When Clara Massons was giving birth to her son, a midwife climbed onto her bed and pushed down on her stomach. The woman was a specialist on childbirth. She explained to Massons that she was helping to deliver the baby.

For the next several hours, the midwife and a doctor closely watched their patient. They took turns pressing down whenever Massons had a contraction -- a movement of muscles when a woman is giving birth. The two were using an old, now debated method for troubled deliveries. It is known as the Kristeller maneuver.

The method was first described in an 1867 German school book. It is sometimes used during labor to help women give birth and avoid a cesarean section.

Massons said her cries for them to stop were ignored at the Spanish hospital where her son was born two years ago.

"I thought I was going to die," she said. "For one month after, my belly was blue and purple."

Many doctors in developed countries say they have stopped using the Kristeller maneuver. They say they avoid it because of the risk of broken bones, organ damage and other painful health problems. The World Health Organization also does not suggest the Kristeller maneuver to medical workers.

Europe has some of the world's lowest maternal and newborn death rates. Reports of mistreatment during childbirth are more common in Africa, Asia and Latin America.

But the Kristeller maneuver and other questionable medical techniques remain common in some European countries.

"Depending on the act, these practices rise to the level of a human rights violation," said Mindy Roseman. She directs a justice and women's rights program at Yale Law School in Connecticut. Roseman said that not receiving permission from women for medical procedures and not taking steps to ease pain is "troubling wherever that occurs."

Last year, Croatian lawmaker Ivana Nincevic Lesandric brought attention to the issue of anesthesia. She told Parliament that she did not receive any anesthesia – a pain control drug -- for an emergency procedure after her pregnancy ended too early.

"I don't think I've ever been in (a) much more painful situation in my life," Lesandric said in her speech.

In answer, the Speaker of Croatia's Parliament criticized her for speaking for longer than her given time and for publicly sharing such personal details.

In the days after her speech, a childbirth advocacy group asked for and received hundreds of reports from Croatian women about poor medical care. United Nations human rights experts later said the stories "showed a pattern of abuse and violence against women undertaking medical procedures."

Ozge Tuncalp is a maternal and reproductive health care expert with the WHO, the UN's health agency. She says the agency has noted increasing reports of mistreatment by women seeking health care in Europe.

The WHO says a once common procedure — a surgical cut to make a woman's vagina larger during childbirth and prevent tearing — should not be used in more than about 10 percent of women. The WHO adds that that consent should be required. Yet government reports show rates of the procedure go from 30 percent to more than 90 percent in countries including the Netherlands, Portugal, Spain and Romania.

In France, a 2018 government report estimated that half of women who had the cut were not told before the surgery. In Italy, one study estimated 61 percent of women did not give their consent for the procedure.

It is not known how often the Kristeller maneuver is used. Doctors often fail to report its use in medical records. But health care workers in at least seven European countries told The Associated Press they see it used weekly, or even daily. And, a French government report last year estimated it was used in about 22 percent of births.

"The evidence says it's not helpful, it's actually harmful," said the WHO's Tuncalp. "The fact that so many women are getting an intervention that both national and international guidance recommend against is very worrying."

The Kristeller maneuver is banned in Britain, said Patrick O'Brien. He is a doctor with Britain's Royal College of Obstetricians & Gynaecologists. In the United States, the American College of Obstetricians and Gynecologists said they had no guidance on the method because it is not suggested.

Massons and her husband, Toni, remain troubled by the birth of their son, who is now 2 years old. Massons was told the method was needed because her labor had slowed, and because the baby was in a worrying position.

In a letter to Massons that she shared with AP reporters, the medical director of the Barcelona hospital where Massons gave birth wrote that doctors took "appropriate measures."

An official for the Catalonia area noted the Kristeller method was "discouraged" but not legally banned.

The WHO's Tuncalp said that changing medical care -- and not just guidelines -- is very difficult. She said, "It can take generations of doctors to actually change practices..."

I'm Ashley Thompson.

And I'm Caty Weaver.

The Associated Press reported this story. Ashley Thompson adapted it for VOA Learning English. George Grow was the editor.

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deliver - v. to give birth

cesarean section - n. a surgical operation for giving birth in which a cut is made in the mother's body in order to deliver the baby (also called C-section)

belly - n. a person's stomach

maternal - adj. of or relating to a mother

practice - n. something that is done often or regularly

advocacy - n. the act or process of supporting a cause or proposal

pattern - n. something that happens in a regular and repeated way

vagina - n. a passage in a women's body that leads from the uterus to the outside of the body

appropriate - adj. right for the situation

discouraged - adj. making people not want to do something