Women's rights are integral to prevention and treatment of PPH

This article by Weeks presents a range of different clinical approaches to prevention and treatment of postpartum haemorrhage. Physical treatments are discussed and the question of their invasive nature raised in this context. It is worth reflecting that the potential for a health professional to commit violence against women is ever present, given their relative position of ‘power’, especially in an obstetric emergency. Even being made to lie down during childbirth can be seen as disrespectful care and an infringement of women’s rights. Many techniques and manoeuvres used to treat complications during childbirth can be perceived as violent, resulting in women (and also the birth attendant) emerging from the experience traumatised. However, in many cases, the action saves lives. The main questions to ask are: Is it effective? Does it work? Is it necessary? Is there a choice? Informed consent is critical, but not always simple to obtain: although women are sometimes not given a choice, sometimes they are and they don’t know what is, or how to make the right choice. In a study of traumatic events in childbirth, multiple and interlaced issues have emerged. ‘Traumatic childbirth events are frequently peppered with accounts of being excluded from decision-making, lack of informed consent, or patronising, impersonal, disrespectful and abusive interpersonal communication. Such treatment by health professionals is associated with feelings of loss of control, but women often blame themselves’. (S€ oderquist et al. J Psychosom Obstet Gynaecol 2006;27:113–9). Clearly knowledge, decision-making and choice are essential for ensuring a positive outcome. Health providers need to have an acute awareness of the nuances of respectful maternity care. Provision of information and careful explanation of any intervention or treatment is essential throughout labour and birth. Where possible, the decisions of the woman in labour and her family should be followed. The link between respectful care and the rights of women has been articulated in the Universal Rights of Childbearing Women Charter (http: //whiteribbonalliance.org/campaigns/ respectful-maternity-care/). This is also supported by the recently released WHO statement on ‘Prevention and elimination of disrespect and abuse during childbirth’ (September 2014 http://www.who.int/reproductivehealth/topics/maternal_perinatal/ statement-childbirth/en/? utm_source= TRAction+Project+Event+Invitations &utm_campaign=2a8b9a44eb-Invitation%3A+Pre-Satellite+%40+HSR+ Symposium&utm_medium=email& utm_term=0_d05e7ff741-2a8b9a44eb -118714001). Although the concerns of respectful care apply everywhere in the world, resource-poor settings face particularly complex issues, as women may be less familiar with biomedical concepts and Western style health systems. Health workers can be pressurised and demotivated. The solutions are not simple but one way of ensuring women are prepared is to create general awareness and knowledge of the different methods used for different kinds of difficulties during pregnancy and childbirth, not just during pregnancy but within a broad educational framework. Birth planning is another approach used, which can give time for deliberation and ‘space’ for women to let their preferences be known before they are in labour or in an emergency situation when they find it difficult to make choices.