20 September 2018

A cry of delivery resounds across Sweden. Women are telling their stories of birth injuries, and they are demanding the right to professional care. In the eye of the storm stands gynaecologist and Alumna of the Year Eva Uustal, with keen eye and calm demeanour.

Eva UustalShe draws a parallel between what is happening with the #MeToo movement.
“Shame is a great inhibitor of development. Now, it is being overcome.”
Eva Uustal is keen to talk about shame. The shame that causes women affected by severe birth injuries to keep silent. The shame that doctors and midwives feel for not being able to prevent injuries, and not knowing the proper way to deal with them. And the shame felt by fathers, helpless and sorrowful.
“Shame is powerful. When shame is removed, invisible shackles are released and an amazing force for change comes into play.”
Just as in #MeToo.

Astounding stories of how women are treated

Eva UustalEva Uustal is senior physician in the Department of Obstetrics and Gynecology at Linköping University Hospital and an expert in birth injuries. Very few births cause serious problems for the mothers, but 3% experience serious ruptures of the genital area. These must be treated correctly to prevent permanent injury.
In more than 30 years as a doctor, Eva has heard some astounding stories of how women have been met by the healthcare system.
One frequent comment, which even doctors and midwives can make, is “Well, you have to accept some level of injury”. This comment can refer to serious injury to the woman’s genital area, leading to lifelong problems with urination and defecation, pain and a poor sex life.
No more.
“Well – at least we can say that slowly but surely things are starting to change”, says Eva Uustal. This is in part due to her insight through the years, and the ability to see beyond the shame of her own profession. Instead, Eva Uustal has systematically, analytically and scientifically investigated the facts of birth injuries and ensured that measures are taken when they arise.

Untiring work and a deep desire for justice

Eva Uustal 2017Her untiring work for safe perinatal care is the basis of her selection as Alumna of the Year. She has established a Swedish register of birth-associated ruptures that follows up women with birth injuries, and she has founded nationwide training courses that demonstrate for doctors and midwives how injuries can be prevented, detected and treated.
Her driving force – where does that come from?
“I gain motivation from my meetings with women. When they tell me about the injuries they have endured without receiving help.”
After a few seconds, Eva Uustal adds:
“It’s also about my deep desire for justice. If something is wrong, I will change it.”

Social media to break isolation

While Eva Uustal has been working systematically as gynaecological surgeon and researcher, the stories told by young women of birth injuries are starting to be heard. She suggests that a major reason that the voices are heard now is the rise of social media.
“Facebook groups have given them the possibility to communicate with each other. They can find people in similar situations, break their isolation and rise above the shame.”
This, in turn, has led to courageous women starting to make their voices heard in the media. For example, a few years ago in the Swedish lifestyle magazine Amelia, one woman described her experiences of anal injury after giving birth. The article was followed by two programmes dealing with birth injuries in the Swedish TV series Uppdrag Granskning. Eva Uustal contributed to these programmes.
“When the mass media take up these questions, there’s an enormous reaction. After the programme, the government contacted me and asked how it would be possible to continue the work. The government is now investing billions of Swedish crowns into perinatal care. In contrast, when we researchers publish our results in scientific journals, they often disappear without trace.”

Baking Babies

Eva Uustal has learnt something from this. She participates in TV, radio and newspaper interviews every time she is asked. She has also started writing on social media in order to bring her expertise directly to women. One blog to which she contributes is “Baking Babies”, one of whose owners is physiotherapist Mia Fernando. It is intended for pregnant and newly delivered women, and women with gynaecological problems.
“I am not a natural blogger, and don’t really have time to work with it actively, but in order to achieve change we researchers must dare to step out and ally ourselves with others who are experts in communication and using social media.”
So how are women to dare to give birth vaginally, when they hear horror stories about births that have gone wrong?
Eva Uustal emphasises strongly that nearly all births take place without complications.
“I am convinced that people will be more frightened if we conceal the facts. Some countries record statistics showing no occurrences of injury, which is simply impossible. The perinatal care in Sweden is among the best in the world, but we document injuries so that we can become even better at preventing and treating them.”
The demand for Caesarean sections is increasing. Eva Uustal does not welcome this development, since birth by Caesarean section can have a negative effect, principally on the newborn, with poorer breathing ability and a lower immune defence. The mother also is at risk from abdominal surgery: scar tissue may form, and internal organs may be damaged.

"Listen to the patients"

Eva Uustal believes that there is only one way to go.
Perinatal care must be designed such that women can feel confidence in it. All newly delivered women must be carefully examined after giving birth. They must feel confident that injuries can be treated, even such injuries that may be difficult to detect immediately after the birth.”
This can only be achieved if those in the healthcare system are prepared to show greater courage than previously.
“We must listen to the patients, not just our mentors. And we must never cease to be curious, never believe that we know everything.”
She emphasises how important it is not to raise feelings of guilt in colleagues. What is required instead is to systematically educate, register injuries, and implement new knowledge along the complete chain of care.
She ends the interview with a diplomatic but clearly targeted challenge:
“We can do things better. Let’s get on with it!”

Translation: George Farrants

Photo: Anna Nilsen
Baby photo: Ocean digital

Brief facts: Eva Uustal trained as a doctor in Linköping and Uppsala. She qualified in 1987 and was awarded a doctoral degree in 2003.
Previous articles in LiU Magazine
A post by Eva Uustal on the Baking Babies blog
Swedish magazine Fokus selected Eva Uustal as Årets medicinsvensk in 2017.

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