In the hands of butchers: Egypt’s obstetric violence crisis
Ruqaya Al-Marasi chose to give birth in a private hospital, hoping for better care. The experience was nothing short of a nightmare.
“I had been having contractions for 48 hours. I called the doctor who had been monitoring my pregnancy, and he asked me to come to his clinic. Despite the continuous pain, he told me it was too early to give birth. I couldn’t bear it any longer and pleaded with him to let me give birth. Instead, he left me on my own. Then the contractions suddenly stopped,” Ruqaya recalls.
What Ruqaya faced with the doctor is legible within the framework of the dismissal of women’s pain; physicians treating it as unreal, a dynamic that prolongs women’s journeys to a diagnosis and proper treatment.
Ruqaya describes her experience in the delivery room to Al Manassa as “worse than I had expected… I kept screaming for someone to help me until I fainted. When I woke up, the doctor was jabbing me with a labor-inducing injection.”
The attending physician did not obtain her consent before administering the synthetic oxytocin, violating her right to informed consent.
The violent medical practices did not stop there: “The pain was unbearable. To make matters worse, the doctor performed an episiotomy using a local anesthetic that did little to ease the pain, then closed the incision with 10 stitches.”
An episiotomy is a surgical incision made during a vaginal delivery to ease the baby’s passage. It may be performed to prevent more severe perineal tears or to expedite delivery.
Subtle violence
Shaimaa Youssef also describes her experience with vaginal birth to be “absolutely terrifying,” lasting two days. “On the second day, the doctor examined me, found that the cervix was 7 cm dilated, and gave me oxytocin. I asked for pain relief, but he refused, even though I was screaming from intense pain,” she tells Al Manassa.
Shaimaa felt neglected by the nurses, who acted with indifference. “When the doctor moved me to the operating room, I stayed there for two hours in the cold, suffering alone through the contractions, with no anesthetist in sight. I went back to my room without giving birth, and only then received my first dose of the epidural. But the fetal heart rate monitor wasn’t working, which terrified me. They decided to deliver me. They pressed on my stomach to push the baby out, and the anesthesia wasn’t fully working. I felt the pain; I even felt the episiotomy.”
The doctor and nurses justified the pain Shaimaa endured because it was her “first birth,” but she remains certain the treatment itself was the cause: “I felt like I was in the hands of butchers, not doctors.”
What Ruqaya and Shaimaa were subjected to during vaginal birth is classified as “obstetric violence”: the neglect, verbal abuse, and sometimes physical violence a woman encounters during labor. This is precisely what happened to Ruqaya, who has never forgotten “the doctor asking the nurse to squeeze my abdomen to push the baby down. I was screaming as if someone was pulling my soul out, and his reaction was to start berating me.”
A 2019 UN study of 2,016 women surveyed across four countries—Ghana, Guinea, Myanmar, and Nigeria— found that 838 women, or 42%, experienced physical or verbal abuse, stigma, or discrimination. Furthermore, 14% of them suffered physical abuse. The figures recorded “high rates of cesarean sections and surgical cuts to the vaginal opening” performed on women during childbirth without their consent, in addition to vaginal examinations.
Inhumane medical practices, such as excessive medical interventions and a lack of privacy, contribute to compounding birth trauma
A survey conducted by “Sharika Wa Laken,” a digital feminist research platform focusing on the Arab world, found that women are exposed to multiple forms of privacy violations and obstetric violence: 7 in 10 women underwent vaginal examinations without consent, and 63% were not informed of the purpose of the examination. As many as five people may conduct these examinations on a single patient.
Obstetric violence ranges from verbal abuse; harsh language, inappropriate conduct, blaming the mother, to physical violence and abusive practices such as slapping, being restrained to the bed, abdominal pressure, and neglect in the form of ignoring the woman’s needs, denying her a companion, or treating her as a passive participant.
According to a 2021 paper published by Alternative Policy Solutions, these inhumane medical practices compound birth trauma.
Hierarchies of care
The challenges of vaginal birth in Egypt vary by hospital type. While abuses in private facilities may be limited to interpersonal mistreatment, violations in public ones are more varied. Speaking to Al Manassa, Dr. Sarah Saad, an obstetrics and gynecology consultant, distinguishes between university hospitals and public hospitals under the Ministry of Health and Population, where procedures are often hampered by resource shortages and administrative obstacles.
University hospitals tend to be more advanced medically but suffer from administrative complexity due to the volume of departments and trainee students. Public hospitals, meanwhile, face resource shortages and overcrowding, which directly affect the quality of care.
The lack of experience of some newly graduated doctors or interns is the cause of many cases of obstetric violence
Dr. Sarah Saad reveals that difficult conditions can drive doctors to deliver babies in the reception area rather than transfer women in labor to equipped delivery rooms. This practice is more prevalent in university hospitals given the high volume of trainees.
Under bureaucratic pressure, medical staff make hasty or poorly considered decisions, leading to the neglect or abuse of patients during delivery. Saad stresses that what Ruqaya and Shaimaa experienced happens regularly: “A doctor might be forced to enlist a nurse to apply pressure to the patient’s abdomen, or even jump on top of her to speed up the birth. Imagine: a woman giving birth without anesthesia, and amidst severe labor pains, she finds a nurse jumping on her stomach.”
Birth under training
The obstetrics consultant attributes many violations during childbirth to the inexperience of newly graduated doctors or interns who may be inadequately prepared for emergency cases.
Dr. Sarah explains that “often, the doctor blames the mother or lashes out at her if the pain drives her to do something that might endanger the newborn,” quickly adding that “this does not justify the behavior, but it sometimes reflects a lack of experience.” The physician, she emphasizes, bears primary responsibility for preventing any abuse directed at the patient by nursing staff or other doctors.
Free healthcare is provided at the expense of women’s dignity
Dr. Asmaa Mahmoud recalls what she witnessed as a medical student at Sohag University. Although patients in university hospitals sign a written consent on admission acknowledging they may be examined by students, Asmaa “imagined there would at least be some boundaries in sensitive departments like obstetrics and gynecology, like draping the patient, providing privacy,” she tells Al Manassa.
In one instance, Asmaa was shocked by a scene where a professor gave a practical demonstration to students on a woman in the delivery room who was in a highly vulnerable state, showing signs of severe exhaustion and suffering intense pain. “He examined her using a metal instrument, with about 60 male and female students crowded around her. The woman was completely refusing. When she tried to object, he threatened to expel her from the hospital, so she surrendered.”
Asmaa does not blame doctors alone, because they work in inhumane conditions, “but it is clear that free healthcare is provided at the expense of women’s dignity, in ways replete with unjustifiable violations.”
A hurt that never leaves
In vaginal birth, keeping women informed about procedures and answering their questions plays a pivotal role in easing the fear and anxiety associated with labor. Ignoring questions or answering them dismissively compounds those fears. This is what happened to Eman Sayed(*), who gave birth to her second daughter at a hospital in El Obour, Qalyoubia Governorate. “The doctor kept checking my cervix and refused to tell me anything. When I asked again, he screamed at me and said, ‘That’s not your concern,’” she tells Al Manassa.
The solution lies in activating professional codes of ethics for medical staff
Eman chose a private hospital expecting humane treatment and did not find it: “I paid a lot of money, and the treatment was terrible. The resident was the one managing my case.”
“I felt restrained to the bed by the catheter and the fetal heart rate monitor. I couldn’t move. Suddenly, my waters broke, and the doctor inserted his hand into my uterus without my consent.” She describes this as a “painful and degrading experience” she has never overcome, and one that kept her from returning to the doctor to follow up on her wound’s healing.
Culture of silence
Women tend to stay silent about the violations they face in labor wards, “viewing them as normal,” says Entesar El-Saeed, Chair of the Board of Trustees of the Cairo Foundation for Development and Law. She points to the role social customs and traditions play in reinforcing the acceptance of violence against women; a dynamic that renders physical or verbal abuse from midwives or nurses acceptable and beyond discussion. Women’s ignorance of their rights as patients compounds the problem, as silence and lack of awareness give medical staff greater latitude to practice abuse.
Women from the poorest and least educated social classes—especially those seeking care in the free departments of public and teaching hospitals—are most vulnerable to this form of violence in all its forms. As El-Saeed notes, they experience the violence they encounter as simply an inherent part of birth and of interacting with doctors.
El-Saeed calls for legislation criminalizing obstetric violence in its various forms, alongside activating professional codes of ethics for medical staff. She stresses the importance of training healthcare workers to respect women’s rights during childbirth, and of encouraging those who have experienced obstetric violence to file official complaints.
As for Ruqaya—who did not file a complaint and emerged from the experience with “severe depression,” as she describes it—she hopes that awareness of women’s rights will spread to resist violence inside delivery rooms: “Society must understand that the psychological and physical pain after childbirth is no simple matter.”
(*) Pseudonym used at the source’s request. (**) A version of this article first appeared in Arabic on April 11, 2025