CEDAW/C/75/D/138/2018 discrimination and could not exercise her personal autonomy, and that her physical and psychological integrity were compromised. 3.2 In particular, the author maintains that, as stated in the clinical obstetrical and gynaecological report that she provided during the domestic administrative and judicial proceedings, the number of digital vaginal examinations performed should b e kept to a minimum: “the reason for avoiding excessive vaginal examinations during labour is that they are intrusive and painful for the woman and can carry germs from the outside environment into the cervix, where they can cause greater damage, especially if they are drug-resistant germs of the kind common in hospitals”. The author points out that, according to WHO, excessive vaginal examinations are a direct cause of possible infections. 6 Moreover, the clinical documentation contains no medical justification for the use of oxytocin, one of the so-called high-risk drugs that has a high potential to harm the mother and the fetus. 7 Since episiotomy is an invasive surgical procedure that involves risks and drawbacks, the author ’s consent should have been sought and confirmed in writing, in accordance with the Patient Autonomy Act, 8 but this did not happen in her case. Ultimately, as stated in the clinical obstetrical and gynaecological report, the medical personnel did not comply with lex artis, since they disregarded the recommendations and protocols for childbirth services issued by the most reputable public health institutions and scientific organizations and societies. It is also stated in the report that the various analgesic methods and body positions that could have prevented the episiotomy and use of the ventouse and allowed a labour that was progressing perfectly well to be concluded in an appropriate manner were not exhausted. Thus, according to the report, after a normal, low -risk, unproblematic pregnancy and labour, the author found herself in an operating room undergoing surgery and her daughter was admitted to the neonatal unit. 9 The author also maintains that, by not allowing her husband to be present at the birth, the hospital violated her dignity, family intimacy and right to privacy and autonomy. She recalls that the emotional support of the chosen companion reduces the need for painkillers and helps labour take its normal course, and that WHO has therefore stated that “for the well-being of the mother a chosen member of her family must have unrestricted access during the birth and throughout the postnatal period”. 10 Lastly, mother and daughter were unjustifiably separated immediately after the birth, in violation of the right to personal and family privacy and to adequate health services. The author notes that the moments following birth are crucial to attachment, since, at birth, the brains of the baby and the mother are flooded with hormones that profoundly affect the bond. Indeed, the European Charter for Children in Hospital states that the admission of a newborn to hospital for observation does not justify separation. 11 3.3 The author maintains that obstetric violence is a type of violence that can only be exercised against women and constitutes one of the most serious forms of discrimination. Discrimination is based on gender stereotypes, the purpose of which is to perpetuate stigmas related to women’s bodies and women’s traditional roles in society with regard to sexuality and reproduction. __________________ 6 7 8 9 10 11 6/14 WHO, Recommendations for augmentation of labour, document WHO/RHR/15.05. See Instituto para el Uso Seguro de los Medicamentos (Spanish branch of the Institute for Safe Medication Practices), Lista de medicamentos de alto riesgo, infographic, September 2012. Basic Act No. 41, of 14 November 2002, regulating patients’ autonomy and rights and obligations in the area of clinical information and documentation. See the expert report attached to the communication [annex 12]. See WHO, Recommendations on childbirth (Fortaleza Declaration), 1985, available at www.ncbi.nlm.nih.gov/pubmed/2863457?report=abstract; and WHO, Care in normal birth: a practical guide, 1996, available at www.ncbi.nlm.nih.gov/pubmed/9271979. European charter for children in hospital, 13 May 1986 (resolution of the European Parliament, Doc. A2-25/86, Official Journal of the European Communities No. C148/37, 16 June 1986). 20-04882