Gender-inclusive language in midwifery and perinatal services: A guide and argument for justice.

Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on "sexed language" reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth-including pregnant trans, gender diverse, and non-binary people-and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.

Shroud waving self-determination: A qualitative analysis of the moral and epistemic dimensions of obstetric violence in the Netherlands.

Obstetric violence is an urgent global problem. Recently, several studies have appeared on obstetric violence in the Netherlands, indicating that it is a more widespread phenomenon in Dutch maternity care than commonly thought. At the same time, there has been very little public outrage over these studies. The objective of this qualitative research is to gain insight into the working and normalization of obstetric violence by focusing on the moral and epistemic injustices that both facilitate obstetric violence and make it look acceptable. Following the study design of Responsive Evaluation, interviews, homogenous, and heterogenous focus groups were done in three phases, with thirty-one participants, consisting of ten mothers, eleven midwives, five doulas and five midwives in training. All participants were already critically engaged with the topic, which was a selection criterion to be able to bring the existing depth of knowledge on this topic of people in the field to the fore. Data was analyzed through Thematic Analysis. We elaborate on two groups of results. First, we discuss the forms of obstetric violence most commonly mentioned by the participants, which were vaginal examinations, episiotomies, and pelvic floor support. Second, we demonstrate two major themes that concern practices related to moral and epistemic injustice: 1) 'Playing the dead baby card', with the sub-themes 'shroud waving', 'hidden agenda', and 'normalizing obstetric violence'; and 2) 'Troubling consent', with sub-themes 'not being asked for consent', 'saying "yes"', 'saying "no"', and 'giving up resistance'. While epistemic injustice has been analyzed in relation to obstetric violence, moral injustice has not yet been conceptualized as a fundamental part of both the practice and the justification of obstetric violence. This research hence contributes not only to the better understanding of obstetric violence in the Netherlands, but also to a further theorization of this specific form of gender-based violence.

The Undercommons of Childbirth and Their Abolitionist Ethic of Care. A Study into Obstetric Violence Among Mothers, Midwives (in Training), and Doulas.

Engaging in dialogue with critical mothers, midwives, midwives in training, and doulas in the Netherlands, this study furthers the theoretical understanding of both obstetric violence and the activist resistance against it. Obstetric violence is understood as part of a process of relational separation, leaving the pregnant person isolated. The activist resistance against it is consequently theorized as the abolitionist building of an alternative "otherworld" of radical relational care. The themes established are: (1) "institutionalized separation" with the subtheme's "expropriation," "carcerality," and "obstetric violence;" and (2) "undercommoning childbirth" with subthemes "fugitive planning," "anarchic relationality," and "obstetric abolition."

Reimagining relationality for reproductive care: Understanding obstetric violence as "separation".

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of "maternal separation". Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.