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Monday
Sep072009

Just because it's the standard of care...

... doesn't mean it's ethical.

 

(This is part of a post I wrote in May 2006 and it seems appropriate even today. This was right after I learned the term "birthrape.")

I worked in hospitals for 15 years before moving to birth centers (there was crossover) and finally now in home and hospital birth. I know what hospital birth looks like. I know what doctors are thinking because I have spent HOURS with them at the nurses station talking to them. Nurses have confided in me, telling me the vile things that come from physician's mouths the moment the door is closed. I have heard vile things with my own ears from doctors and nurses - and midwives.

Birth trauma is not a doctor-only proposition. Birth trauma happens with nurses, direct-entry midwives, licensed midwives, certified professional midwives, certified midwives, etc. Some of the most horrid things I've seen have come from a midwife's hand or mouth.

Here, from an old post and my birth stories blog - and while midwives are specifically addressed (because of the original discussion) it obviously encompasses physicians and nurses as well:

Birthrape: The experience of having fingers, scissors, and/or tools put/pushed/shoved inside a woman's vagina or rectum without her direct (or indirect) permission.

Being coerced, manipulated, or lied to regarding the health and safety of the baby or themselves so the midwife is able to do something to the mother's vagina, rectum, cervix, or perineum, usually with excuses; rarely with apologies.

Some find the definition expanded to:

The midwife taking the woman's Power by using disparaging comments, unsupportive expressions, speaking around her as if she is unable to hear or process requests or information.

and

Even though consent forms are signed in the hospital, birth center, and at home, consent for care does not include the manipulations or coercive words to get women to obey the caregiver.

I thought it was time I shared some of the thousands of comments I have personally heard that have facilitated birthrape over the years.

I share them and am writing about them and speaking about them and nearly screaming about them in the hopes that midwives will hear what they are saying that is sending their clients into therapy, pushing them to depressions that require medication and alternative therapies, keeping them from coming back to the midwife at all because of her Power Hunger and covert misogyny. Too many women (in my opinion) find Unattended Birth their only acceptable option after their experiences with professional caregivers in birth.

You see, most midwives talk a good game. They will say any number of things in pregnancy to lead the woman to believe she (the mom) is in control. I have sat through hundreds and thousands of prenatals with midwives and listened to the party line about how they believe in a woman to know, how they will "let" them labor how they want, how they will limit vaginal exams, etc. And then, when labor is in full swing, I sit by (or participate) in the amazing disregard for the woman's prenatal wishes and dreams of an unhurried, unfettered, un-directed birth. I am not a part of the delusion or lies anymore.

Common Beliefs

* Women in labor don't really want to use their birth plan.
* Women in labor aren't able to verbalize their needs.
* Women in labor don't know when they need to pee or drink or eat.
* Women in labor don't know when to change positions.
* Women in labor can't make decisions.
* Women in labor want an epidural.
* Once labor kicks in, they all want epidurals.

Directives That Disembody Her Being

* Lift her leg.
* Move her to the bed.
* Grab her knees.
* Put her feet in the stirrups.
* Put her hands on the grips.
* Push her head to her chest.
* Push her chin to her chest.
* Put pillows under her head.
* Put pillows under her butt.
* Pull her down to the edge of the bed.
* Push with her so she knows how to do it right.
* Count for her so she knows how to do it right.

(while these next phrases end in periods and question marks... almost exclusively, the following words have been shouted at women... an exclamation mark is more appropriate, but there aren't enough in the computer to add them all)

Comments That Negate Her Intelligence (spiritual, physical, emotional, and intellectual)

* You aren't pushing right.
* Push like this.
* Get mad at the baby.
* Quit making noise.
* No, push longer.
* Push like you are having a bowel movement.
* Push the watermelon out.
* Push the bowling ball out.
* Don't push in your chest, push in your butt.
* Push like you mean it.
* What are you doing?
* Can't you push harder?
* Have you ever been raped? (asked in labor)
* Are you an abuse survivor? (asked in labor)
* Have you been abused? (asked in labor)

Coercive and Manipulative Remarks

* I need to get in there.
* (pressing knees apart) I need to do a vaginal exam.
* C'mon, just let me see what is going on.
* I'll do it quick and fast, I promise.
* I promise to be gentle.
* I just want to feel the baby's position.
* I just want to see how dilated you are.
* You asked me to be your midwife, now let me do my job, okay?
* I'm a woman, too, I know how it feels... I promise to be gentle.
* I remember how vaginal exams felt in labor, I promise to be gentle.
* Do you want the baby to come out or not? Just open your legs.
* Are you sure you are ready to be a mom?
* You had no problem opening your legs 9 months ago.
* Just let me break your water, it will speed things up.
* If I break your water, the head will be applied better on the cervix.
* If I break your water, prostaglandins will stimulate things nicely.
* Here, drink this. (as Gatorade with cytotec is given to the mom)
* You might feel a pinch. (as pitocin is injected into the vaginal vault)
* I am just wiping up some stuff. (as pitocin on a gauze is pushed inside the vagina or rectum)
* Here, drink this. (as blue and black cohosh are given without consent)
* Here, put these under your tongue. (as homeopathics are given without information or consent)
* I'm just feeling your cervix... it might hurt a little. (as manipulations to the cervix are done... from stripping the membranes to manual dilation)
* I'm just feeling your cervix. (as cytotec is put onto the cervix)
* Do you want your baby to die?
* You don't know the seriousness of the situation.
* You have been a martyr long enough.
* Just take the medication.
* Just get "your" epidural.
* Would you like something for the pain? (in the middle of a contraction)
* This will take the edge off.
* It doesn't do anything to the baby.
* If you were my daughter/sister/mother....
* I have had three scheduled cesareans myself! I don't know what you are complaining about. (being wheeled into the OR)
* Stop whining.
* Why are you crying?
* What is wrong with you? Are you trying to hurt your baby?
* In this day and age, no one needs to suffer in childbirth anymore.
* Mothers and babies died without hospitals 100 years ago.
* Let me call the anesthesiologist... just talk to him about your options.
* No, you can't eat... just in case you need a cesarean... and your labor is rather slow moving.
* No, nothing by mouth after 7 centimeters. (or any number the caregiver randomly pulled out of her ass)
* Only ice chips.
* Oh, Bradley... they always have cesareans.
* You wanted a homebirth? That's child abuse!
* Are you one of those La Leche League people who nurse until the kid dates?
* Do you vaccinate? (after discussion of no erythromycin in the baby's eyes)
* You want your baby to go blind? (after refusal of erythromycin in baby's eyes)
* Your baby might bleed to death. (after refusal of Vitamin K injection for the baby)
* It's just antibiotics.
* God, you have terrible veins!
* Where are your veins?
* (to the Licensed Midwife during a transport, a nurse asks) Do you know how to take a blood pressure? Did you do any?
* Why did you wait so long?
* Why did you get here so early?
* You aren't in labor.
* How would you not know if your water broke or not?
* Can't you stop moaning?
* Be quiet!
* Oops, your water broke! (while using fingernails or fingers to break it on purpose)

Whispering to Other Birth Attendants

* My god, I wish she would hurry up.
* I am so bored!
* She is going so slow.
* I wish she would let me break her water.
* My baby needs to nurse, I need to go home.
* My boobs are going to burst if I don't go home and nurse. She needs to hurry up.
* I am so tired.
* I want to go home.
* I am going to talk her into letting me break her water so she will hurry up.
* I am going to talk her into letting me manually dilate her so she will hurry up.
* I need her to hurry up.
* She's holding back. There must be some emotional barrier we haven't found yet.
* I bet she was abused. Look how she: keeps her legs together/cries with exams/doesn't want us to touch her/doesn't take her clothes off/won't take her shirt off/won't relax enough to let the baby out/is afraid to be a parent/hasn't worked through her issues/has body image issues/has eating issues/is fat/is thin/lives in her head/isn't in touch with reality
* She is so noisy.
* She is too quiet.
* She needs to let go.

---------------------------------------------------------------

I am exhausted writing this much pain. I know there are hundreds of thousands of remarks that have been said that I haven't been witness to and I encourage women who have had them said to them to email me privately so I might start a list that lets caregivers know what not to say to women during pregnancy, labor, birth, and postpartum.

---------------------------------------------------------------

This came as an addendum to that blogspot:

* There's not much happening here (as the midwife does a vaginal exam)
* One woman wanted to stand on her own during her births, but, both times, was forced to do a deep squat or be supported by others, causing vaginal tears and "mad" that she wasn't honored at her own births (her words).

* I had a midwife write me thanking me for disclosing what she, too, has seen in her training.
Blessed Be! I am not alone!

This next series from a nurse friend of mine:

* "Stupid Bitch" (said by a Doc before he even left the room)
* The same doc (we hated this prick, he still practices) elbowed a woman (hard) in the thigh because she wouldn't open wide enough for him
* "Well, the Anesthesiologist is here now for another pt and he wants to go home, this is your last chance for an epidural"
* "If you would just stop moving we could get a good tracing on the baby" (and other variations of the same)
* "Quit being such a baby"
* "Oh come on, it doesn't hurt that bad, you are only ____cms dialated."
* "These stupid wetback women just scream and scream, I wish they would shut up" (same prick as above)
* "If you don't hurry up we will have to do a c-section"
* "No way is that one going to deliver vag, did you see the size of her?" (I personally have never seen a vag delivery of anyone over like 200, that is after preg weight)
* "No you can't walk because you are on pit" (everyone I have ever seen in labor was on pit)
* "Walking doesn't do anything for labor" (said by a doc, different one than above)
* "Oh no, she has a birth plan"
* "If you wanted to walk you should have stayed home" (after her IV is in and she is on pit now)
* "Give her a sleeper already so she will be quiet and stop bugging us"

-----------------------------------------------------------------

How can people NOT believe women would consider their experiences traumatic and abusive.

It would be wonderful to demonstrate a completely natural birth in the hospital (NOT a homebirth in the hospital as many would want to call it) and watch all the care providers squirm with discomfort as their jobs became almost useless "just" sitting and observing. It would take an incredibly strong woman to be able to withstand the intense tension brewing, but it would be a great lesson for hospital personnel to witness. I believe it could never be done - and that's just so sad. It's sad that not only could we not even demonstrate a normal birth, but that nothing like it would ever occur in the hospital setting. The closest I have seen is in in-hospital birth centers, but even that is difficult to compare to a homebirth.

When I first heard the term "birthrape," I was really offended as a woman who has been raped before. However, talking to police and deputy sheriffs as well as lawyers, the above descriptions of what happens in hospitals absolutely fits the LEGAL definition of rape and assault. It is simply so foreign to our legal system and our mental health system, the designation hasn't yet been given its rightful place. There were times when terms and syndromes or disorders didn't exist even when people carried them in their brains and bodies. This simply is a new one - BECAUSE of our medical system seeing women as THINGS and not people - the pain is catching up to us all.

Medical care sees women as a number - as a collection of symptoms to be treated. It is in this disembodiment that abuse can occur without thought or concern.

Many, many, many of us are saying NO MORE.

No more.

Reader Comments (41)

Thank you for this. NO MORE, indeed!

September 7, 2009 | Unregistered CommenterStassja

Barb, I absolutely would not deny that awful things happen to women. I agree that it needs to be talked about. I absolutely agree that it needs to change.

But, it also seems like everything lately revolves around the same theme...homebirth is the only option for women who want a great childbirth experience (or just a normal childbirth experience). It's only possible to come close in a birth center, and it ain't ever gonna happen in a hospital. This is getting to be a very common (and old) theme in your writings on this topic. I'm becoming frustrated by it.

I am a certified nurse midwife and I see beautiful natural childbirth in the hospital all the time. I see women delivering in whatever position they choose. I see women labor wherever and however they want. I see women choose whether they want to have a vaginal exam or not. The women that my practice sees are given choices...truly.

I know this doesn't exist everywhere and bad things are happening all over this country. BUT it does exist here in my practice, and I can't imagine we are the only ones. Don't devalue and diminish what I do in a hospital. Don't devalue or diminish where a woman chooses to give birth (and yes, sometimes women don't have a choice). Will a woman who birthed naturally (or with pain meds/epidural at her choice) and is happy with her experience read your writings and feel as though her experience isn't as wonderful as the woman who birthed at home?

September 7, 2009 | Unregistered CommenterBethany midwives

Thank you so much for this post. As tragic and horrifying as it is to read, it's necessary.

I consider myself an extremely fortunate woman to have never been sexually assaulted and to have been treated (relatively) respectfully during my daughter's birth 16 months ago, so I have no personal experience with rape. I recently saw Karen Brody's play "Birth", and was struck most strongly by the depiction of one woman's unconsented episiotomy during her birth. My first thought was "That's rape". I was a little amazed by how viscerally I reacted to the scene.

The value of birth, the value of our bodies, must stop being ignored and underestimated. Thank you for helping that happen.

September 7, 2009 | Unregistered Commenterdarlene

Bethany, Please remember this was written in 2006 right after I learned what birthrape was.

I agree that I find it nearly impossible to imagine a real natural birth in the hospital, but I don't doubt the births YOU do are great. I have to remind you, though, about when you weren't the provider and what *those* births were like. Were they as glorious as the births you describe? I doubt it. It is *great* that there is someone like you (and Dr. Jen and Dr. Biter, etc.) who make a difference in birth. But I write with a broad stroke; it doesn't always need to be there, but sometimes it's best to remember what it is everywhere else.

I mean you no offense. Thanks for the work you do. Not becoming a CNM is my one true regret in this life.

September 7, 2009 | Registered CommenterNavelgazing Midwife

Thanks for posting this. There are many horrific statements here - I could, sadly, add a few more to them. Thanks for witnessing this and adding a voice to what many cannot find the strength to utter publicly. Yet to my ears, a couple of these don't really strike the same chord with me...so I'm wondering what you might say instead to some of these such as "push like you are having a bowel movement", "don't push in your chest, push in your butt", "can you push harder", "I promise to be gentle", "I just want to see the baby's position", "If I break your water then..." I realize there is a wide variety in what a woman finds acceptable in a provider's language, which is why it is *so important* for a woman to choose her provider very carefully. But I'm wondering if you could take a stab at some more positive statements to say to women in these same situations.

September 7, 2009 | Unregistered CommenterKristinaF

Two others I've heard (not at me) are:

"you're not pushing, you're just breathing" - while mom was effectively bringing baby down with her efforts.

"just relax, you're fine."

September 7, 2009 | Unregistered Commentermommymichael

It's going to be an interesting thing, seeing if I should have re-written this instead of re-posting it. As I was reading over it, I thought the same things about several of the phrases, including the ones you mention. Trying to remember what I was thinking back 3.5 years ago, I suspect I was really in a place where almost every word was suspect. I think that is where some of these have found themselves.

I do know that the energy behind the words can make a huge difference, the woman being respected in the other aspects of her birth and such.

I've heard several times that women don't like equating pushing with having a bowel movement, but, for me, when women are needing guidance with pushing, I say, "Down in your bottom," or "down and out." Women just don't like thinking of their babies as pieces of poop.

Words like, "I promise" are words perpetrators use on their victims. "I'll do my best to be gentle" is a more respectful way of letting a woman know you will do your best not to hurt her physically. No person can honestly "promise" anything when it comes to birth... don't you think? *I* can't promise anything but to do the best I can in each situation that comes along. We can never promise not to hurt, scare, worry or anger anyone else. All we can is our best.

September 7, 2009 | Registered CommenterNavelgazing Midwife

I am so, so, so happy to see you posting again, and you have been on a major role lately! But, I agree that there seems to be a major push across the blogosphere lately to equate home birth = ideal birth without a discussion of how to fix hospital birth. CNM's seem to be vilified by many bloggers lately (not just you), and I'm not sure that that is fair. I love reading your older posts, and you have posted several beautiful transfer stories where the hospital birth went well and the mother and baby were treated with respect. Birthrape is not exclusive to hospital birth either--I personally know a few home birth mothers who felt violated post birth.

September 7, 2009 | Unregistered Commenterwb

I'm confused why people are thinking this sounds like a hospital/doctor bashing post when I specifically speak about midwives. Is that not clear enough? And that I take responsibility for my own transgressions? Not sure what else I can say to make it more clear.

September 7, 2009 | Registered CommenterNavelgazing Midwife

I forgot to sign my previous post! This is Tiffany :) Can you add my name to it? After all, there are five of us at our practice :p

I also noticed a couple phrases that I have said and thought of as innocuous. But how things are said (tone, attitude, etc) definitely makes a huge impact on perception.

I remember when I was a nurse and was triaging a young girl (maybe 17 or 18) who had been seeing the family practice residents. She had scant care with them and had some problems with the pregnancy that she hadn't been following up on . The resident on call shocked me by doing a very rough and aggressive pelvic exam. I had never witnessed this type of treatment before. I felt like he was punishing her (he had his fingers in her vagina and was pushing down on the muscles repeatedly while telling her to "relax these muscles" over and over. I was so stunned at the time I didn't say a word while it was happening. But afterwards you can bet I raised hell....and nothing was ever done to my knowledge.

I personally don't feel that I have ever experienced birthrape. I feel that I experienced factory birth with my first two. I felt like an object, dehumanized.

I would not ever ever want to be party to birthrape or just plain old unhappiness about a birth experience.

Tiffany

September 7, 2009 | Unregistered CommenterBethany midwives

NGm, I'm so glad you're writing again! So thought provoking! I have wanted for many years to become a homebirth midwife (started on the CNM path, got sidetracked while having two kids close in age, now considering a CPM . . . ) but one thing that makes me very fearful of becoming a midwife myself is possibly accidentally contributing to a bad birth experience by unintentionally saying the wrong thing at the wrong time.

I wonder if sometimes midwives are idolized TOO much (even more than doctors!). Midwives are human like the rest of us, after all. Sometimes they will say the wrong thing at the wrong time, and that's life. Hopefully if the client and the midwife have a good relationship a poorly-worded and/or poorly-timed comment will not be too horribly traumatic. I feel this way about my own midwife. I do not agree with her 100% on matters spiritual/philisophical, and that's okay. If she gives me some spiritual advice (she is a Christian midwife) that I don't agree with, I listen and then ignore it, no harm done. Of course this only works because I have a good relationship with her and, while I may not always agree with her philosophy or religious views, I TOTALLY trust her clinical advice and would (did) trust her with my life.

September 7, 2009 | Unregistered CommenterJoanne

NGM, I agree critiqueing or even criticising midwives when they fail their mothers is extremely important. For several generations, we revered the obstetrician, a man who brought babies into the world, before we finally, finally, acknowledged that such blanket reverence was helping no one, and that it harmed women, harmed babies, and harmed families. Just so, simply revering midwives as an automatic bastion of all that can be right about birth is equally senseless.

There are many, many wonderful midwives, who always think of their clients first, who question the standard of care when it fails to adhere to the evidence, who are always honest and forthright, fully inform their clients and acquire proper consent before procedures. But while that may be fairly common, it may even be the general rule, it is most certainly not universal. It would be fantastical to think that it was. My own midwife failed to get proper consent before a variety of procedures during my birth (it was still, overall, a positive experience, though her failures certainly sully its memory).

As you say, it is important to include the actions of midwives in our criticisms of the current standard of care. Just as any healthcare provider is capable of respecting a woman's body and birth, any healthcare provider is equally capable of failing her. Reading such criticism from a midwife is reassuring, indeed, that the midwifery community is unlikely to suffer foolishness by its own members.

September 7, 2009 | Unregistered Commenterdarlene

Would you consider non-consensual stripping of the membranes birthrape as well? Because so many doctors and midwives with do this during a pelvic exam without even telling the woman. In fact, it happened to me twice. I don't MIND that they did it except they didn't COMMUNICATE with me about it, if that makes sense.

I think this post was very powerful and very disturbing at the same time. I've been trying to explain to my husband that these types of things happen to women all the time, but his response was, "Is this all about you and your comfort or is it about the baby?" It made me feel as though I was selfish and ridiculous for wanting and desiring to be comfortable and respected during labor and delivery.

I hope to share this with him and open his eyes. He's not a jerk, really. Just naive and completely blind to what goes on in hospitals.

September 7, 2009 | Unregistered CommenterJoy

With my son, I had a completely natural birth in the hospital with midwives. It was lovely.

My daughter though, I had a Bosnian doctor come in at the last moment and start screaming at me to push harder/faster/harder. A few days earlier when I was in prelabour, I'd had an American doctor do a stretch and sweep without permission (he had permission to check me, not to sweep though).

September 7, 2009 | Unregistered CommenterVeronica

I think it comes across as doctor/hospital bashing because it starts with a discussion of hospitals and doctors (with midwives tacked on at the end of a sentence at the end of a paragraph "I have heard vile things with my own ears from doctors and nurses - and midwives.") You go on to elaborate on midwives, but people look for the tone of a piece to be set in the beginning, and the beginning is about doctors and hospital birth.

I know that these practices are rampant in hospitals (I know much less about homebirth, so defer to your experience) but I also agree with Bethany midwives that comments like "It would take an incredibly strong woman to be able to withstand the intense tension brewing, but it would be a great lesson for hospital personnel to witness. I believe it could never be done - and that's just so sad. It's sad that not only could we not even demonstrate a normal birth, but that nothing like it would ever occur in the hospital setting." seem very devaluing to those of us who make a lot of effort to attend births without bringing with us our own desires and wishes. I've attended plenty of lovely births that unfolded in their own time with no intense tension brewing, and no pushing to do more and hurry it up.

That said, it does not negate the amount of harm and hurt caused to birthing women and all of us need to be conscious of how our words are heard by a vulnerable laboring woman.

September 7, 2009 | Unregistered Commenterdoctorjen

Dr. Jen, you know you are a Goddess to me and I appreciate whatever you say. I was very angry when I wrote the original post. I think I'll re-write it and replace this one with the new one. I'm not so angry anymore.

September 7, 2009 | Registered CommenterNavelgazing Midwife

I was 222 and 205 pre-pregnancy and had both my boys vaginally, naturally in the hospital with a midwife and a doula. Both births were incredible, with no tearing or episiotomies. My second time I was laughing and chatting right up until transition (which I went through standing up). The two biggest recommendations I have are EDUCATION about birth and having a good support system (partner, especially, but care provider, too).

September 8, 2009 | Unregistered CommenterHilary

Don't give up being angry - just hit who you're aiming for!

I do think it's very important to watch what we say and how we act. I thought some of the phrases on your list would not automatically be hurtful, though. I don't coach pushing except in rare circumstances (dense epidural for example, and no urge to push even after laboring down for hours in a mama unwilling to have the epidural turned off) but I have said things like "push in your bottom." I know women don't like to have their babies compared to poop, but sometimes realizing it's the same pelvic floor muscles that you need to let go with does help a bit. Of course tone and emotion behind the words often mean quite a bit more than the words themselves. I do think as a previous commenter mentioned that of course birth attendants are human and sometimes we say the wrong things and this can be overcome when there is a good trusting relationship between provider and client. I think your article is more about the whole environment and attitude of care. It's one thing for a concernced caring provider to be trying anything to help someone with a dense epidural to figure out how to push, and another for a hurried, hostile provider to be harrassing a client, no?

I especially hate to see birth attendants or nurses pushing women's legs apart. There just isn't any reason for that. I've never met a woman yet who didn't spontaneously open enough to let the baby out in the end - but I have met a lot of women who preferred to push with their legs together until THEY felt like opening. The most recent birth I attended was just like this - mom had a spontaneously urge to push after SROM. Her second baby (who I also caught) was pushed out in less than 5 min, so I was expecting a baby very quickly, but as it turned out mom felt best on her side, with her legs bent just a little, and did not want to lift her leg, or move to anything more upright and open. She pushed off and on for nearly an hour with her legs clamped pretty tight, and we just waited. We never did do an exam, so maybe she was only 8 when she started pushing, or maybe the baby was very high, or maybe it was right there the whole time, doesn't really matter. She liked to be covered up, too, so I just sat and waited, and she pushed off and on, and rested well in between, and then at the last minute, she rolled halfway to her back, and pushed her little boy's head out into her own hands while supporting her own tissues. I merely helped her catch (her arms weren't quite long enough to reach him all once the shoulders came!) and lifted him to her arms. The nurse had whispered to me several times that shouldn't we make her open her legs and push harder and longer, etc but of course there was no need to. Her whole labor was only 4 hours, we can certainly wait the hour it took her to push spontaneously and comfortably, and it just doesn't matter why as long as the baby is fine. I'm sure we could have instead been constantly instructing her to push for the whole contraction, push harder, open your legs, and even held her legs open instead, but this way her baby was gently birthed in her own time.

September 8, 2009 | Unregistered Commenterdoctorjen

Barbara, thank you so much for this. I read it before, and it's still powerful and hopefully enlightens a lot of readers about coercive and abusive "care" at the hands of care providers.

KristinaF asked what you're supposed to say instead of "push toward your butt" or "push like you're pooping", and I just wanted to mention that those statements and sentiments actually lead to pushing against the body and potentially harming the pelvic floor. Please read The Female Pelvis Anatomy & Exercises by Blandine Calais-Germain. She goes into detail about the anatomy od the womb and vaginal canal, especially during labor and birth. She (and I) believe that pushing shouldn't be coached in a normal situation, and that accurately visualizing the curve of the uterus and vagina which the baby corkscrews down helps prevent needless strain (associated with urinary and fecal incontinence in the mother, tearing, and other pelvic disorders.

Essentially, DON'T push like you're pooping, because you're not; You're giving birth. I love that book for its simple, straight forward, anatomically driven advice and exercises . . . Including why women should birth upright and plenty of great illustrations to help you become familiar with your pelvic structures during many stages of life.

September 8, 2009 | Unregistered CommenterLeslie Kung

After consideration, I am re-writing the post, updating it instead of letting it remain in the anger-driven place it was in back in 2006. I will leave this one up, but will also post the new one as soon as I finish it. There was so much anger because of Dr. A (ptwey) and my urge to make her see what a jerk providers can be. I didn't get anywhere near my goal and moved on to other ways of talking about birth abuse and birthrape. It's obviously time I do so again.

I really appreciate everyone's comments here. Thank you.

September 8, 2009 | Registered CommenterNavelgazing Midwife

My first birth experience was absolutely horrible. I had a natural birth, but the nurses forced me to get an IV, added pit without telling me, and constantly monitored me. I wasn't allowed to walk, even before the IV. After 12 hours of them telling me there was no way I could birth without drugs, I proved them wrong. I was so upset by what happened that I vowed it'd never happen again. My midwife stood up for me and removed the pit, but it'd already done it's job and I was contracting a lot harder than I should have been.
My second birth was completely natural and in a hospital. I had to fight, tooth and nail to get it though. I walked in at 6cm, told the nurse that I wanted a natural birth and didn't want an IV, and she couldn't find my baby's heartbeat. How wonderful? At that point, another nurse entered the room, screaming "Do you want a healthy baby?" I just yelled back that I wanted my midwife. The nursing supervisor was called in and I got a nurse who just left me alone to do what I needed to do. No drugs, no IV, perfect little healthy baby.
My third birth was probably the best one (it was only a week ago). I started cramping and called my midwife's office to give her a heads up. She wasn't on call that day so I made the decision right then and there. I would be having this baby at home without assistance. My labor lasted 40 minutes! I was happily in my tub, my contractions weren't nearly as painful as they were when I was in the hospital, it went so fast, and my little girl is healthy and happy. You know what? That line about women and babies dying without hospitals 100 years ago is a load of crap. There wouldn't be over 6 billion people on this Earth if that were the case. Blessed Be!

After my experiences, I'm going to become a natural childbirth teacher. I want more women to have the wonderful experiences I had with my last two. More women should fight to keep their bodies under their control.

September 8, 2009 | Unregistered CommenterCharity Kraynak

Thank you for this. I agree with every word. I cannot tell you how many horrible things were said to me during my VBAC, and I just had to suffer through it if I wanted to birth vaginally, which I did. (story here: http://thefeministbreeder.typepad.com/the_feminist_breeder/2008/05/jules-michael-birth-story.html)

One of the moms in my ICAN chapter is trying to have a VBAC right now, and her doc keeps threatening her and saying her baby "WILL BE STILLBORN" if she tries for a VBAC. It's sickening. This mother had 4 natural births, then a cesarean, and now they insist she can never birth vaginally again... why? Oh, no reason, except that one cesarean.

September 9, 2009 | Unregistered CommenterTheFeministBreeder

I would imagine for the more "neutral" things said, that *tone* is everything, and that's hard to get across in a blog post. You can say something that sounds very caring like "I'll try to be gentle" in a very threatening or impatient way. Or not.

Thanks for this post, as with all of your posts. The overall theme of so much that I'm seeing is that we have vastly overcomplicated most births; if all these people are standing around impatiently or making up things to do to a laboring woman...are they really needed? Aside from trying to hurry her, there so often seems to be no need for most of them to be there at all, does there? Which begs the question of why do we need all of these people at most births at all?

And that's the conflict of interest; hard to make doctors, nurses, or attendants root for an ethos of birth that puts their jobs at risk. Though of course we do keep hearing about a primary care dr. and nurse shortage, so maybe they just need to be nudged into that instead. Or get midwife or doulas certifications if they love what they do.

September 9, 2009 | Unregistered Commenteremjaybee

Great post, Barb. I had my niece attend two of my homebirths. Once as an aspiring L&D nurse, the other time as an L&D nursing student. I was hopeful that being grounded in these two experiences before entering the hospital would give her pause. It didn't. My other two nieces who attended one of the births went on to have horrific birth experiences. As much as I wish that hospital staff would be affected by seeing with their eyes a beautiful birth, I don't think it would change most belief systems. They have to be willing to see 'with their heart'. I'm in the middle of writing a book (The Way of the Peaceful Birther) in hopes that it will inspire everyone to see with their hearts and not their eyes. That's where the real power lies, and then having a visual witness leads them to shift paradigms. Blessings to you.

September 9, 2009 | Unregistered Commenteramy jones

Yes, what you write is horrible (things said) but I agree. I attended my first birth (other than my own 3!) two nights ago and I was kind of shocked even though I knew it was coming. The doctor said "well you can just push for 2 hours then if you're not going to do this properly. I'll come back in 2 hours". And the nurses were all young things who had never had kids before. How would they know how badly it hurt? I was telling them "she's feeling her ctx one on top of another and it's hard to know when one ends and another begins" and they were saying, while pressing on a sore abdomen "your ctx is over, stop it"...etc. :-( Not to mention baby kept from mom for 40 min. after the birth...*sigh*

September 10, 2009 | Unregistered CommenterFio

Yes, what you write is horrible (things said) but I agree. I attended my first birth (other than my own 3!) two nights ago and I was kind of shocked even though I knew it was coming. The doctor said "well you can just push for 2 hours then if you're not going to do this properly. I'll come back in 2 hours". And the nurses were all young things who had never had kids before. How would they know how badly it hurt? I was telling them "she's feeling her ctx one on top of another and it's hard to know when one ends and another begins" and they were saying, while pressing on a sore abdomen "your ctx is over, stop it"...etc. :-( Not to mention baby kept from mom for 40 min. after the birth...*sigh*

September 10, 2009 | Unregistered CommenterFio

I'm surprised still when people interchange the terms vaginal and natural. The two are not synonymous. Is it natural to give birth strapped to monitors, hooked to IV's or to have foreign fingers inserted into one's vagina? Yes, there are times when these interventions are necessary and beneficial, but they are, by definition, not natural.

And, Bethanymidwives, fwiw, I think anyone who DID have a good experience in a hospital could read this and clearly distinguish the difference between their experience and the bad experiences. I don't see how anyone could be confused by that and I don't see how the author is *making* anyone feel badly when there is clearly a difference.

September 10, 2009 | Unregistered Commentersurprised

"You can labour like a woman or you can labour like a peasant." (OB when asked about epidurals.)

"I'm going to examine you, and it may cause your waters to break." OB then draws amnihook out from behind his back.

Unknown (male) OB enters room for first time and prepares for amniotomy. Client declines. Later, she's pushing hard, decent is slow and membranes remain intact. She: I think I'd like my waters broken now. He (in a petulant tone): No, no, go natural if that's what you want!

Those are just the first three that popped into my head. {sigh}

September 10, 2009 | Unregistered CommenterRean

Barb, you've never seen a vaginal delivery with a gal over 200lbs? Really, even your own births? Wow. Should have been there for mine, and I do plan on doing it two more times - ideally I wouldn't weight 330 but I do. I will say the nurses whose shift was over stayed on for the delivery, and they were the old hands - we ended up with a bevy of birth attendants not because of need but because they could be there and I suppose it was a "good" birth.

Anyway, you're invited if you wish when I get pregnant again, my doula retired from being a doula so I have room in my heart to have another. It's not so bad up here either.

My personal one is the young OB/Gyns trying to place a foley catheter for manual cervical dilation with a posterior cervix and no epidural, and full force pitocin - that was awesome when my sister is also a survivor and talking about it months later makes her cry. She just remembers crying and crying and them apologizing, I am glad they apologized since they should be ashamed, she's one of the most gentle women I have ever met and more tenderhearted then I have ever seen.

September 10, 2009 | Unregistered CommenterEthel

It would be wonderful to demonstrate a completely natural birth in the hospital (NOT a homebirth in the hospital as many would want to call it) and watch all the care providers squirm with discomfort as their jobs became almost useless "just" sitting and observing. It would take an incredibly strong woman to be able to withstand the intense tension brewing, but it would be a great lesson for hospital personnel to witness."

Your most recent post just reinforces what I already believed about my daughter's birth: that I was incredibly lucky! I had a nearly all-natural birth in the hospital with a midwife. The only intervention was when my midwife broke my bag of waters with my consent, and then only after discussing it with me, letting me walk as long as I wanted, and leaving the room for my husband and I to talk it over between contractions. The hospital staff absolutely didn't know what to do with themselves and were amused/bewildered by seeing me and my husband walk the halls for so long, but I didn't experience any negativity from any of them, either because they didn't have any or my midwife shielded me from it, or perhaps because they were able to remain professional and just keep it to themselves - my idealism makes me hope it was the first option.

I could tell they thought it was a little weird when I asked to keep the placenta, but they didn't hesitate to find me a container, which the nurse carefully labeled "do not discard."

September 11, 2009 | Unregistered CommenterJackie

Ethel: Not sure where you got the idea I've never seen a woman birth over 200 pounds. I have seen puh-LENTY of women deliver over 200 pounds... had a nearly 300 pound woman this year alone. What makes you think that I hadn't?

September 11, 2009 | Registered CommenterNavelgazing Midwife

Jackie, you are me. Had my daughter with the midwives at UCLA in August 2008 and had just about a perfect hospital birthing experience. I only wish that I had someone tell me that I didn't *have* to start pushing just because I was 10cm. I didn't feel any true urge to push until an hour or two after and probably could have saved quite a bit of energy if I had just waited a bit. FWIW, I totally didn't "get" pushing, but the midwife was incredibly patient and helped me make the most of my petering-out contractions at the end.

I think the bewilderment of the nurses and techs was a little less there than Jackie may have experienced...I was told that the epidural rate among midwife patients was under 50%, so they were probably pretty used to women walking around. But that day, I was the only one in labor with the midwives group, so I had the entire hallway to myself. There were at least a dozen other women laboring with other providers at the same time, but all were tied down to their beds with epidurals.

September 11, 2009 | Unregistered Commentericedancer

I'm just not seeing how this post is being taken as anti-hospital when it clearly speaks directly of homebirth, but also mentions several things that only a homebirth midwife would do or say.

Also, most births take place in hospitals, so most birth rape is going to happen there - that's just the way it is. If 5% of births take place at home, then 5% of this post should deal with homebirth. However, a much larger percentage then that is taken up by discussion of homebirth midwives, so what's to complain about? Most posts like this would not even mention homebirth midwives. Most people don't think birth trauma or birth rape even happens in homebirth. It might be fitting though that homebirth takes up a larger portion of this post, as I have noticed that a larger amount of women are traumatized by homebirth then would be expected given the actual percentage of homebirths to hospital births.

I think the thing that defines a "birth rape" the best, is when a woman is not allowed her legal rights to informed consent and refusal. This happens at home and in the hospital, but for different reasons. In the hospital, it is fear of litigation that drives this. At home, it may be fear of losing licensing or being prosecuted. The problem here is that women are not seen as mentally competent to make even the smallest choices for herself in birth. In most cases, she can't even decide to eat or drink, let alone decide whether an episiotomy will be performed, or whether her cervix will be manually dilated, or whether her water will be broken, or whether she an VBAC, etc. Being that she is not allowed to make big decisions, she is now forced small ones.

September 13, 2009 | Unregistered CommenterJennifer Z.

Ethel's confusion over the 200+ lbs vaginal birth comes from your original comment, which was: (I personally have never seen a vag delivery of anyone over like 200, that is after preg weight). I too was confused!

Love your writing, it's very thought provoking.

September 13, 2009 | Unregistered CommenterHilary

apprentice (to pushing mother): do you want some support while you're pushing?

supervising midwife: oh just do it.

pushing mother: don't touch me!

~

supervising midwife was also observed forcing an anterior cervical lip as the mother cried "stop! ow! don't!"

September 17, 2009 | Unregistered Commenterann nonymous

jennifer wrote:
"a larger amount of women are traumatized by homebirth then would be expected given the actual percentage of homebirths to hospital births."

this speaks more to our culture and the types of women who choose to birth "outside the box". i believe that homebirthers are more likely to speak up if something isn't to their liking.

just like marsden wagner says, fish can't see water. probably many hospital birthers accept the status quo without questioning, without thinking, without even knowing that another way of birthing is possible.

September 17, 2009 | Unregistered Commenterann nonymous

I'm a midwife apprentice (currently on hiatus due to economic reasons) and I've only ever doula'd ONE woman in the hospital who actually managed to have a completely un-interfered with labor. No Iv's, drinks and snacks were (snuck) eaten, mom labored where she wanted and in the positions she wanted. This out of dozens and dozens of births, was the ONE and only time here in the midwest that I've seen a NATURAL birth in the hospital. Unfortunately it quickly went downhill as they believed the baby to be 8 weeks early. OOPS.... dates were wrong, baby was only slightly less than 3 weeks early and completely F I N E. But that didn't stop the "trauma" team from swooping down on the baby and rushing it to NICU where it was virtually impossible to extract for over 24 hours despite apgars of 9 and 10 and a birthweight of over 7lbs!!!
I don't attend hospital births anymore, as my psyche, my soul, my heart and mind just takes too fricking long to recover from it.

Please keep speaking the truth. I too have heard many of these comments.
I especially dislike the "Who's the doctor here, you or me?" as if the mother becomes completely ignorant of her body, her choices, her autonomy simply because the MD has said degree. I've seen many EDUCATED women completely FOLD to this ridiculous question. Disgusting.

September 21, 2009 | Unregistered CommenterJennifer

Great post Barb. The comments from caregivers are unfortunately all too familiar. I think it is important to get these out in the open and say No! that is not OK to say to a woman giving birth (or any woman). I am in my first year of practice in New Zealand and unfortunately can add the following comments that I heard during my training (mostly from doctors, a couple from midwives).
- To a husband thanking the on-call obstetrician for suturing his wife's perineum: 'You'll thank me when you use it next".
- '"Watch out Tinkerbell, here comes Captain Hook" (obstetrician about to rupture membranes).
- "She just wants her baby now" (midwife recommending caesarean)
- "Primips always need instrumental deliverys or suturing" (Registrar to trainee intern suturing woman's perineum)
...and so on.

Pretty despairing sometimes.

September 26, 2009 | Unregistered CommenterNew Midwife, New Zealand

My wife and I have four children, each with the goal of a natural birth. None of the births went as planned and the comments you've heard could have been taken from a recording of our births. The worst experience was the last, at a small hospital in NZ with a midwife from the UK... she was horrendous (forcefully telling my wife she needed an epidural in the middle of a contraction, during transition, despite our clearing stating from the time of the first appointment that we hadn't used epidurals for our first three births and didn't intend on using one this time) but there weren't many midwives to choose from.
Thankfully, I'm quite a forceful man and was able to cow the attendants into giving us the peace and quiet we wanted for our birth.

It's clear to me that the medical profession needs more training, not only on what constitutes a natural birth, but also what constitutes basic empathy.

October 14, 2009 | Unregistered CommenterNaturalDad

My first birth was attended by a wonder midwife team but, during a sudden turn for the worse, one of them had to enter me with their hand to manualy manipulate my very stuck baby. Unfortunately I was not told what was happening. I was in hands and knees postion at the time so I couldn't tell. I understand the necessity, I'm not angry at them for the procedure, but I felt very confused by the pushing/pulling/twisting that I didn't understand at the time, and very violated afterwards. My midwife was so sorry, she was there for me the whole time and cried with me afterwards, apologizing profusely for not letting me know what was going on and for the act itself (despite its necessity). While I dealt with/deal will feeling of violation because of the birth (and subsequent first month of my childs life while he was in NICU), I am not angry at my midwife, and feel so empowered by her, her admission of guilt and apology in a very real way allowed me to greive and acknowledge my feelings. I think this is why people get more upset at doctors who do these things. Doctors do not apologise afterwards, and they are very likely to blame the intervention on the woman (well your body just wasn't going to birth that baby by itself) that really hurts a woman's ability to grieve and deal with feelings of trauma, so you end up with a lot more internal angst. Just my thought. I realize not all midwives are as wonderful as my first one was, but I think a doctors reluctance (or inability given hospital rules) probably has a lot to do with why midwives are frequently left out of the conversation on birth trauma.

December 1, 2009 | Unregistered CommenterJessica

I'm so relieved i found this blog, its diffently put my experience in its place. I hope more women having babies open there eyes to the reality of how women are being treated and that they may take a stand when it comes to there labor and delivery. Never again will I allow MY labor and delivery to be controlled by anyone other than me.

June 2, 2010 | Unregistered Commentermayra

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