HEALTH
Experiences of violence in the delivery room
During childbirth, many women feel they are victims of physical and psychological violence in the form of unannounced, painful grips on their abdomens and humiliation. Complaints are made about the lack of education. The "Kristeller maneuver" is also medically controversial.
Online since today, 20.15 clock
Between 82,000 and 86,000 children are born in Austria every year, 98.5 percent of them in a hospital. There are no surveys on how many women experience violence in the delivery room during childbirth. Subjective perception also plays a major role. However, women often describe great pain during the "Kristeller maneuver." This is when a doctor or midwife presses on the upper abdomen during the contraction to speed up the birth of the baby. Peter Husslein used to head Austria's largest maternity ward at Vienna General Hospital. His research influences how babies are born here: "We tried to find out with a study at the hospital whether the 'Kristeller hand hold' is basically useful, and there the answer was quite clear: No."
"Kristeller handle" has a tradition
Until the 1990s, the handgrip, which was developed as early as 1867 by German gynecologist Samuel Kristeller, was routinely used in nearly a quarter of all births under the motto "Faster with Kristeller." "There is no question that it is a physical assault for a woman if someone stands at the head of the bed and, without explaining anything, presses massively on the upper abdomen," Husslein told "Thema" and "ZIB Magazine." It could, of course, lead to birth injuries, because the head does not slowly but quickly stretch the soft tissues, the vagina and the vulva.
Binding conditions for application
The benefits are scientifically disputed and the risk of injury is high. In the United Kingdom and Norway, the "Kristeller hand grip" is not used, and in Germany, individual clinics have banned it, according to an article in "Die Hebamme. In 2020, the Austrian Society of Gynecology and Obstetrics regulated the handgrip in its "S3 Guideline on Vaginal Delivery at Term." "Fundal pressure" should only be considered in an emergency. Conditions: Consent including veto right of the woman and continuous communication.
Communication crucial
Psychotherapist Daniela Venturini cares for women who have suffered birth trauma. "If she (the woman giving birth, note) understands what exactly is being done, recognizes the meaningfulness and is self-determined, then she can also integrate great pain well: 'I'll push along a bit' is not enough as an explanation for the 'Kristeller hand grip'." The possible consequences of trauma are depression, anxiety disorders and post-traumatic stress disorder, he said. This also strongly influences the mother-child bond, which in turn influences the child's development. "Communication with the woman during childbirth determines whether she can handle it well, not the administration of painkillers," Venturini concludes from her study "Cesarean, vaginal and natural childbirth." She is able to quantify the vulnerability of childbearing women: "There is no time when women are more likely to experience a mental illness than during the pregnancy, birth, postpartum window. Eleven percent of all women develop depression, anxiety disorders, obsessive-compulsive disorders here for the first time in their lives."
Those affected speak of "ordeal"
Andrea Nikowitz gave birth to her daughter in October 2020 in Vienna, Veronika Konrad to her son six years ago. They experienced the births as a psychological and physical ordeal. Nikowitz told ORF that a midwife's sayings sent her into a panic. Konrad said she was scolded and a military tone prevailed. But both were particularly imprinted with a situation in the delivery room during the pushing contractions. "I was lying on my back like a bug, they were holding my legs and pushing from behind my head with full force on my belly. I screamed in pain, and afterwards my belly was all blue."
Serious consequences
The "Kristeller maneuver" was used on both Nikowitz and Konrad, according to their statements without education. Nikowitz was discharged after the birth in severe pain - a sacral fracture, it later turned out. Numerous doctor visits followed, and she suffered from panic attacks and anxiety. She saved herself by making music, taking photographs and following a mindfulness program for trauma management on the Internet. Konrad does osteopathic therapy with her son. She hasn't gotten over the birth trauma well: "Every birthday is an anniversary when everything comes up."
Clinics apologize
Andreas Brandstetter, head of the maternity department at St. Josef Hospital, where Nikowitz had given birth, told ORF: "Ms. Nikowitz was not picked up well emotionally by our midwife, and I am simply sorry for that. I can only apologize for that." The Hietzing Clinic, where Konrad had given birth to her son in 2017, also asked for an apology. Both clinics said there had been no alternative to the "Kristeller procedure" because the birth had to go quickly due to the child's poor heart tones.
Telling the experience of violence
On the homepage of Roses Revolution Austria there are numerous stories - most of them anonymous - of humiliation, unannounced, painful handholds and abuse of power by midwives and doctors during childbirth. Founder and midwife Margarete Wana noted that there is a lot of shame surrounding the issue. "'Just be happy you have a healthy baby!" women often hear. It's an important step for them to be believed for once." The elective midwife calls for better patient education, more staff in hospitals and, above all, targeted communication training in their education. And she wants to encourage women to share their experiences and also confront hospitals about them.
Contact points for those affected
The majority of Austria's maternity wards also offer psychological support. If the hospital staff does not point this out themselves, it is advisable for mothers and their companions to inquire about it. Clinics with psychiatric departments can also be points of contact. The clinics of the Vienna Health Network each have their own ombudsman's office. Legally, after traumatizing birth experiences, the interests of those affected are to be represented by patient ombudsmen. There is one in each federal state, and there are also other contact points. In Vienna, the Nanaya - Center for Pregnancy, Birth and Life with Children is a non-profit association that has also established itself as a contact point for help in crises. For pregnant women with a previous stress - be it from a past difficult birth or from another social, psychological or medical crisis - there is the possibility of free prenatal care in Vienna by a midwife from the Midwife Center Vienna as part of the pilot project. The UNUM Institute is a trauma and pain competence center that is currently seeking to combine offers of help for stressful pregnancies and births from a wide variety of fields into an Austria-wide network called "TrauBe" (for trauma care) in all provinces. "TrauBe" is only in the process of being established, contact can be made by mail to office@unum.institute. There is the possibility of contacting psychotherapists with a focus on pregnancy and birth. However, the costs are to be borne by the patients themselves, except for the amounts subsidized by the respective health insurance.
Online since today, 20.15 clock
Between 82,000 and 86,000 children are born in Austria every year, 98.5 percent of them in a hospital. There are no surveys on how many women experience violence in the delivery room during childbirth. Subjective perception also plays a major role. However, women often describe great pain during the "Kristeller maneuver." This is when a doctor or midwife presses on the upper abdomen during the contraction to speed up the birth of the baby. Peter Husslein used to head Austria's largest maternity ward at Vienna General Hospital. His research influences how babies are born here: "We tried to find out with a study at the hospital whether the 'Kristeller hand hold' is basically useful, and there the answer was quite clear: No."
"Kristeller handle" has a tradition
Until the 1990s, the handgrip, which was developed as early as 1867 by German gynecologist Samuel Kristeller, was routinely used in nearly a quarter of all births under the motto "Faster with Kristeller." "There is no question that it is a physical assault for a woman if someone stands at the head of the bed and, without explaining anything, presses massively on the upper abdomen," Husslein told "Thema" and "ZIB Magazine." It could, of course, lead to birth injuries, because the head does not slowly but quickly stretch the soft tissues, the vagina and the vulva.
Binding conditions for application
The benefits are scientifically disputed and the risk of injury is high. In the United Kingdom and Norway, the "Kristeller hand grip" is not used, and in Germany, individual clinics have banned it, according to an article in "Die Hebamme. In 2020, the Austrian Society of Gynecology and Obstetrics regulated the handgrip in its "S3 Guideline on Vaginal Delivery at Term." "Fundal pressure" should only be considered in an emergency. Conditions: Consent including veto right of the woman and continuous communication.
Communication crucial
Psychotherapist Daniela Venturini cares for women who have suffered birth trauma. "If she (the woman giving birth, note) understands what exactly is being done, recognizes the meaningfulness and is self-determined, then she can also integrate great pain well: 'I'll push along a bit' is not enough as an explanation for the 'Kristeller hand grip'." The possible consequences of trauma are depression, anxiety disorders and post-traumatic stress disorder, he said. This also strongly influences the mother-child bond, which in turn influences the child's development. "Communication with the woman during childbirth determines whether she can handle it well, not the administration of painkillers," Venturini concludes from her study "Cesarean, vaginal and natural childbirth." She is able to quantify the vulnerability of childbearing women: "There is no time when women are more likely to experience a mental illness than during the pregnancy, birth, postpartum window. Eleven percent of all women develop depression, anxiety disorders, obsessive-compulsive disorders here for the first time in their lives."
Those affected speak of "ordeal"
Andrea Nikowitz gave birth to her daughter in October 2020 in Vienna, Veronika Konrad to her son six years ago. They experienced the births as a psychological and physical ordeal. Nikowitz told ORF that a midwife's sayings sent her into a panic. Konrad said she was scolded and a military tone prevailed. But both were particularly imprinted with a situation in the delivery room during the pushing contractions. "I was lying on my back like a bug, they were holding my legs and pushing from behind my head with full force on my belly. I screamed in pain, and afterwards my belly was all blue."
Serious consequences
The "Kristeller maneuver" was used on both Nikowitz and Konrad, according to their statements without education. Nikowitz was discharged after the birth in severe pain - a sacral fracture, it later turned out. Numerous doctor visits followed, and she suffered from panic attacks and anxiety. She saved herself by making music, taking photographs and following a mindfulness program for trauma management on the Internet. Konrad does osteopathic therapy with her son. She hasn't gotten over the birth trauma well: "Every birthday is an anniversary when everything comes up."
Clinics apologize
Andreas Brandstetter, head of the maternity department at St. Josef Hospital, where Nikowitz had given birth, told ORF: "Ms. Nikowitz was not picked up well emotionally by our midwife, and I am simply sorry for that. I can only apologize for that." The Hietzing Clinic, where Konrad had given birth to her son in 2017, also asked for an apology. Both clinics said there had been no alternative to the "Kristeller procedure" because the birth had to go quickly due to the child's poor heart tones.
Telling the experience of violence
On the homepage of Roses Revolution Austria there are numerous stories - most of them anonymous - of humiliation, unannounced, painful handholds and abuse of power by midwives and doctors during childbirth. Founder and midwife Margarete Wana noted that there is a lot of shame surrounding the issue. "'Just be happy you have a healthy baby!" women often hear. It's an important step for them to be believed for once." The elective midwife calls for better patient education, more staff in hospitals and, above all, targeted communication training in their education. And she wants to encourage women to share their experiences and also confront hospitals about them.
Contact points for those affected
The majority of Austria's maternity wards also offer psychological support. If the hospital staff does not point this out themselves, it is advisable for mothers and their companions to inquire about it. Clinics with psychiatric departments can also be points of contact. The clinics of the Vienna Health Network each have their own ombudsman's office. Legally, after traumatizing birth experiences, the interests of those affected are to be represented by patient ombudsmen. There is one in each federal state, and there are also other contact points. In Vienna, the Nanaya - Center for Pregnancy, Birth and Life with Children is a non-profit association that has also established itself as a contact point for help in crises. For pregnant women with a previous stress - be it from a past difficult birth or from another social, psychological or medical crisis - there is the possibility of free prenatal care in Vienna by a midwife from the Midwife Center Vienna as part of the pilot project. The UNUM Institute is a trauma and pain competence center that is currently seeking to combine offers of help for stressful pregnancies and births from a wide variety of fields into an Austria-wide network called "TrauBe" (for trauma care) in all provinces. "TrauBe" is only in the process of being established, contact can be made by mail to office@unum.institute. There is the possibility of contacting psychotherapists with a focus on pregnancy and birth. However, the costs are to be borne by the patients themselves, except for the amounts subsidized by the respective health insurance.
Source (German)
