Let’s get this over, I’ve got a golf game.

Across the world, a violent pattern persists in maternity wards: (some) medical professionals continue to silence the voices of (some) women during childbirth. This silencing means that the pleas for attention, autonomy, and empathy of (some) women in labour are not only dismissed but actively suffocated by (some) doctors at a moment of profound vulnerability and incomparable pain. A silencing that sometimes seems to happen simply because (some) doctors are too eager to get to a golf match (or whatever golf entails).

Besides the intuitive wrongfulness and rage I have personally felt while reading about such silencing, here I would like to confront some more intellectually charged questions (and possible answers) that might help us begin to find common ground: What shareable—and outside-my-own-emotions—element makes the act of silencing, especially of a laboring woman, so morally problematic? Where does the communication between the laboring woman and medical professionals break down? How can the philosophy I have studied help me (or us) make sense of this horrible form of harm?

A white, male doctor narrating childbirth: what could ever go wrong?

Before skyrocketing to fame as a writer and TV personality, Adam Kay wandered the corridors of an NHS maternity ward as a junior doctor. It was there, amidst the chaos of childbirth and emotional highs and lows, that Kay’s curious journey from obstetrics to storytelling unfolded.

After assisting with a harrowing C-section, Kay made the audacious leap to step away from his medical career. Yet, instead of leaving his experiences of birthing women behind, piercing his left ear, trying hot yoga, and/or downloading a dating app, he:

  1. Penned the experiences of “his” laboring women down;

  2. Published them in the 2017 non-fiction memoir This is Going to Hurt (without the women’s consent);

  3. Managed to become a literary sensation, and

  4. Got them immortalized in a homonymous BBC series starring an famous Ben Whishaw (probably only famous in the UK), playing none other than Kay himself.

In a society where women still struggle for their rightful space, the remarkable generosity demonstrated by laypeople (even men!) in wanting to watch and read about the labor experience would only seem worth praising: how is it not highly heartening that, for the first time, even a TV broadcaster is willing to make “childbirth as it is” accessible to the broader audience, in its “genuine” brutality, messiness, and goriness?

If you picked up on my sarcastic undertone, you’ll know this is not all feminist glitter and glory. Both the book and the show, distinguished by their annoyingly sardonic humour, mask a disturbing premise: childbirth, chronicled through Kay's masculine medical gaze, is not only depicted but publicly accepted as an inherently traumatic and self-displacing experience. Here, a woman's bodily autonomy must be sacrificed because ‘the baby is all that matters, thus validating doctors in the rapacious dismissal and silencing of a bunch of pregnant “wet hens”1.

It is rather upsetting to read how enjoying “one of the most beautiful, heart-wrenching, hilarious books” 2 ultimately boils down to feeling at ease with laughing about women screaming in agony, begging for epidurals that never come, “supported” by sneering medical staff who mock their pain.

The only reason I brought up the story of “Dr” Adam Kay is to reveal a sickening truth: the success of both this “hilarious” book and the broader series perfectly exemplifies how deeply normalized a phenomenon like obstetric violence has become in the public eye. Obstetric violence is the precise, “technical” term used to describe the physical and psychological abuse women often endure at the hands of healthcare providers during childbirth. This includes being silenced, dismissed, coerced, or subjected to unnecessary and sometimes harmful interventions without informed consent.

A study conducted by public health researchers across 34 countries collected seven major categories of obstetric violence:

  1. Physical abuse.

  2. Sexual abuse.

  3. Verbal abuse.

  4. Stigma and discrimination.

  5. Failure to meet professional standards of care.

  6. Poor rapport between women and providers.

  7. Health system constraints. Within this classification, women's accounts reveal a consistent and broader picture of being “humiliated,” “bullied,” and “made to feel incompetent” by medical professionals (at a moment of profound vulnerability and incomparable pain).

Why is it important to talk about silence?

The urgency to address practices of silencing during childbirth strikes painfully after realizing that being ignored remains the most common cause for 81% of maternal deaths.

Shockingly, if the situation is already alarming for all women globally, the likelihood of mistreatment worsens for those patients who are not white, straight, or do not have a prosperous economic status. For instance, Black women are reported to be two to three times, or 243%, more likely to die from pregnancy- and labor-related dismissals3.

For the women who do return home, the effects of this silencing attitude can extend into their postpartum, dragging in the cumbersome baggage of hefty psychological conditions such as depression, anxiety, and post-traumatic stress disorder.

While examining these numbers and facts is crucial to understanding the scope of the issue, reducing the problem to sobering statistics and empirical data alone fails to fully capture the profound harm endured by every silenced woman in labor. Whether a silenced woman leaves the hospital with significant aftershocks or eventually skips home alive, happy, and without a care in the world, the injustice is the same. Dismissing her cries for help and brushing aside her hard-earned bodily knowledge is unambiguously wrong, no matter the (absence of) psychological and/or medical consequences.

If we want to grasp the nature of the unifying harm inflicted on every silenced laboring woman, we shall then trade our lab coats and scrubs for a pair of ethical-augmenting spectacles. With these philosophical lenses on, the visibility of the harm is sharper: obstetric violence is wrong because it qualifies as testimonial injustice.

Testimonial injustice? Are laboring women giving birth in a courtroom?

Unexpectedly, no, laboring women do not (usually) give birth in a courtroom and are not (usually) facing a judge or a jury—at least, not in a legal sense. Even if 'testimony' may echo images of courthouse drama, philosophers approach this term with a greater dose of modesty. Indeed, testimony is used to broadly denote any communicative act in which a speaker shares knowledge with a listener.

Philosopher Jennifer Hornsby further explains that for this kind of knowledge-sharing to succeed, one crucial element is required: reciprocity. In simpler words, this means that the speaker and the listener need to be on the same page: the speaker needs their testimony to be understood, and the listener needs to respond and act in a way that recognizes the speaker’s intention. When this happens, we have testimonial justice: the speaker’s voice is heard, acknowledged, and respected by the listener.

To understand how this reciprocity principle works in practice, imagine a woman named Amanda who is in labor and trying to communicate with her gynecologist, Dr. Kay. In this scenario, Amanda tells Kay, “Please slow down; I’m feeling something strange.” For Amanda’s testimony to be successful (that is, for communication to be truly reciprocal), two things must happen:

  • Dr. Kay needs to understand Amanda’s words. That is, he must speak the same language and determine what “slowing down” means.

  • Dr. Kay needs to grasp Amanda’s intention and act accordingly: Amanda is not just making a verbal observation; she is asking him to do something. In this specific case, she is asking him to physically slow down.

If Dr Kay understands Amanda’s message (1), acknowledges its intention, and acts on it by slowing down (2), then reciprocity is achieved, and justice is served. Amanda has not only spoken, but she has truly been heard; her words made a difference; her testimony successfully influenced action.

On the contrary, if Dr. Kay perfectly understands what Amanda means yet actively chooses not to slow down, i.e., he purposefully ignores her request, reciprocity breaks down, and communication is unsuccessful. Philosophers call this phenomenon “illocutionary silencing”—a ”fancy way of saying that Amanda’s testimony is suppressed as she fails to achieve what she intended and requested through speech.

This is where the (testimonial) injustice kicks in: Amanda knows something important about her own body, her own pain, her own boundaries, her own child, but when she tries to communicate that knowledge, she is not truly believed or acknowledged; her intentions are simply dismissed.4 Amanda speaks up, but her words, even if fully understood by the listener, have no effect. She voices her needs, but they are not taken seriously. In practice, it’s as if she hadn’t spoken at all (but she did!). It’s a word-filled silence.

While Amanda stands as just an example, this reality of dismissal (and injustice) seems to be the norm for far too many labouring women, who are religiously instructed not to “interfere,” not to “make much noise,” and to simply “grit [their] teeth and bear it.” 4

Is dismissing a speaker always a form of (testimonial) injustice, then? Should we always believe and acknowledge everything people say?

No, dismissing or disbelieving a speaker is not always a form of injustice. On the contrary, it is entirely understandable (and often wise) not to believe everything everyone says. Some people lie, and others may be genuinely delusional. Similarly, not every doctor has to believe everything every patient says blindly. For instance, no competent doctor is expected to take at face value the claim of a person crawling into their office on all fours, insisting they are about to transform into a full-fledged werewolf under the next full moon.

However, in cases like Amanda’s, that is (clearly) not what’s happening. From an intuitive standpoint alone, it seems deeply unreasonable to assume she’s lying about what she’s saying (and asking): she’s in severe pain, potentially risking her life, and in the process of bringing a child into the world.

From a more conceptual standpoint, this dismissal (and others like it) appears rooted in a form of prejudice held by the listener. Medical professionals like Dr. Kay often do not believe women in labor, not because they have unequivocal proof that the women are lying. Rather, they operate under assumptions such as

  • The speaker is “just” a lay patient with (allegedly) no medical knowledge and thus no authority on the medical process. This, in turn, reflects the underlying assumption that medical expertise invariably outweighs a woman’s lived experience of her own body, regardless of the circumstances.

And/or, in more insidious cases:

  • The speaker is a pregnant woman in labour who is conveniently dismissed and not taken seriously only because she is framed by default as a hysterical, overly dramatic “wet hen” (like in This is Going to Hurt). Silly old sexism, right?

This explains precisely why Amanda’s silencing (and that of countless other laboring women in similar situations) amounts to a form of testimonial injustice. There is no sound or rational justification for dismissing their testimony. What drives these dismissals is typically a set of deep-rooted prejudices about gender, authority, and credibility that predate and inevitably shape the interaction between the woman and the medical professional.

It’s also fundamental to remember, however, that it is more than reasonable for medical professionals to be entrusted with (some) authority: they have the technical knowledge that comes from years of study, training, and (hopefully) experience. This is exactly why laboring women go to a hospital and not to a car repair shop.

Nonetheless, valuing only the science mediated by medical professionals cannot justify systematically dismissing what women know and feel about their own bodies—the same bodies they’ve lived in their entire lives and the very ones where their babies have been growing for months. Again and again, that silencing keeps objectifying them, strips them of their autonomy, and disregards them to the status of “disposable card wrapper”/baby envelopes/something someone has to deal with before finally going to play golf.

Lastly, if labouring women continue to be dismissed by doctors like Kay, the blame cannot be pinned solely on one individual who feels entitled to label childbirth (an experience he will never undergo) as “naturally” painful or over-dilated women as pompously dramatic, squawking geese. The original sin brews in an undeniably sexist health system (and society as a whole :P) that has been unapologetically built around (white) Man and that keeps pursuing (white) Man, researching (white) Man, prioritizing (white) Man, and factually relegating everything that is not (white) Man-explainable to the “wastebasket of hysteria”5, where women (and their knowledge) “belong.”

What can we do?

The most accessible approach to fill up this silence(ing) entails:

  • Getting ourselves informed—this article is fine, but reading more about this topic surely won’t hurt, especially if that means listening to and/or reading the direct testimonies of women who were directly affected by this violence.

  • Feeling empathy, feeling sadness, feeling rage (if you can).

  • Talking about what you have read here or what you will read anywhere else to anyone you know—everyone is here because someone gave birth to them. Start with talking to your friends, even if they have “odd” political opinions, especially if they have “odd” political opinions. And then talk to your mother; ask her about her experience; value her testimony; hug her.

  • Start believing that, generally speaking, women do not necessarily lie about things they experience.

References

Dusenbery, M. (2018). Doing Harm. The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. New York: Harper Collins Publishers.
Fielding-Singh P., Dmowska A. (2022), ‘Obstetric gaslighting and the denial of mothers' realities.’ Soc Sci Med.
Hossain, A. (2021). The Pain Gap. How Sexism and Racism in Healthcare Kill Women. New York: Tiller Press. Kay, A. (2017). This Is Going to Hurt. Secret Diaries of a Junior Doctor. London: Picador.
UNFPA (2023), ‘Maternal Health of Women and Girls of African Descent in the Americas,’ United Nations Population Fund.

1 Kay, 2017: 135.
2 Goodreads’ review of Kay’s book, This Is Going To Hurt (2017).
3 Hossain, 2021: 11, 40; see also UNFPA, 2023.
4 Fielding-Singh and Dmowska, 2022.
5 Dusenbery, 2018: 136.