Mariam's birth story: Obstetric Violence against refugee women in Greece

Ibone Olza, Perinatal Psychiatrist and Childbirth Activist

Erin Kilbride, Human Rights Researcher and Advocate

Laura Lecumberri, Midwife

Working as doctors, translators, and midwives in Greece's refugee camps in April and May 2016, the vast majority of new mothers we met had given birth via C-section. Public hospitals in Greece are understaffed and the situation has seriously worsened with the increased arrival of refugees in very vulnerable situations. However those reasons cannot be an excuse for the obstetric violence that both Greek and refugee women suffer at birth. Apparently caesarean rates in Greece are the highest in Europe, with an estimated rate of 60-70% according to Human Rights in Childbirth. (http://www.humanrightsinchildbirth.org/hric-case-study-greece-part-i/)

Mariam´s case, detailed below,illustrates the extreme obstetric violence perpetrated against refugee women in Greece, which includes at least: forced Caesarians, post-partum episiotomy, and denial of care.

Two Spanish midwives volunteering at a refugee camp near the Macedonian border met Mariam and she told them her story on two occasions, once with the assistance of a translator. Mariam wants to remain anonymous but has given permission to an international team of advocates to share her story to stop obstetric violence against refugee women. She is now receiving midwifery and psychological care as she suffers from childbirth related acute stress disorder. The team also offered her legal assistance should she choose to pursue her case at any point in the future.

Mariam´s story demands that human rights in childbirth are respected in Europe and raises the question of why the vast majority of documented refugees are being refused natural births in Greek hospitalswithout medical indication or informed consent.

Mariam´s birth story.

Mariam was pregnant with her third child when she and her husband left Syria. She has two children 3 and 1 yrs old.After crossing through Turkey and the Greek islands, Mariam and her family now sleep at refugee camp at the Greece-Macedonia border. In her first week at the camp, one of Mariam´s Syrian friend, who was also pregnant, went into labor. Her friend, who had previous had five vaginal births in Syria, was refused a natural birth at the Greek hospital. The doctor performed a Caesarean. Upon returning to the camp, Mariam´s friend had a difficult time breastfeeding and Mariam helped her.

In the following weeks, Mariam learned of at least three more Syrian women who were refused natural births at the same Greek hospital near the border.

In late April, Mariam began havingcontractions and went to the hospital around midday.

She told the hospital staff that she wanted to have a vaginal birth. The doctor told her it wasn´t possible. He said she would have a caesarean because they only do caesareans. Mariam refused, and the staff called a translator who spoke with her over the phone. She insisted she didn´t want a caesarean and again they told her that this was her only option.

At some point during this hospital visit, a nurse examined Mariam. Without warning or explanation, the nurse inserted a liquid up Mariam´s rectum. Mariam said it was very painful, and that the nurse inserted it ¨strongly and quickly¨. After that she went to the washroom ad she defecated red blood. The nurse toldher it was ¨no problem¨.

After speaking with the translator, Mariam decided she would rather give birth in a dirty tent than have a caesarean in a clean hospital. As she left the hospital, staff explained to her via translator that if she left she could not return.

In the refugee camp a few hours later, Mariam gave birth to a baby girl in her tent. Her sister helped. It was a ¨normal¨ labour.

After the birth, she wanted a doctor to see and clean the newborn in a sanitary space so she went back to the hospital.

At the hospital, sheasked for someone to examine the baby. The same doctor from the previous visit was there, and said he was going to examine Mariam also.

With Mariam onthe obstetric chair. He put his hand up her vagina to ¨clean¨ her. Then, with scissors, he cut her vagina without explanation. Mariam did not and does not know why he cut her. She said her screams ¨could be heard across the whole hospital¨.

Outside the examination room, the nurse was yelling at Mariam´shusband. Then the doctor stitched her up ¨with five quick stitches and some serum¨.Mariam said it was all extremely painful and no explanation was given to her at all.

Mariam´s baby was crying and nobody was taking care of her.

After the surgery, staff told Mariam and her husband to leave without their child. They refused to leave without the baby. The hospital staff retained her and her baby in the hospital for 6 days. Neither she nor her husband. Nobody checked her up again or clean her stiches. At some pointone of the staff told Mariam and her husband that they would call the police or keep the baby at the hospital if Mariam tried to leave.

After six days they returned went back to camp. Mariam has seen other refugee mothers turning to camp from hospital with two bags of supplies, one for mom and one for baby, but she received neither.

Mariam is now in the camp breastfeeding her little girl. She has pain in her back and blood with her feces. When she is in pain she remembers when the doctor cut her and she feels that is happening again. This is affecting how she relates to her newborn and also her two other babies. When she thinks about her time in hospital ¨my heart is beating fast and it is like I am there all over again, and it happens again. ¨

Due to severely limited medical facilities and privacy issues at the refugee camp, it was not possible for doctors present to perform a vaginal examination at the time of Mariam's interview. Her testimony was gathered by 3 experienced researchers in the fields of midwifery and human rights on two separate occasions. The team has arranged for Mariam to receive medical care in another location in Greece this month.

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News:

- "More support needed for female refugees, says European vice-president". The Guardian