While doing household chores, Hellen closes her eyes and recalls her stomach being as “purple as an eggplant.” Her eyes fill with tears. She opens them and is overcome with a sadness she tries to avoid so she can get on with her day.
The flashbacks fly through her memory almost nine months after having her third daughter.
This is how her torment began.
“Doctor, it’s really hard to breathe. I can’t take it anymore,” she told the on-call doctor a few hours after her C-section.
The man in the white coat in front of her said, “yes, yes, that happens. Just hold on.”
After that, Hellen went in and out of the emergency rooms at least four times between August and December 2018.
It’s your fault. You didn’t take care of yourself. Being overweight doesn’t help you either,” she says one of the specialists told her during one of her emergency visits.
While her health grew delicate with a wound that wouldn’t scar over combined with the inhumane and humiliating treatment she received, her daughter grew, but Hellen doesn’t remember the first 40 days. The depression and pain she felt didn’t allow for it.
She still blames herself. “I just couldn’t dedicate time to her,” she says as if she is trying to convince me of why she wasn’t around. “I couldn’t stop crying. My mom and my sisters helped me with my daughter. They were unforgettable months for me. It hurts to think about them.”
It is Violence
Without knowing, Hellen suffered obstetric violence, a term used to describe the lack of respect pregnant women suffer before, during or after childbirth. It includes things like not being able to choose what position to give birth in or, in her case, medical personnel not informing her about the treatment they are providing, or even insulting and screaming at her. And that violence has consequences.
Gabriela Arguedas, a researcher for the Women’s Studies Research Center at the University of Costa Rica (CIEM), has studied the issue since 2013 and says the consequences can be physical or psychological.
There are light and profound consequences. Some of them lead to permanent problems with having sexual relations, with maternity or with their own body,” the specialist said.
Another seven women in the province, and the country, just like Hellen, gave us their testimonies about how they lived through episodes of obstetric violence during pregnancy in public and private hospitals and how, as a consequence, they live with depression and stress.
Carol, for example, says she could only breastfeed her son for two months because of a mental block. Claudia (we changed her name to protect her identity) still doesn’t understand why no one told her about the complications she had and blames herself for losing her daughter. Karoline can’t remember the moment she gave birth. She erased it from her memory in order to move on with her life.
Obstetric nurse Zayra Méndez at the Carlos Durán Clinic in San José says the most difficult thing for a woman after recognizing that something is wrong with her body and mind is expressing it and asking for help. Before that can happen, she must recognize that she experienced violence during pregnancy, and that is also difficult.
In her opinion, society has constructed the idea that a pregnant woman must suck it up.
“Sometimes we forget that the woman needs psychological help because we assume that if the baby and the mother made it through alive, then there are no negative consequences,” Méndez said.
Arguedas, the CIEM researcher, says that the woman’s emotional health is shamed and women don’t feel they have the right to talk about it with someone because that would imply “being a bad mother.”
“In Costa Rica, we have a general problem of poor mental health, and in the case of women it is viewed as if they are lying, exaggerating or doesn’t know what she’s talking about,” she says.
Who Can I Turn To?
Hellen thought about seeking psychological help to get through the situation, but she didn’t know who to ask and the health system didn’t offer any. She was exhausted from the experience and gave up.
The Costa Rican Social Security Institute doesn’t recognize the term obstetric violence, according to María Esther Serrano, coordinator of the construction of identities and projects department at the National Institute for Women’s Affairs.
Despite this, the institution does have a guide defining how humanized attention should be provided for soon-to-be mothers as well as other tools like the General Health Law and the CCSS Duties and Users’ Rights Law. These exist precisely to prevent cases like Hellen’s.
But the documents don’t specify how to deal with psychological consequences a woman has after suffering obstetric violence during pregnancy.
The Voice of Guanacaste demanded the Health Ministry’s press department provide details on whether or not the institution has a specific protocol or guide for psychological treatment for women who suffer this type of violence. They didn’t respond by the time this newspaper went to print.
Marvin Palma, director of the Enrique Baltodano Hospital in Liberia, said if the family or patient files a complaint about an episode of violence in a hospital, the department of psychology and social work begin the process of attending to it.
The La Anexión hospital in Nicoya didn’t respond to a request for comment, but the Nicoya Health Clinic said the woman must request a general checkup appointment and the on-call doctor will determine whether or not to refer her to a psychologist, just like any other patient.
More than 90% of women in Costa Rica go to public hospitals to give birth.
“We have a public health problem and, without a doubt, the state needs to take care of women who have been victims of obstetric violence so they can be cured physically and psychologically,” Serrano said.