Within the maternal health field there has been a long standing concern about obstetric violence, or mistreatment during childbirth, with it first being defined at the First International Conference on the Humanization of Birth in 2000. A succinct explanation of this health issue from Lamaze International is that “obstetric violence is anytime a person in labor or birth experiences mistreatment or disrespect of their rights”. In Ecuador as of 2020 levels of obstetric violence varies from 40 to 46.5% which indicates that almost half of mothers may experience mistreatment while giving birth in Ecuador (Ortega et. al 2021).

My research was conducted at a particularly complicated moment in awareness of maternal patient rights. In the same month that I met with my nine participants, the constitutional court of Ecuador followed in the footsteps of Venezuela and created an official definition for obstetric violence under the law (Sadler et. al 2016).

However, this victory stems from a case of severe medical neglect in 2011 where a woman was forced to give birth in an emergency room unattended (Quillupangui 2021). As was mentioned in the introduction, maternal health researchers assert that mothers are still very much at risk of experiencing obstetric violence, a concern that was echoed within my project's findings.

My interviews investigated the perceived causes of obstetric violence being normalized, what they viewed as the important elements of a respectful birth, how obstetric violence being normalized, how they came to be aware of the issue, what they considered to be respectful maternal care and what changes to the health system would ensure that mothers received humanized childbirth care.

Doctors, midwives and the participants who claimed both of these titles at once agreed that the roots of obstetric violence are pervasive and multiple interviewees emphasized how it impacts the well-being of everyone associated with the healthcare system from patients to maternal health professionals. They discussed how underlying attitudes of a doctor's absolute authority to make decisions during childbirth was rooted in sexism and led to patients being denied agency throughout their time at hospitals. That the structure of hospitals and maternity wards also hobbled the well-being of care providers and their ability to use humanized practices they knew were important and effective was also noted. The last aspect that tied the damaging effects of obstetric violence to the home birth front was instances where patients and their parteras who had experienced mistreatment in hospitals postponing admission in the case of medical emergencies leading to higher maternal health morbidity and moralities which are both attacks on the well being of mothers.

Because my participants had experiences in both hospital and home births, and pulled from both ancestral and biomedical medical knowledge, ideas to improve maternal health care included changes to how both options for childbirth worked in relation to the other. A maternal health worker from the public system emphasized the need for more privacy for the patients she worked with to reduce stress as well as providing sufficient people power. Her concern was that though staff were aware of the benefits of humane improvements to childbirth such as assisting with vertical birth positions there were not sufficient hands to apply that knowledge to actual patients’ treatment on the floor. A doctor/partero believed that community building between traditional birth attendants like parteras and hospitals would alleviate distrust on both sides and would allow for networking so patients could transition smoothly from home to hospital as needed during childbirth. Parteras efforts to educate mothers about their medical rights would be of great importance, as many patients do not understand how to advocate for themselves in the current system where an awareness of being mistreated only becomes apparent when they have been given more humanized care outside of the hospital.

In addition to becoming far more aware of the issues of maternal health in Ecuador, this project provided me with valuable insights for conducting future research projects. I learned the importance of being flexible, as what questions became most important evolved with the number of interviews I had conducted. Additionally, I learned that I definitely want to pursue future work in investigating maternal health issues as this is an area where social determinants of health and negotiating patients and providers' different cultural backgrounds is available to be explored.

Ortega, I. M. A., Rojas, M. del C. S., Bailón, P. M. A. B., & Martínez, J. R. M. (2021). VIOLENCIA OBSTÉTRICA EN EL HOSPITAL SAN JOSÉ DE TAISHA, AÑO 2020.: Obstetric violence at the San José de Taisha Hospital, year 2020. Más Vita, 3(1), 66–84. https://doi.org/10.47606/ACVEN/MV0062

Quillupangui, S. (2021, November 15). Mujer no dio a luz en el IESS por falta de aportes; CC se pronuncia. El Comercio. https://www.elcomercio.com/tendencias/sociedad/mujer-atencion-medica-iess-corte-aporte.html

Sadler, M., Santos, M. J., Ruiz-Berdún, D., Rojas, G. L., Skoko, E., Gillen, P., & Clausen, J. A. (2016). Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence. Reproductive Health Matters, 24(47), 47–55. https://doi.org/10.1016/j.rhm.2016.04.002