Obstetric Violence Committees in Hospitals: Between Institutional Frameworks and Lived Practice

A confrontation between two narratives from a tertiary-level public hospital in central Barcelona

Barcelona, July 2025

Authors

• Dr Laura Abojer – Head of the Obstetrics Department at San Isidro Mother and Child Hospital
• Dr Javier De Cicco – Obstetrician specialising in high-risk pregnancies and Head of Emergency Services at San Isidro Mother and Child Hospital
• Ivana Iriarte, Lic. – Certified breastfeeding counsellor and doula at San Isidro Mother and Child Hospital. Licentiate in Communication Sciences.

Institution

San Isidro Mother and Child Hospital. Buenos Aires, Argentina.

Within the framework of the IPOV project, which aims to document and promote experiences to combat obstetric violence, this account brings together two testimonies from a public hospital in Barcelona. The first is an institutional systematization narrating the creation of the Obstetric Violence Committee from the perspective of several practicing midwives. The second is a recent in-depth interview with a lead midwife that offers a situated, sensitive, and critical view of the committee’s current functioning. Confronting both materials does not mean opposing them, but rather placing two levels of analysis in dialogue: that of declared institutional policy and that of embodied, everyday practice.

1. Origins: Desire, Drive, and Professionalism

Both accounts agree that the committee was not imposed from the hospital’s upper management, but emerged from the initiative of professionals—mainly midwives—who, after participating in earlier workshops on obstetric violence, saw the need to create a space for institutional listening, analysis, and care. The more recent narrative adds an interesting nuance: one professional, after attending a conference at Can Ruti, envisioned that if she ever became head of service, she would implement such a committee. The decision was not purely technical—it was also born from desire and a personal promise.

2. Composition: Who Is Inside and Who Remains Outside?

Both documents describe a mostly intra-institutional composition: head of service, midwives, attending physicians, medical residents, nurses, and patient liaison representatives. There are no service users, community agents, or external stakeholders involved. The interview points to this absence as an outstanding issue: opening the space to collectives such as El Parto es Nuestro could democratize knowledge and foster productive tensions in decision-making. The idea exists, but remains unrealized.

3. Categories: What Counts as Obstetric Violence?

Here lies a significant divergence. The institutional/practitioner account appears to narrow the definition of obstetric violence to clearly disruptive or traumatic situations. The interview, however, highlights how experiences of discomfort, lack of information, or emotional neglect are often excluded from the classification, even if recognized as problematic. The interviewed midwife stresses that while such situations may not be formally labeled as OV, they are still discussed in meetings to foster internal learning. Yet this difference in categorization may be a trap: what is not named as violence is not fully addressed or repaired.

4. Modes of Listening and Feedback

Both sources note the existence of complaint boxes, email submissions, and the possibility of speaking directly with committee representatives. The interview adds crucial details on complaint management: the names of the professionals involved are omitted to avoid direct finger-pointing, yet feedback to the woman is always ensured. Sometimes, in-person meetings are organized with patient liaison staff and the professionals concerned. In these encounters, active listening, explanation, and apology emerge as symbolic tools of reparation. Honesty—even when mistakes stem from personal difficulties—tends to be met with gratitude from service users. This ethical dimension is less evident in the midwives’ institutional narrative.

5. Training and Awareness-Raising for Staff

Training in non-technical skills—such as empathy, emotional management, and communication—is another strong point. The interview provides a moving account of perinatal grief training using theatrical simulations. This innovative approach not only improves the quality of care, but also opens spaces for reflection on what is not taught in traditional medical education. In the midwives’ collective account, this training is mentioned, but without the same depth or affective charge conveyed in the lived experience.

6. Indicators and Institutional Tensions

Both narratives note the absence of systematic indicators to measure the committee’s impact. However, the interview raises an important warning: an incentive system based on “having no complaints” can foster a culture of silencing rather than transformation. This reflects the ambivalence of certain institutional strategies which, instead of prioritizing continuous improvement, may reward the invisibilization of conflict.

Conclusion: Listening to Voices, Revising Frameworks

Bringing these two perspectives—the institutional view of practicing midwives and the situated view of the lead midwife who inhabits the committee’s daily life—into dialogue makes it possible to highlight both progress and challenges. On the one hand, the committee has opened channels for listening, training, and reflection, with significant transformative potential. On the other, structural limitations remain: the absence of community representation, a cautious use of the term “obstetric violence,” and performance metrics that lean toward productivity logic rather than transformative care.