In January 2024, Balkans society was shocked by a social media post by a Serbian woman sharing her experience during childbirth and claiming that her baby died as a result of obstetric violence (OV). The woman stated that after being admitted in hospital it was decided that she could not give birth naturally and a C-section should be performed. However, as time passed no action was taken. The doctor decided to let her give birth naturally, although nothing had changed, and the baby was too high to do so. According to the woman’s testimony, the doctor threatened her, hit her, squeezed her jaw and insulted her nationality. The doctor stopped the labour and began to give her anaesthesia and to cut her so that he could forcefully deliver her. As the baby couldn’t descend, he kept jumping on her stomach and squeezing her, breaking her rib after which she lost her breath and consciousness. After several hours of labour, the baby girl was born unresponsive; the doctors helped her and she started to breathe a little, however, by morning she had passed away. An autopsy showed that the baby's death occurred due to OV during the childbirth. The doctor was arrested and placed in detention.

Protests under the slogan ‘Hospitals, not slaughterhouses! We will not be silent’ were organised in support of the woman, calling on the authorities to take all necessary measures to investigate and sanction those responsible. More women started sharing their stories from the same hospital, but also other hospitals around the state, indicating a long-term systemic problem.

The Minister of Health stated that an internal and external inspection would be conducted to establish the facts of the case and take adequate measures. She also stated that the state’s expert commissions of the Ministry of Health were already working on regulations to determine future rules of conduct and behaviour in maternity hospitals. She also promised to allow spouses or partners to attend births if they wish so, giving mothers extra security.

What is obstetric violence?
OV is a multifaceted and complex human rights infringement and public health issue with serious health consequences. The World Health Organisation (WHO) defines OV as ‘the outright physical abuse, profound humiliation and verbal abuse, coercive or non-consensual medical procedures (including sterilisation), lack of confidentiality, failure to get fully-informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth, leaving them to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay’. CEDAW, CEDAW General Recommendation No. 24, WHO 1996 practical guide, WHO 2020 Labour Care Guide, 2019 UN report and the 2019 CoE Resolution 2306 are just some of the international legal instruments which address OV.

A systemic problem
In 2022 three lawyers prepared an analysis on the Treatment of Women in Gynaecological and Obstetrical Institutions in Serbia. Based on the testimonies of around 200 women they defined 16 types of OV categorised in eight groups – verbal violence and bad communication, frequent application of the Kristeller manoeuvre and vacuum extraction, forced episiotomy, physical injuries, physical violence, other inhumane and degrading treatment, consent and entering incorrect data in the discharge list.

More than three-quarters of the reports concerned verbal violence and bad communication including insults, cursing, humiliation, threats of worsening of the situation and lack of information.

Who do you think you are? That you are really smart if you are a philosophy professor? What do you want? A c-section? You’re not a queen. (The woman had a tumour on her ovary and after 37 hours an urgent c-section was performed.)

Why are you whining? It’s about to hurt!

Don’t worry, if you faint, we'll slap you awake.

Sew her up, so she’ll be pretty for her husband.

Why did you get pregnant if you didn’t know that it hurts?

When you didn't want to help your child to be born, now keep quiet and suffer!

(2022 study on the Treatment of Women in Gynaecological and Obstetrical Institutions in Serbia)

Due to the application of the Kristeller manoeuvre and vacuum extraction many women suffered serious health consequences such as ruptured uterus and large haematomas. The consequences that have been observed in babies are haematomas on their heads. A 2018 study showed that 28.4 per cent of the women subjected to the Kristeller manoeuvre had consequences such as ruptured muscles, unlike 14.1 per cent of women where it was not used.

The doctor started jumping on my stomach telling me he is helping me. After I tried to push him off me so I can catch a breath, he told me that I want to kill my baby and that I am thinking only about myself.

Three doctors pushed on my stomach, afterwards my ribs were bruised. They reanimated the baby, he was unresponsive. They urgently drove him to the children’s clinic. My placenta didn't come out whole. First, the doctor manually tore the remnants of the placenta, and then scraped the uterus with a curette [knife], finally sewing me up. All this without anaesthesia with the excuse that the anaesthesiologist was busy with the baby.

(2022 study on the Treatment of Women in Gynaecological and Obstetrical Institutions in Serbia)

Forced episiotomy is widely used, despite the scientific proof that it does more damage than the natural process. The WHO has given recommendations that episiotomy should be performed only due to special health indications, and not routinely, as is done in Serbian hospitals.

She doesn’t know how to push, cut her, she will not push out the baby.

Somewhere halfway through, she started yelling at me about how rude I was and how I wouldn't cooperate and just took the scissors and butchered me up to my anus.

They were sewing me up for about an hour, with no anaesthesia and kept telling me that it was taking so long because of me and that ‘I don't cooperate’, ‘I make their job difficult’.

(2022 study on the Treatment of Women in Gynaecological and Obstetrical Institutions in Serbia)

Women also reported physical injuries, such as accidental cutting of a blood vessel during the episiotomy and not being able to stop the bleeding, cutting the large intestine during c-section and damage to the small intestine and rupture of the uterus. Inhumane treatment and disrespectful behaviour have also been reported, from tying their legs, without any explanation, even if that is standard procedure, up to insensitive examinations that have left the women feeling like they were raped. Furthermore, a special form of trauma has been suffered by women that had miscarriages being left alone to deliver their babies in their hospital rooms or the bathroom, with no medical staff present to support them.

The report also indicates that there is a practice of health workers asking consent from the patients while they are in the delivery room, in great pain, and some may be under the influence of analgesics and not fully aware of what they are signing. It also indicates cases of entering incorrect data in the discharge list, especially in situations where ‘unforeseen circumstances’ occurred.

A campaign #PrekinimoŠutnju was initiated on social media in Croatia in 2014 and 2018, and thousands of women shared their story. The second wave in 2018 was initiated by the MP Ivana Ninčević Lesandrić sharing her personal experience of a miscarriage and the performance of a medical procedure without any anaesthesia. Similarly in North Macedonia a feminist NGO Meduza in 2020 conducted a survey ‘In What Conditions Are We Giving Birth?’ for which it collected 120 stories of women who gave birth 1990 to 2020. They selected more than ten stories which were represented in several videos. The stories in both countries raise the same issues as those in Serbia and represented above and the conclusion was – ‘they treat us like animals’.

Way forward
Society continuously pressures women to become mothers, however, it is ignoring the conditions in which women are giving birth – and the conditions have remained the same for decades. Women are finally sharing their stories, speaking publicly about their experiences – which in the past was seen as normal behaviour by medical staff. However, despite the public attention it seems that the authorities in the counties in the region are not taking serious measures to prevent OV. Giving birth has many risks, however, women should be treated with respect and feel safe in the hospitals, where they will not be treated as they are supposed to know everything about childbirth and to just endure the pain. OV is a serious systemic issue and should be treated as such. Balkan states must take serious steps to ensure normal and safe spaces for giving birth in line with the guidelines of the relevant international institutions. One measure is to allow a person close to the mother to be present, however, it should not be expected that they overrule medical staff, who must be professional and respect the rights of the patients.

This week we are delighted to publish a new post by Ana Funa, our Regional Correspondent for South-East Europe. Her previous posts are available here, here, here, here and here.

The GCHRP Editorial Team

Cite as: Funa, Ana. "Becoming a mother in the Balkans: How happiest day can turn into worst nightmare", GC Human Rights Preparedness, 21 November 2024, https://gchumanrights.org/gc-preparedness/preparedness-gender/article-detail/becoming-a-mother-in-the-balkans-how-happiest-day-can-turn-into-worst-nightmare.html