or witnessing domestic violence, as well as maltreatment such as physical, sexual, and emotional abuse and neglect, prior to the age of 18 years, tend to develop more adverse health conditions. In particular,

• chronic obstructive pulmonary disorder

• ischemic heart disease

• tumour growth

• major depressive disorder

• post-traumatic stress disorder

• risky health behaviours including drug and alcohol abuse

• early initiation of sexual activity

• unintended pregnancies

• foetal death

• being violent or being a victim of violence

• poor academic achievement

• financial stress

• suicide

• early death

There is a dose-response relationship between adverse childhood experiences and worsening health outcomes as an adult. This means that the more adversity the child endures, the more likely they will become an adult with problematic health concerns (Felitti et al., 1998). Further, women who are experiencing IPV are more likely to have preterm birth and low birth weight (Sigalla, et al., 2017).

Stunningly, those very women with health concerns that would benefit from targeted medical care are precisely those women who are more likely to be mistreated and abused by those whose only role is to provide medical care. According to Vedam, et al., (2017) women who had conditions like high blood pressure, diabetes, compromised foetal status, depression, lack of social support, or unstable housing, were four times more likely to report disrespectful care than someone with no risk factors. Something about their medical and/or social status seems to evoke more disrespect than a healthier customer.

As I presented at the Reclaiming Birth Conference in 2025, narcissistic perversion may reside at the heart of obstetric violence and mistreatment of the vulnerable obstetric customer. Sadly, trauma informed training would be unlikely to impact individuals with this kind of personality perversion.

Further, obstetric violence is so pervasive and so normalised that there are no consequences to the perpetrators and only shaming for the victim who didn’t appreciate it.

Further complicating this issue is that the hospital, that very place where a victim of IPV is more likely to be mistreated, could be the safest place for her as there are structures in place that could keep her abusive partner out of the birth room. It’s even possible that despite likely obstetric mistreatment, other support structures could be in place to provide support for her domestic situation.

I have personally worked with several women whose home situation was complicated by IPV. I have accompanied several of them to family court as their situations needed legal recourse. And I have worked with survivors after they had escaped their abuser. Sadly, IPV is pervasive and just like obstetric violence, the victim is often blamed.

It’s time to train a new generation of birth helpers. Neighbours who don’t mistreat the vulnerable and let the institutions continue to offer rescue care ~ we call them traditional birth companions.