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A Outra Dor do Parto: Género, relações de poder e violência obstétrica na assistência hospitalar ao parto
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O parto não é um evento apenas médico. É um acontecimento com significações pessoais, familiares, sociais e culturais. O parto pode ser entendido como um rito de passagem, repleto de rituais e símbolos. A hospitalização e medicalização, ao contrário de refutar crenças e tabus arcaicos, reforça os rituais em torno deste evento fisiológico, reafirmando a perceção do corpo feminino como defeituoso e incapaz de parir naturalmente. A dor do parto não é apenas fisiológica, mas também fruto da cultura, que tem o poder de intensificá-la. O corpo feminino tem sido instrumentalizado, alvo de controlo e intervenção social, tido como um corpo frágil e defeituoso, que difere da norma (o corpo masculino). A assistência ao parto é um exemplo expressivo deste controlo. Há um excesso de medicalização e intervenção nos partos, como se não pudessem ocorrer de maneira natural e saudável sem a “ajuda” da medicina e da tecnologia. O que ocorre é que, para além do excesso de medicalização e intervenção, há recorrentes maus tratos e abusos às mulheres nos partos. Isso pode ser classificado como violência obstétrica, uma violência de género institucionalizada, naturalizada e invisibilizada. A violência obstétrica pode ser de carácter físico, psicológico e sexual e inclui também o excesso de procedimentos e intervenções bem como o desrespeito à liberdade de escolha e consentimento informado das mulheres. Neste contexto, apresentam-se os resultados de um inquérito realizado no âmbito deste trabalho, que expõe a violência obstétrica, onde se observou que as intervenções foram realizadas de maneira rotineira, com destaque para as episiotomias, executadas em 68,5% dos casos. O que se sobressai no estudo é que grande parte das intervenções foi realizada sem informar as mulheres ou mesmo diante de sua recusa a consentir com os procedimentos. Para além dos resultados quantitativos, os depoimentos recolhidos através do inquérito são muito expressivos desta violência, que se revelou através de desrespeito, ofensas, ameaças, humilhações, linguagem rude, sujeição e agressão. O parto é um momento muito significativo na vida das mulheres e o atendimento prestado a elas no parto tem forte impacto em suas experiências de parto. Apesar de, sem dúvida, haver experiências de parto muito positivas e satisfatórias, nas quais as mulheres sentem-se seguras, confiantes e apoiadas, fica evidente que há muitas experiências negativas e traumáticas – em que as mulheres sentem-se vulneráveis, assustadas e inseguras – e que podem acarretar consequências futuras em suas vidas. A violência obstétrica institucionalizada é também uma violência consentida, no sentido de que muitas mulheres se calam e não denunciam, por opressão, medo ou por parecer inadequado se opor a quem é suposto cuidar delas. Para além de responsabilizar os profissionais de assistência ao parto enquanto um grupo, é preciso direcionar o olhar para as raízes do problema, que se inserem nas relações de poder e desigualdades de género. É preciso reconhecer a singularidade de cada mulher e cada parto e restituir às mulheres o protagonismo e o poder sobre seus corpos e seus partos.
Childbirth is not only a medical event. It is an event with personal, family, social and cultural meanings. Birth can be understood as a rite of passage, full of rituals and symbols. Hospitalization and medicalization, rather than refute beliefs and archaic taboos, reinforces the rituals around this physiological event, reaffirming the perception of the female body as defective and unable to give birth naturally. The pain of labour is not only physiological, but it is a product of culture, which has the power to enhance it. The female body and its processes has been instrumentalized, target of social control and intervention, perceived as a fragile and defective body, which differs from the standard (the male body). Childbirth is a significant example of this control. There is an excess of medicalization and intervention in childbirth, as if it could not occur in a natural and healthy way without the "help" of medicine and technology. What happens is that, in addition to excessive medicalization and intervention, there are recurrent mistreatment and abuse to women in childbirth. This can be classified as obstetric violence, one institutionalized gender violence, naturalized and invisible. Obstetric violence can be physical, psychological and sexual and also includes the excess of procedures and interventions as well as disrespect of freedom of choice and informed consent of women. In this context, we present the results of a survey carried out in the scope of this work, which exposes obstetric violence, and in which it was observed that the interventions were performed routinely, especially episiotomy, executed in 68.5% of all cases. What stands out in the study is that most of the interventions were performed without informing women or even in face of their refusal to consent to the procedure. In addition to the quantitative results, the statements collected by the inquiry are very expressive of this violence, which was shown through disrespect, insults, threats, humiliations, rude language, subjugation and aggression. Birth is a very significant moment in women’s life and the care provided to them has a strong impact on their birth experiences. Although there are, undoubtedly, very positive and satisfactory birth experiences, in which women feel safe, confident and supported, it is evident that there are many negative and traumatic experiences - where women feel vulnerable, frightened and insecure - and that can lead to future consequences in their lives. Institutionalized obstetric violence is also a consensual violence, in the sense that many women stay silent and do not denounce, either by oppression, fear or because it may seem inappropriate to oppose to those who are supposed to care for them. Beyond indict care professionals as a group, it is required to regard the roots of the problem, resting upon power relations and gender inequalities. It is necessary to recognize the uniqueness of each woman and each birth and reinstate to women the role and power over their bodies and their births.
Childbirth is not only a medical event. It is an event with personal, family, social and cultural meanings. Birth can be understood as a rite of passage, full of rituals and symbols. Hospitalization and medicalization, rather than refute beliefs and archaic taboos, reinforces the rituals around this physiological event, reaffirming the perception of the female body as defective and unable to give birth naturally. The pain of labour is not only physiological, but it is a product of culture, which has the power to enhance it. The female body and its processes has been instrumentalized, target of social control and intervention, perceived as a fragile and defective body, which differs from the standard (the male body). Childbirth is a significant example of this control. There is an excess of medicalization and intervention in childbirth, as if it could not occur in a natural and healthy way without the "help" of medicine and technology. What happens is that, in addition to excessive medicalization and intervention, there are recurrent mistreatment and abuse to women in childbirth. This can be classified as obstetric violence, one institutionalized gender violence, naturalized and invisible. Obstetric violence can be physical, psychological and sexual and also includes the excess of procedures and interventions as well as disrespect of freedom of choice and informed consent of women. In this context, we present the results of a survey carried out in the scope of this work, which exposes obstetric violence, and in which it was observed that the interventions were performed routinely, especially episiotomy, executed in 68.5% of all cases. What stands out in the study is that most of the interventions were performed without informing women or even in face of their refusal to consent to the procedure. In addition to the quantitative results, the statements collected by the inquiry are very expressive of this violence, which was shown through disrespect, insults, threats, humiliations, rude language, subjugation and aggression. Birth is a very significant moment in women’s life and the care provided to them has a strong impact on their birth experiences. Although there are, undoubtedly, very positive and satisfactory birth experiences, in which women feel safe, confident and supported, it is evident that there are many negative and traumatic experiences - where women feel vulnerable, frightened and insecure - and that can lead to future consequences in their lives. Institutionalized obstetric violence is also a consensual violence, in the sense that many women stay silent and do not denounce, either by oppression, fear or because it may seem inappropriate to oppose to those who are supposed to care for them. Beyond indict care professionals as a group, it is required to regard the roots of the problem, resting upon power relations and gender inequalities. It is necessary to recognize the uniqueness of each woman and each birth and reinstate to women the role and power over their bodies and their births.
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Palavras-chave
Obstetrícia Parto Género Violência Gender Childbirth Obstetric Violence