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United Kingdom
Author: Camilla Pickles ¹ ²
Affiliations
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Durham Law School, Durham University, Durham, UK
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Oliver Schreiner School of Law, University of the Witwatersrand, Johannesburg, South Africa
Journal
International Journal of Gynecology & Obstetrics
Section: Ethical and Legal Issues in Reproductive Health – Gynecology
Publication details
Published online: 1 May 2025 - DOI: 10.1002/ijgo.70174
License
Open access under the terms of the Creative Commons Attribution License (permits use, distribution, and reproduction in any medium, provided the original work is properly cited).
© 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of the International Federation of Gynecology and Obstetrics.
This article examines emerging human rights standards relevant to obstetric violence and abuse during childbirth in healthcare facilities. It traces the evolution of the concept of “safe motherhood,” moving from a narrow focus on physical safety to the recognition of respectful and dignified care as a fundamental right. The analysis highlights key developments from the WHO, UN Special Rapporteurs, and landmark decisions by human rights bodies such as the Committee on the Elimination of Discrimination against Women and the Inter-American Court of Human Rights. These decisions define obstetric violence as a form of gender-based discrimination and clarify state obligations to prevent and address it through legislative reforms, professional training, effective complaint mechanisms, and remedies for victims. The article underscores the importance of free and informed consent, addressing structural inequalities, and promoting respectful maternity care to safeguard women’s reproductive rights.
Publications approval reference: 001559 - Specialty guides for patient management during the coronavirus pandemic - 9 April Version 1
The COVID-19 pandemic posed a significant challenge for the NHS: balancing the delivery of high-quality care to patients with severe symptoms of the virus with the safe provision of core non-elective services such as maternity, a field with limited scope to reduce demand. This situation required some clinical staff to be redeployed to areas outside their usual practice, while self-isolation among midwives, obstetricians, anaesthetists and support staff temporarily reduced the available workforce, with varying impacts across regions. In response, local maternity systems (LMS) were advised to adopt a phased approach to sustaining intrapartum services, ensuring staff are deployed effectively and that women and babies continue to receive safe care. The document sets out principles for maintaining service safety, guidance for reorganisation, and provides a template for communicating changes to women and their families. It was developed in consultation with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, the Royal College of Anaesthetists, the Obstetric Anaesthetists Association, and maternity service user representatives.
Helena Wigert, Christina Nilsson, Anna Dencker, Cecily Begley,
Elisabeth Jangsten, Carina Sparud-Lundin, Margareta Mollberg & Harshida Patel
International Journal of Qualitative Studies on Health and Well-being, 15:1, 1704484, DOI:
10.1080/17482631.2019.1704484
Results: The main findings reveal a deeper understanding of women’s experiences of fear of childbirth, interpreted through the metaphor of “being at a point of no return”. Reaching this point meant that women felt there was no way back from their situation. This was further elaborated in three themes: suffering the consequences of traumatic births, lacking assurance and understanding, and facing the fear. Conclusions: Women experiencing fear of childbirth are in need of support that addresses their existential concerns about being at this “point of no return”, enabling them to express and integrate their feelings, experiences, and expectations during pregnancy, childbirth, and the postnatal period. Women who develop fear following a previous negative birth experience require support that helps them to rebuild trust in maternity care professionals and their commitment to providing safe, respectful, and individualised care. First-time mothers require comparable support to reassure them that others’ negative experiences will not necessarily be their own.
Citation for published item:
Pickles, Camilla
pp. 140-160.
Further information on publisher's website:
https://doi.org/10.4324/9780429443718
Publisher's copyright statement:
This is an Accepted Manuscript of a book chapter published by Routledge in Childbirth, Vulnerability and Law:
Exploring issues of Violence and Control on 23rd August 2019, available online:
http://www.routledge.com/9780429443718
Evidence-based guidelines are promoted as tools to improve maternity care and protect women from disrespect and abuse. However, this chapter shows that their application can silence women, exclude them from meaningful care, and violate their psychological integrity. These harms are not accidental by-products of good medical practice but constitute obstetric violence, facilitated and justified through the misuse of evidence-based guidelines. The law currently offers little protection against such practices, partly because abuse in maternity care is not fully recognised as violence. Recognising it as such triggers state obligations to prevent and address it. This requires promoting guidelines as a means to support informed decision-making rather than as instruments for providers to impose decisions, and exploring legal mechanisms that safeguard women’s diverse needs and autonomy in care.
Heather A. Cahill MA BSc RGN RMN RNT Cert Ed Senior Lecturer and Programmes Leader, Acute and Critical Care, Department of Health Studies, University of York, York, UK - Accepted for publication 20 September 2000
This paper examines, through historical analysis, how medicine appropriated and medicalised pregnancy and childbirth, and the consequences for women’s experiences of maternity care. Rooted in patriarchal traditions, this model has long defined women as biologically defective and pregnancy as pathological, justifying legal regulation and medical intervention. Feminist critiques highlight how these assumptions, embedded in medical education and practice, are internalised and reproduced, shaping doctor–patient interactions and reinforcing gender inequalities. As a result, women’s autonomy in maternity care remains constrained, with their capacity for genuine choice and informed decision-making frequently undermined.
