German mother Susanne Reif* cried continuously the day after the birth of her son. Even now it's still difficult to talk about.
She is among a rising number of women reporting traumatic childbirth and obstetric examination experiences, experts say.
Campaigner the Roses Revolution usedthe International Day for the Elimination of Violence against Women this week to highlight the issue. It sees women lay a rose in front of the delivery room where they experienced the violence. Some write their experience on a small piece of paper as part of an initiative to break the silence and create awareness among professionals.
Reif said when she arrived at the hospital to give birth, her cervix did not dilate, and she was forced into a bathtub.
A midwife rolled her eyes and told the woman her pain was "ridiculous".
"After that I was delirious. I was fainting and I was throwing up all the time. Only in those moments did I come to consciousness," Reif told Euronews.
The epidural anaesthesia, which an anaesthetist injected into her back five times after several hours of waiting, did not feel right.
Midwives called the anaesthetist three times without success.
The next morning it was decided to deliver the baby by caesarean section. The anaesthetic was injected in the same area of her back and as she struggled to breathe, a nurse yelled at her and slapped her, saying: "if you can still talk so much, then you can also breathe".
She later learned that the epidural was wrongly placed from the start, a so-called high spinal anaesthetic, which gradually paralysed her organs, including her heart and lungs.
"I was suffocating then and there on that table," she told Euronews, still in disbelief and shock over the event.
When the professional staff realised the seriousness of the situation, they put her under general anaesthesia and delivered the baby by emergency caesarean section.
The dramatic birth of her son, who was under anaesthesia even for the first 20 minutes of his life, is part of her trauma. But she finds the behaviour of the professional staff particularly shocking.
"Where has their humanity gone?" she asks. Her therapist classifies what she experienced as severe violence.
The taboo of obstetric violence
An international study in the British journal BMC Pregnancy Childbirth found that 66.7 per cent of the women who described a traumatic birth found the "care provider actions and interactions as the traumatic element" in their childbirth experience.
"The topic has been known for a long time and yet it is still an absolute taboo," says Munich head physician and gynaecologist Prof. Dr Gerlinde Debus.
"Even a routine procedure such as an ultrasound can represent a violent intervention in the perception of mother and child," says Debus.
Many pregnant women do not know that they do not have to go to the hospital for routine tests, explains midwife Julia Huegel, and most vaginal examinations are also unnecessary.
Although there are more and more demands for better care for women by having more midwives, childbirth is becoming more medicalised in Germany, she says.
Huegel explains that doctors perform interventions because they cannot be completely sure how the child is doing in the womb.
"We don't know how the child is doing until it is born," says Huegel.
Debus says a possible explanation for the increasing number of interventions in obstetrics is a so-called professional fear.
In order to safeguard themselves, the gynaecologist explains, the professional staff take all measures known to them to monitor the child and mother intensively during birth.
Midwife Huegel also finds many doctors anxious: on the one hand, there is the fear of being sued if the child "comes out badly". On the other hand, some are concerned about their reputation among colleagues or in their careers, which puts them under pressure.
Psychologist Nergiz Eschenbacher explains the violence as a combination of fear of harming the newborn, the general image of women in Germany and the working conditions of midwives and gynaecologists.
She says women compare their experiences to being "tortured like in the Middle Ages" or "slaughtered" when they eventually seek help.
A rose lies in front of the entrance to a delivery room: midwives and gynaecologists usually know that women are making a statement with it.
'We were all afraid of being assigned to the delivery room'
A survey published in the German Midwifery Magazine in July this year shows that many midwifery students become witnesses, (co-)perpetrators or victims of violence during their training.
"It was terrible," Huegel says of her training 13 years ago. "We were all afraid of being assigned to the delivery room," says the Munich-based midwife.
Veronika Selters* from the Frankfurt area also remembers her midwifery training well, during which the romantic idea of birth quickly turned out to be an illusion.
She has often witnessed violence in her field. A few months ago, she advised a young mother to take legal action against a senior doctor.
"The woman had explicitly said during the birth that she wanted neither a suction cup nor an episiotomy. Then she was threatened with a caesarean section. Immediately afterwards there was a contraction, during which the obstetrician simply cut and used the suction cup."
Women seek help after traumatising births
Catrin Domke, a former surgeon who founded an association for traumatised women after experiencing violence during the birth of her son, says afterwards comes a new form of violence.
She was turned down by numerous therapists and in self-help groups, she was told she was not in the right place. Often, people played down the violence, she said.
"You should be happy to have a healthy child", people told her.
Her association, Traum(a)Geburt e.V., counsels pregnant women, helps traumatised women and provides legal advice. Just six months after its founding in 2018, the association had around 200 members.
"Violence during childbirth can affect anyone," says Domke, explaining that there are parallels to how rape victims are treated.
Many relationships break up within a year after such an experience, she says. Some women -- like Domke herself -- cannot return to their jobs, which means that the violence often triggers a financial crisis as well.
Ten out of 15 women who turn to her association seeking help are considering suicide, Domke told Euronews.
Awareness of violence growing
Psychologist Eschenbacher has noticed that more and more women are consciously seeking help after a traumatising birth.
She herself has networked well in her region around Freising, with the health department even referring women to her. But "there is still a lot of resistance in society," she says.
More and more women are coming forward at Traum(a)Geburt, looking for legal help or to participate in the support groups that are taking place online because of the COVID crisis.
"We advise women to take legal action against the hospital or the obstetricians," says Domke. "But the judicial system has to follow up".
She finds that experts appointed by health insurance are biased and that many lawyers either do not want to accept cases of obstetric violence or represent doctors and hospitals at the same time.
Melanie Woche also decided to file a criminal complaint for bodily harm because a caesarean section was performed against her will and without clear indication during the birth of her second child.
She had previously asked the attending doctor for more time - for a natural birth, which he denied her.
Without her consent, the child was then born by caesarean section.
"It was like forced treatment," says Woche, who realised a few days after the birth that she had developed a trauma disorder.
Her case, which is similar to what many women have experienced, is now before the Federal Constitutional Court in Karlsruhe. They will decide whether the right to bodily integrity has been violated.
Midwife Huegel says that women do not need to be better prepared for birth, but that they need to be helped to learn to listen to themselves and their feelings.
In her experience, women who have a good connection to their child and body are less likely to give up their self-determination.
Catrin Domke expects midwives and doctors to reflect more on their own work and behaviour and to take up offers of supervision.
At the same time, her association, together with a family therapist and doula, has developed a living will for pregnant women, which expectant parents can discuss with the hospital staff before the birth in order to prevent unwanted interventions.
She would like to see more awareness in dealing with traumatised women in general.
Acknowledging that this is what they experienced and they "are right that something was wrong" is a good start, she said.
*These names have been changed to protect the two women's privacy.