Reflecting on Phenomenology, Care, and Obstetric Violence

Introduction

In this post, we reflect on Tömmel’s recent contribution to feminist scholarship on childbirth that uses phenomenology to interrogate how birth is experienced, interpreted, and ethically assessed. Read as part of our Obstetric Violence Reading Group, the article speaks directly to ongoing concerns about epistemic injustice, relational harm, and the structural conditions that allow obstetric violence to persist. By centring women’s narratives of birth, Tömmel challenges dominant medical frameworks that marginalise experiential knowledge and reduce care to technical intervention. Our reflections take up these insights to consider how phenomenology reshapes understandings of harm, autonomy, and responsibility in maternity care, and what an ethics grounded in lived experience demands of obstetric practice.

Reflection 1: Approaching Care through Phenomenology

Our first reflection centres on the choice to centre phenomenology, the philosophical study of lived experiences and their meanings, within a study of birth and obstetric care. Tömmel makes use of women’s lived experiences to provide a patient-oriented account of the experiences of labour and obstetric care, offering a vital counter-narrative to dominant medical frameworks. It challenges the assumptions of neutral medical care and reflects upon how these can cause harm for women. As Tömmel notes, “in order to understand how to best care for someone during birth, health professionals have to understand what the embodied subject is going through”. Likewise, a phenomenological account of obstetric care allows us to see how “specific measures, interventions or forms of communication” are experienced as harm, regardless of the intent of the perpetrator. This broadens our understanding of obstetric violence, allowing us to see beyond traditional conceptions of violence as intentional inflictions of malicious force and instead develop a more nuanced understanding of the phenomenon. Ultimately, Tömmel’s important choice to champion the phenomenological lens demonstrates the power that women’s voices can have in changing perceptions on the harms which can be experienced during birth.

Reflection 2: Marginalising Women’s Voices

Our second reflection considers epistemic injustice and the minimisation of women’s testimonies, specifically the privileging of certain narratives over others. Epistemic injustice is rooted in structures of power, which distort who is perceived as credible and whose experiences and views are considered valid knowledge. The voices of birthing women are routinely dismissed or considered less credible or untrustworthy, whereas healthcare providers’ voices are prioritised. This also translates into the way certain medical procedures are framed based on their ability to fit within the supported medical framework of obstetric care, rather than how women experience them. The example given in this paper is epidural analgesia, which, whilst regarded as medically safe, is associated with an increase in interventions, which often leads to lower subjective satisfaction—something that is usually not fully explained to birthing women. Prioritising medical knowledge over all else undermines genuine autonomy and decision-making, as institutional needs are often prioritised over the individual. Epistemic injustice in this context speaks to the structural nature of obstetric violence, where structures of power, including in the patient-healthcare provider relationship, lead to dismissal of the birthing subject’s experiences. Especially given that birthing experiences are subjective, failure to prioritise women’s voices and to validate their knowledge and experiences leads to specific needs remaining unmet and violence continuing.

Reflection 3: Relational Care and Conditions of Autonomy

Our final reflection turns to the relational dimension of childbirth and the way in which the absence of adequate, responsive support can give rise to obstetric violence. Feminist ethics of care has shown that childbirth is not merely a clinical event but a transitional, emotionally charged process that unfolds within a network of relationships—including the mother, her close support system, the baby, and healthcare professionals. When this relational context is overlooked, care becomes standardised and detached, reducing women to passive recipients rather than active agents in their own birthing experience. This shift often results in a loss of control and diminished agency, which many women describe as central to traumatic or negative birth experiences. Although the promotion of patient autonomy has been heralded as a corrective to these issues, autonomy alone cannot compensate for systemic constraints that limit women’s ability to participate meaningfully in decision-making. Structural factors such as institutional routines, resource limitations, and entrenched hierarchies continue to shape how care is delivered, often prioritising institutional efficiency over individual needs. Understanding childbirth as a relational experience thus reveals how obstetric violence emerges not only from isolated acts, but from broader structures and practices that sideline women’s voices and undermine their capacity to shape their own birth processes.

Conclusion

This article invited us to reflect on how a specific methodology which raises women’s voices can have a profound impact. It allows us to reflect upon the centrality of experience, and the ways in which medical structures can quieten or even eradicate these important perspectives. This is acutely important in the context of childbirth, a richly relational process, more so than many other medical processes. Thus, it is not enough to focus purely on encouraging women to speak up, when we do not have sufficient infrastructure, both resources and personnel, to support this.

Caitlin Daly, PhD candidate, University of Leeds

Simone Gray, Lecturer and PhD candidate at the School of Law, University of KwaZulu-Natal.

Frances Hand, DPhil in Law candidate at St Edmund Hall College, University of Oxford.

Patricia San Juan, PhD student at Andalusian Interuniversity Institute of Criminology (Malaga Section), University of Malaga.

Camilla Pickles, Associate Professor of Biolaw, Durham University.

Georgia Speechly, DPhil in Law candidate at Exeter College, University of Oxford.