Zipping around Facebook a couple of weeks ago was the My OB Said What?!? site. It reminded me of an old post I wrote in 2004 right after I learned what birthrape was. I’d been quite angered by the women who used the term because, as a woman who has been raped, it was offensive. How could anything in birth be equated with the horrific experience women around the world experience? I could have closed my mind and left myself in anger, but I probed and really pressed the women to explain it so I could understand what they meant.
Reading around the Net, women have written about birth traumas and abuses, including birthrape. Kathy shares information from Rixa Freeze’s doctoral dissertation about how some women choose to deliver unassisted because of their past experiences with medical or midwifery care. Interestingly, Rixa and Kathy used my own description of the abuses I participated in as I was learning to be a midwife. I’ve written about my sadness and sincere apologies to the women I have hurt (emotionally and physically) and that, in speaking about exactly this, I could find a place of peace inside myself. (Reference the post I wrote in 2004 above.)
Back in 2004, I listened to the words women used to describe their pain and was told about actions that did, indeed, sound extremely coercive, manipulative and even pushing women to do things completely against their will. I went to Sarah who at the time was a Deputy Sheriff and I read through her official code book that defined things like “assault,” “battery” and “rape.”
Legalese regarding the definition of assault includes (emphasis mine and my comments in parenthesis):
“… the essential elements of assault consist of an act intended to cause an apprehension of harmful or offensive contact that causes apprehension of such contact in the victim. (“You need to have a cesarean or I will get a court order to make you have one.”)
The act required for an assault must be overt. Although words alone are insufficient, they might create an assault when coupled with some action that indicates the ability to carry out the threat. (“Open your legs. I’m going to do a vaginal exam.” And the woman tells the practitioner that she doesn’t want an exam or tries to close her legs before the exam begins.)
Intent is an essential element of assault. … the intent element is satisfied if it is substantially certain, to a reasonable person, that the act will cause the result. In all cases, intent to kill or harm is irrelevant. (I’m going to give you an episiotomy.” “No!”)
There can be no assault if the act does not produce a true apprehension of harm in the victim. There must be a reasonable fear of injury. The usual test applied is whether the act would induce such apprehension in the mind of a reasonable person. The status of the victim is taken into account. A threat made to a child might be sufficient to constitute an assault, while an identical threat made to an adult might not.”
Battery definitions include: “The act must result in one of two forms of contact. Causing any physical harm or injury to the victim—such as a cut, a burn, or a bullet wound (episiotomy, cesarean, IV, internal monitors, IV antibiotics, etc.) —could constitute battery, but actual injury is not required. Even though there is no apparent bruise following harmful contact, the defendant can still be guilty of battery; occurrence of a physical illness subsequent to the contact may also be actionable (a post-cesarean infection, systemic yeast after IV antibiotics, etc.). The second type of contact that may constitute battery causes no actual physical harm but is, instead, offensive or insulting to the victim. Examples include spitting in someone's face or offensively touching someone against his or her will.
Intent: Although the contact must be intended, there is no requirement that the defendant intend to harm or injure the victim. (This allows for the belief of doctors and nurses that the procedure/intervention is helpful, but the woman sees it in a completely different light.)
Intent is not negated if the aim of the contact was a joke. As with all torts, however, consent is a defense. Under certain circumstances consent to a battery is assumed. A person who walks in a crowded area impliedly consents to a degree of contact that is inevitable and reasonable. Consent may also be assumed if the parties had a prior relationship unless the victim gave the defendant a previous warning.”
Still, my biggest quibble is with the term “birthrape” because most definitions connote rape with sexual intercourse or genital to genital contact.
Among the common definitions of “Rape,” we find this: “Forced sexual intercourse; sexual assault; sexual intercourse between an adult and a minor. Rape may be heterosexual (involving members of opposite sexes) or homosexual (involving members of the same sex). Rape involves insertion of an erect penis or an inanimate object into the female vagina (gloved hand, speculum, internal monitors, amniohook, etc.) or the male anus. Legal definitions of rape may also include forced oral sex and other sexual acts.
Victims of rape suffer physical and mental trauma. Physical trauma may include cuts, bruises and abrasions in the pelvic area as well as elsewhere on the body. Mental trauma may include overwhelming feelings of humiliation, embarrassment and defilement (classic signs of PTSD). Rape victims should seek treatment at a hospital. There, doctors and nurses can treat the injuries (eek! Not for birth traumatized women), administer antibiotics to prevent sexually- transmitted diseases, and provide counseling or any other additional therapy (mental or physical) that the patient requires. The hospital team's evaluation and report will help document the condition of the patient for legal purposes.”
These legal descriptions of rape do not take into account birth trauma/abuse and trying to use these definitions to prove it would be very challenging (I suspect). I know that the majority of people reading the definition of rape and attempting to apply it to birth trauma will feel it is a stretch to do so. It took decades to believe that rape occurred in marriage or that women could be rapists, too, so expanding the definition to include birth might take a very long time and, I am sure, many, many years and a slew of failed lawsuits before anyone in the legal system recognizes birth traumas/abuses, much less birthrape. In fact, I have known of women to talk to lawyers as they consider suing their care provider and the lawyers won’t even discuss it. The typical proof of “lasting physical harm” is even abandoned as some women have had to have reconstructive surgery to repair the damage caused by their doctor or midwife. What is a traumatized woman supposed to do? I think we all know it takes an extremely powerful woman to even think about bringing a lawsuit against a perpetrator and the aftermath of trauma is not the most conducive time to do this.
I believe this is where a support system can take a major role. Women who have been traditionally raped or assaulted, including domestic abuse, have dozens of places to turn to for help and support. The hurt woman may not realize this or know how to find those resources, but they are there. I know the Internet has changed the face of helping hands, although women in domestic abuse situations still have to be careful lest their Net records be looked at. For those who are not in fear for their lives, but for their mental stabilities, the Net can be a haven for the women who need it. One former birth traumatized mom started Solace for Mothers. An organization in the United Kingdom, the Birth Trauma Association, began at the same time I learned about birthrape/birth trauma in 2004. I’ve corresponded with several of the women who keep that organization going and they are just as committed to helping women as the newer groups here in the US.
Look at that. 2004. Only 5 years of the realization of birth trauma. But, how many decades (centuries?) before were women living with the painful and scary memories of their births?
Above, I alluded to the challenge of trying to get anyone to understand the reality of birth trauma… that people will roll their eyes and think, “Why is she being so dramatic? Women have been having babies for eons.”
When I began talking to my mom about this a couple of years ago, she told me about my own birth in 1961. She said that when she went for prenatals, all the women went into the bathroom, peed in a cup and put their underwear in their purses. They would then have to sit for hours together in a hot room waiting for their few minute appointments with the doctor. When they went into the exam room, they were put in stirrups and left there until the doctor walked in, did a vaginal exam, listened to the baby and sent mom on her way. When she was in labor with me, there were four women to a labor room and when she started pushing, they moved her to the Delivery Room, put her in the lithotomy position, legs buckled into stirrups, arms put in constraints and left until someone came in to catch the baby. She remembers how horrified she was that a very young man (black, something that was an important factor in that time) kept looking at her perineum to see if I was coming out. My mom is so shy I have never seen her naked. She can’t even pee in a public place, so being stared at was, for her, humiliating.
As I asked her how she felt about the birth, she matter of factly told me that that was just the way it was. No one questioned it. She said it was always good to hear other women’s stories at baby showers, that it was affirming of her own experience, but she was too busy to consider the experience as much more than having her first child.
Women birthing in the United States have it really easy compared to some women around the world. We don’t have 1 in 8 women die at births. We don’t lose our babies like too many other countries. We don’t labor on the floor with rats and roaches, sitting in the blood of a hundred other women who birthed before us. We don’t give birth as mortar shells explode outside the window. We don’t really have to worry that our children probably won’t make it to their first year’s birthday. Women in other countries can labor for a week before someone gathers the few dollars it takes to get her to a hospital hundreds of miles away, only to know the baby has already died and the mom now at serious risk of dying from hemorrhage or infection.
Do these women have PTSD? Or do they live in some sort of Traumatic Stress every moment of their lives? Do stressors have ratings? The stress of trying to staying alive much higher on the scale than having a mother-in-law that won’t allow you to go to the hospital? What would these women think of us who are saying they have PTSD for being touched where we said we didn’t want to be touched? Would they think we are absurd? Would they think we are so privileged and take for granted aspects of life they cannot even fathom a woman would be granted.
Is Postpartum Post-Traumatic Stress Disorder (PPPTSD) an illness of luxury? If we were huddled in a migrant camp, would we really be concerned that the doctor pushed our legs apart to do a vaginal exam? Or would the multi-rape experiences overshadow the minimal intrusion the roaming doctor or midwife does.
Is PPPTSD judged by societal norms?
When I was in sexual assault self-help groups (almost always led by therapists), there was a tendency among the women to rate the abuse, almost always minimizing their own. “Well, I was just sexually abused at twelve from the guy next door. She was six and it was her brother. She had it much worse than I did.” Over and over, we had to remind each other (and be reminded) that rating the abuse discounted our own. We had to really work to learn that the measuring stick with which we measured was created by our own hearts. Continuing on that path, it is important for women to take their own experiences and not judge them, comparing them to others. “I just had my membranes stripped without permission… she had an episiotomy!” Your own trauma is just as valid as the next woman’s. I like what Jennifer Zimmerman says: “But, rape is rape. One woman may label it that way, one woman may not, but it is what it is. …if a women has her membranes stripped without her knowledge or consent, that act is a violation no matter what the woman feels about it. If she was not offered informed consent, it doesn't matter whether she is thrilled that she went into labor a day later, she was still not offered informed consent and that makes it wrong for the provider to have done it.”
So do we start telling women who loved their births that their births really sucked? Do we burst the bubbles of those great stories we hear all around us? Were we elected to Name the Abuse of every woman we meet?
When I had Tristan (and you can read his story here), I thought the birth experience was so great I wrote a letter to the doctor, nurses and hospital administrator thanking them for the great birth I had in their hospital. When I was pregnant with Meghann, I was talking to a group of Bradley mamas, most of whom had had homebirths. I proudly showed Tristan’s birth pictures, all green draped, lithotomy, oxygen masked, baby across the room… all the things we know now are awful! The women never said a word to me about how horrified they were looking at the pictures. It wasn’t until the whole experience was re-framed by Bradley standards that I began to see the experience as sucky and blech. Even today, the feeling of joy far outweighs the supposed-to-be horrible, angry emotions I should have had back then. It was others that used their knowledge, given to me, pulled into my own psyche, that gave the first experience the shadow it now carries. I asked the Bradley moms how come they didn’t wince and cringe when I so proudly showed Tristan’s pictures off and the Bradley teacher said, “We knew you would figure it out yourself when you were ready.”
The dilemma, of course, is what do we do?
I say we write and speak our realities. I want women to write in blogs, write articles and get them published, write the hospital, write the doctor, write the nurses. I vacillate between asking women to write filled with their anger and sadness or if they should wait until the anger has subsided and they can write in a voice that will be heard more than a shrill postpartum patient. Angry letters are often dismissed. I think they are fabulous to write and hang onto for awhile before sending them, re-vamping them as time passes, but I’m not sure how helpful the highly charged letters are. If it is a serious part of your healing, then I say go for it. But, know that you may not get any response. If you do write, speak as unemotionally as you can. Speak of specific actions, not a blanket “She sucked” kind of way. Ask someone else to read it to see if it makes sense, flows well and isn’t defamatory. Please don’t threaten the doctor with, “And I’m going to tell everyone I know how awful you are” because you can find yourself in court for defamation of character.thrilled that she went into labor a day later, she was still not offered informed consent and that makes it wrong for the provider to have done it.
For the women too traumatized to write, draw. If you can read (I could not in my depressions), get Birthing From Within and work through the art suggestions. They can be very telling and very healing. Showing your pain on paper can help those around you “see” what you are talking about.
Clay is another outlet. I used to do collages. I went to used bookstores and got dozens of magazines and pieced together a collage that spoke my pain in words and pictures. I still have a couple of them. You can also do a collage of what you hope to be/look like after you pass through the storm. Painting… deep, dark colors… the canvas holding the pain through brushstrokes and pallet clumps.
Find your own outlet. Therapy, of course. Find a therapist who gets it, though. It really is hard to have to teach a therapist about birth trauma before you can get to the meat of the healing. You shouldn’t be the teacher, you are the client. There are many different types of therapy for PTSD. These include talk therapy, medications (temporary or long-term), holistic treatments, dietary changes, acupuncture, hypnosis (although that can be felt as a loss of control to some women – unacceptable), EMDR (Eye movement desensitization and reprocessing), and more. I wish there were Group Therapy groups, but I haven’t heard of any. There certainly are enough women to get dozens going. It really is important in self-help groups to not just be in a place of “poor, poor pitiful me,” but to actively work towards healing and a whole life with the trauma assimilated into the grand scheme of a woman’s life. With the acknowledgement of PPTSD, I believe women are more apt to begin their healing.
Oftentimes, the therapy includes telling the perpetrator how the woman feels. I’ve seen letters, heard of throwing clay/dough around the room (at his/her hands or face), speaking to the abuser as s/he sits invisibly in a chair and, for many, eventually finding the power to be able to speak to the person face to face or through a letter or email that goes beyond the write & burn stage. It can be freeing to tell the perpetrator your feelings, but really, only if the person acknowledges their culpability in the experience. I remind women that most care providers will act defensively and even put some (all?) of the blame back on her. A woman has to be incredibly sure she can withstand a firestorm before she confronts her provider in person. I believe it is much easier to accuse and confront in writing, at least in the early stages of healing.
As a healthcare provider, it is imperative for me to listen to women, believe them when they tell me about their abuse/trauma/rape whether it was someone else who did it or even if it was me. And after my 2004 disclosure of the past abuses I participated in, I have been involved in other women’s traumas, albeit accidently. It pains me knowing my actions have hurt another. I am definitely more aware of what I do and say, but there are times when situations create a ripe atmosphere for hurt and anger.
My wish is that all providers find a place where they can listen –and hear- those that have been hurt, whether it was us or someone else. Until we all can hear, women must keep talking, writing, photographing and screaming about birth trauma. Providers can do the same.
Maybe then, someday soon, we will all be heard.