El habitus médico autoritario: resistencias a la humanización de la atención obstétrica en la República Dominicana a partir del análisis crítico del discurso

Introduction: I analyze the resistance to the humanization of childbirth in Dominican public hospitals, examining how the authoritarian medical habitus affects the implementation of a woman-centered care model promoted by the Ministry of Public Health since 2021. Objectives: To analyze healthcare personnel’s discursive expressions in Dominican public hospitals around the humanization of childbirth, identify manifestations of the authoritarian medical habitus in obstetric care, and examine how those discursive expressions reproduce or question power structures in obstetric care. Methods: Qualitative study with interpretive design. In March 2024, I conducted two workshops on obstetric violence using purposive sampling. The first workshop included 20 humanization evaluators from the National Health Service (80% women) and, the second, 30 hospital administrators (general and quality directors, 67% women) from public hospitals with poor humanization indicators. All participants were physicians. The workshops lasted 7 to 8 hours each and were recorded with consent. We discussed each persistent form of obstetric violence. Using critical discourse analysis, I examined patterns of power dynamics and institutional resistance by identifying key expressions and categorizing them according to the power dimensions they manifested and their impact on users. Results: Expressions such as “that birth was my doing,” “we are gods,” “the neighborhood enters the hospital,” “the Haitian woman arrived,” or “we do it boss style” show the appropriation of women’s bodies and reproductive autonomy, hierarchical relationships, discrimination, and the institutional perpetuation of obstetric violence that characterizes the authoritarian medical habitus in maternal and neonatal care. Conclusions: Obstetric violence, far from being a series of isolated incidents, is the systematic manifestation of hegemonic and patriarchal power structures that have normalized the dehumanization of childbirth in healthcare facilities. Transforming these practices requires a strategy that incorporates effective accountability mechanisms, community participation, and reforms in medical and nursing education toward models that challenge traditional hierarchies of knowledge and power, while promoting women’s reproductive rights and autonomy.