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Wednesday
Apr132011

Birth Abuse

I was contacted by a lawyer who is working on a law review article about birthrape… she found me via my blog. A couple of days ago, she presented me with a list of questions that have come up as she is writing her paper. As I answered her, I thought my comments would make a great stand-alone post, so here I present the information I have given to the brave lawyer who is poised to stand strong against the storm that is sure to come after her piece is read and digested. She is already our hero, just for taking on the legal aspects of this fight. 

Addendum: Patricia Shepard, the lawyer I referenced above, has asked that I share her information with you all. She says, "I'm particularly interested in hearing from women who have attempted to find counsel to take their cases in civil court, or attempted to press criminal charges, but have been denied." Patricia's email is: patricia DOT s DOT shepard AT gmail DOT com

This piece is rife with definitions and commentary. Each topic can be stand-alone and deserves its own space in our discussions. 

What About the Baby?

Let us just get this out of the way now. The baby is important, but not more important than the mother. Equally important. I discuss emergency procedures below, but lest you think, “The mother’s feelings be damned! Doctors, nurses and midwives can do anything to save the baby,” that is not what we are talking about. We are speaking about non-emergent issues, experiences that have zero to do with aid, but everything to do with Power and control. 

Trigger Warning

It hardly needs saying, but this piece is filled with possible triggers for women who have been birth abused. Some of the links contain photographs or videos of extremely graphic procedures, so click links with caution if you are watching for triggers. While I respect and honor your processes and truly desire not to hit those painful buttons, with this issue, in this situation, I feel the more graphic the information, the better lawyers and law enforcement will understand; comprehension can come from the nuances. If you find yourself being pulled into the pain, please attend to yourself kindly, calling a friend if you need to. And always remember: you are not alone. 

Conflicts

Because there are no legal definitions of what we are going to be talking about, I have attempted to define the different aspects of Birth Abuse, breaking them down into their basest forms and outlining the actions that make up the violation. I am using the term Birth Abuse as the umbrella term. I do this not to discount or soften the blow of the word Birthrape, but to give a definition that encompasses Birth Violation, Birth Dehumanization (which includes Humiliation), Birth Violence, and Birthrape. Note that terms may (and often do) overlap in each incident a woman experiences. I have struggled with always capitalizing the words to create a deeper sense of urgency and emotion, but also know it can be disconcerting when reading and might detract from the message. So, I have chosen to capitalize when defining or using a word as a noun. For example, the term informed consent is different than Informed Consent; Informed Consent is the formal process of questions and answers and the signed contract between a client and her care providers –the complete package. I use the words informed consent to mean individual parts to the complete package of Informed Consents. This is my personal distinction which, to anyone else, might mean nothing, and, as we know, what we sign in the hospital is not even called Informed Consent, but merely Consent Forms. Part of what we are looking for here is the Informed part, right? 

When I first heard the term Birthrape (sometimes written Birth Rape or birth rape) in 2004, I was horrified someone would be as arrogant or blind as to equate anything done at birth, even atrocious things, with rape. As a rape survivor, it was beyond insulting that anyone could use the word birth and rape in the same context. And then I started talking to the birthrape survivors and was humbled by what I heard. In the ensuing seven years, I have talked to hundreds of women who have identified as birthrape survivors… women who have had physician, obstetrician, nurse, nurse midwife and non-nurse midwife perpetrators. 

Terminology

Because there are no legal definitions of any birth abuse terms, but there are women who have been birth abused, it is imperative for these women to join together, in their pain, and come up with a consensus of verbiage to use when talking about their own experiences. I am unsure whether this will happen in support groups, in online support forums such as Solace for Mothers, in a specific Terminology Facebook page or through comments to this piece, but somehow, it has come time to create the language the law will use when prosecuting our cases. While I have not been birth abused, I was certainly birth disrespected and painful as it is to say, I have witnessed accounts of birth abuse (including birthrape) and have also been a perpetrator early in my midwifery training. It is in that light that I try to define experiences that I have not personally had, but have participated in. This in no way allows me to define another woman’s experiences; women define their own and if I define birthrape one way and a birth abused woman defines it another, she is correct; not me. Some might even find extreme arrogance in my attempting to define these terms as a former perpetrator, but I am humbly offering my services and if it is offensive to you, I do apologize. Yes, I am sure there are serious overtones of mea culpa in why I write about birthrape; it is the least I can do for my past. 

So, here I go. 

Perpetrator

Throughout, I use the term perpetrator, again, struggling whether to capitalize it and give it an uglier, we-see-you aspect or lowercase because they are doing despicable things to women and to keep them in a place of derision. I’m choosing the latter. 

Perpetrators come in many guises including doctors, nurses, certified nurse midwives and non-nurse midwives. While it might be shocking to some that one or the other has the possibility to birth assault a woman, I promise, there are a dozen more that can attest to their abilities.

Birth Abuse

I have gone back and forth on whether to call the umbrella term Birth Abuse or Obstetric Abuse. The word “obstetric” is so clinical, devoid of emotion and almost always takes the mind immediately to a doctor, an obstetrician, and, I would guess, for many of us, a male obstetrician. Later, we bring in the word “rape” and that word is almost exclusively centered on male perpetrators. Because I am hyper-aware that perpetrators come in different identities, I really wanted to use a term that did not automatically conjure up a male in a white coat; therefore I chose the words Birth Abuse. 

Birth abuse covers all aspects of abuse a woman might encounter during her pregnancy, labor, birth or postpartum. There is a gray area when, if the woman is pregnant, abuse occurs during a Pap test or during a breast exam, but this can be sorted out later. For the moment, this specific piece speaks to a woman’s experience during labor, birth and the immediate postpartum period, which I would consider during the first week after the birth or so; the most vulnerable time for women, as well as the time when perpetrators have the highest access to women. 

Birth Violation

We come to our births full of hope and expectation. We hope to have a healthy baby and be able to mother our child fully. Beyond that, we also trust we will be treated with respect and to maintain our dignity as a human being. When this does not occur, our trust has been violated. Violations can take on many guises including:

  • Ignoring our birth plans
  • Ignoring our demands to stop
  • Ignoring our requests
  • Any touching without permission  

All of the following definitions are included in birth violations, too. 

Dehumanization

Much has been written about the dehumanization of women in birth… whole books and even research papers have explored this topic. But in the birth abuse context, re-visiting the list of the “normal” events that are dehumanizing is important. I think noting that depending on a woman’s emotional or physical history, she might construe dehumanization as birth violence. Again, her perception is the right one.

  • Being required to wear the hospital gown when she says she wants to wear her own clothes
  • Being required to wear the hospital gown open to the back without being given another gown when she expresses concern about modesty
  • People entering her room without knocking
  • People entering the room without introductions
  • People watching her without her consent
  • Strangers touching her without her consent
  • People touching her baby without consent
  • Her baby’s condition not being revealed to her when she asks
  • Not being given her healthy baby when she asks
  • Being addressed as “mommy” instead of using her name 

Birth Violence

Moving on to birth violence, these now become the more physical of the violations, although not all are physical, but violent, nevertheless.

  • Intimidating the woman, either in labor or even in the pregnancy (i.e. telling a woman she hasn't been to medical school and s/he has so s/he knows better or, the most classic of all intimidation tactics, what we've come to call the Dead Baby Card) In fact, you can see the enormous amount of intimidation tactics on the My OB Said What?!? site.
  • Forcing a woman to have an IV when she expressly refuses
  • Forcing a woman to have no food or drink during labor
  • Giving the woman sedatives, narcotics, pitocin, magnesium sulfate or any other medication, prescription or otherwise, without express informed consent
  • Physically restraining a woman who is trying to change positions
  • Physically moving a woman against her will (i.e. pushing her from hands and knees to on her back during pushing)
  • Yelling at the woman (i.e. belittling her ability to cope with pain or demanding certain behaviors)
  • Negating her experience (i.e. "It hasn't even begun to hurt yet," or "Just wait until you start having real contractions")
  • Doing aggressive perineal stretching in the guise of perineal massage or support (perineal stretching often causes physical damage to the mother; perineal massage and support are extremely gentle procedures)
  • Abandoning a woman (I had one client delivering and the doctor stood across the room, refusing to come catch the baby, punishing her for trying to have a homebirth)
  • Pulling aggressively on the umbilical cord to get the placenta out before it has detached (this is very different than the Active Management of Third Stage in that it physically hurts the birthing woman especially if she does not have an epidural, and can cause severe hemorrhage)
  • Aggressively and painfully "massaging" the uterus after the delivery of the placenta (I learned to "touch the newly postpartum woman's spine" with my balled up fist... I've since learned that the only thing most women need is a quick and gentle feel for if the uterus has remained contracted and if it has not, gentle massage will "rub up" a contraction.)
  • Grabbing a woman's breast and shoving it into the baby's mouth without warning or without consent to do so ("I found my experience with the hospital nurses and breastfeeding to be frustrating. They were very pushy and grabbed my breast and the baby’s head and made her cry and she wouldn’t latch on while they were doing that."). 

I cannot talk about Birth Violence without mentioning that Venezuela, in 2007, coined the term Obstetric Violence. Many of us did not catch it until the Special Editorial in the International Journal of Gynecology and Obstetrics entitled “Obstetric Violence: A new legal term introduced in Venezuela” in December, 2010. (I have the original article in .pdf; if you want it, please email me: Navel gazing Midwife AT g mail DOT com.) 

“In Article 15, 19 forms of violence are described, including obstetric violence, which is defined as: the appropriation of the body and reproductive processes of women by health personnel, which is
expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and
sexuality, negatively impacting the quality of life of women.” 
 

While this is somewhat encompassing the topic here, I feel as some do, that it is woefully lacking not only not describing what women who have been birth abused have experienced, but also leaving the descriptive words too broad, allowing perpetrators too much leeway in believing that what they are doing/did could not possibly be considered birth abuse/obstetric violence. 

I definitely think the term obstetric violence has potential as the term to use for all of these segments of birth abuse, but I did want to weigh in on why I chose differently. 

Birthrape

The hottest button word of them all. Birthrape is, for many women, an all-encompassing term and, as I have said before, the woman defines her experience. But, as I have listened and talked to women over the years, I have come to distinguish birthrape as having actual penetration involved. All of the below scenarios include being done either without warning,  without full informed consent, if the woman withdraws consent and/or if she is actively forbidding the procedure. The perpetrator might even restrain or use force, or ask for help in restraining, the woman in order to continue with the procedure. For example, if a woman is refusing a vaginal procedure and the perpetrator physically pushes her legs apart in order to continue; this is force being used.

Consent Forms

Much is said about the Consent Forms a woman signs when she checks into the hospital, but as anyone who has been to court knows, Consent Forms mean nothing if they are not adhered to. And a woman always has a right to withdraw consent. Some believe reading the consents and crossing off what they do and do not want to consent to makes a difference, but the ultimate argument in doing those procedures crossed off is: it was to save the mother’s/baby’s life. Even if it was not, who is to say for sure? (That is the courtroom argument, anyway.) 

So what do we do with Consent Forms? Do we simply not sign them at all? Do we ask to be informed every step of the way? What would happen if we did not sign the forms? How can it even be legal to have a woman in the throes of labor sign forms she cannot take the time to read and digest? But, then we face the “a woman in labor is not in her right mind and can’t make a decision about anything, so we get to make all the decisions for her” argument and that is not acceptable, either. I do not have the perfect answer for that yet and really hope the courts are able to figure out the answer to this one, even if it is, ultimately, the Supreme Court. Of course, I am with many of you, feeling our litigious society needs to stop the madness, but our legal system is there for a reason and birth abuse seems like a pretty damn good reason to me. 

Intention

Continued discussions about birth abuse entail talking about the perpetrator’s intention in the scenarios, but I believe birth abuse, violations, violence and rape are defined/named by the victim; the perpetrators’ intent is completely irrelevant. When comparing birthrape to the typical understanding of what rape is (which, to me, is a separate issue altogether, but if we were to do so), just as there are birthrapists who do not intend to harm, there are also rapists who do not intend to hurt their victims. Perhaps the rapist intends to teach a girl or woman how to have sex or to help her understand what a great lover he is. Rape is not always intended to intimidate or harm the woman… from the perpetrators’ viewpoint. Again, it is totally irrelevant what the perpetrator believes is his/her intent. Whether the doctor, nurse or midwife intended to hurt, scare or intimidate the woman does not matter… it is how the woman experiences the behavior or procedure that defines the event.

Prevalence

Looking at the examples and definitions I have given, you can imagine how prevalent birth abuse is. I do understand most women would never consider calling the same experiences birth abuse, but that might be because they have not been able to name the feelings at the time or after the birth. Perhaps if the terms became more common, more women will name the offenses. I know that women have developed Postpartum Depression (PPD) or Post-Traumatic Stress Disorder (PTSD) after traumatic births they could not name birth abuse because they were not aware of the terms. For many women, learning the terms and naming the actions or events that involved the perpetrator/s became a significant step in the healing of the experience. 

The most common types of abuse I have seen are dehumanization and intimidation, but I have either witnessed or participated in all of them. Detractors might argue, if so many women experience even one of the above behaviors, perhaps what I am calling Birth Abuse, really is merely a random interpretation and that, instead of what we consider despicable, really is not only typical behavior, but even normal? That what I am naming Birth Abuse is so common, it is my own perception that is skewed, perhaps even wrong? Might my own abuse history or my own guilt at (what I would call) Birth Abuse be coloring the acts themselves? Might I be giving women an idea that really does not exist at all? These are all great questions that, I am sure, will soon be debated. 

Future Topics That Must Be Addressed 

Birth Abuse & Emergency Procedures

I find this a challenging aspect because when the emergency is a true and honest emergency, I have not found women to be angry about any of the listed violations that are emergency-driven. I have known women (many, in fact) who initially were grateful the actions were taken, but upon reflection and with time, reframed their experiences to one of birth abuse. Women, especially ones who were told one thing and then later read very different stories in their medical charts are wont to reframe their births. But when women feel the emergency actions were justified, I have not seen them in anger. Shock, yes, but anger, no. I think we need to hear more stories than just mine, though. 

Witnessing Birth Abuse

What happens when a doula (or nurse or doctor or midwife... or family member, phlebotomist, etc.) witnesses birth abuse? Does s/he say anything right then? Is there a place to let the client know later that what she experienced was birth abuse? Is it another person’s place to name the trauma or abuse? Or are those of us in birth work merely reflections for women, acknowledging and validating their experiences. 

I believe many birth trauma feelings are caused by birth abuse. However, that does not mean all the women identify it as such. Over the years, when women shared emotions with me, they often stumbled over the right words to use. I have given them words other women have used, but I have been very careful not to preemptively name the abuse or trauma for women. It can take months or even years for women to come to terms with their birth experiences. If a doula (or support person) sees a woman struggling, is it her moral imperative to assist her with information? Up until now, I have tended to wait for them to question what happened. But is this the right thing to do? If I identify an action or behavior as abuse, but the woman does not, is it abuse? If a battered woman believes she deserves the punishments, is she being abused? In other situations that lead to PTSD, it can be a race to see who names the abuse first – television, magazines, books, relatives, physicians, therapists, etc. When a molested child is rescued, one of the first things that happens in therapy is naming the abuse, seeing it as abuse, reframing the experience in the light our culture requires. But, what if our culture does not see the trauma like we do? Whose barometer do we use? 

And what of the witnesses’ mental state? How will we attend to our hearts and minds as we are required to watch the abuse happen again and again. I know birth abuse is the main reason for burn out of doulas. How can we support witnesses so they/we are able to keep going, so we are able to be there for the women who need/want us with them?

Power & Convenience

I think birth abuse happen for distinct reasons and addressing these will be required.

  • It is easier to have each woman behave exactly the same, variations take more time and energy for providers.
  • Women who want to/demand to be treated as an individual can provoke anger in frustrated nurses.
  • Being in control of most aspects of the birthing environment, doctors, nurses and midwives can feel a sense of entitlement and react negatively when their Power is questioned.
  • Hospital staff 100% believes they have the women’s and babies’ best interests in mind and when their care is questioned, they take it personally.
  • Even as most hospital staff understands many protocols are made because of insurance companies and not based on scientific evidence, they support the protocols, even if they believe they harm women, knowing they could lose their jobs if they buck the system… it is easier to intimidate women into compliance than to fight The Establishment.  

Accidental Birth Abuse

I was asked if there were accidental cases of birthrape or birth violence, but to me, the distinguishing factor in birth abuse is it is always associated with Power and/or control. Along with the emergency issues above, I believe if women understand the person did not mean to hurt them and sincerely apologizes, I think women are able to process the experience in a non-birth abuse way. Again, others might feel differently and we will need to hear from them. 

I have found that even in the most dire of situations, one can ask permission to help at least assign one person to explain to mom what is happening and why. It can be a short statement: “I need to get your baby out now,” or “You’re bleeding. I need to help.” It takes a second of time and I know seconds count, but that doesn’t mean the life-saving procedures are abandoned in order to converse with the woman! One particularly gnarly shoulder dystocia I had, I was getting a laboring woman out of the tub as I asked, “May I help?” She says that quick and simple question helped her to not be so traumatized by the birth even though her hip was dislocated trying to get the baby out. (We did; she’s fine.) In the hospital, there are many people associated with emergencies, so I feel someone needs to be assigned to talk to the woman and, during drills, they need to practice what to say to the laboring and birthing woman. I believe this can help women in a myriad of ways, the least of which is they are part of the team… and they most definitely are.

Reporting Birth Abuse

I know several women who have filed complaints to medical and midwifery boards, but the complaints are addressed half-heartedly, if at all. I filed one against a doctor, several nurses and a hospital and during the review, of which neither I nor the parents were permitted to speak, the hospital staff refuted our claims and the hospital received a glowing review anyway. One governing board did fine the hospital, but the parents, who divorced because the birth abuse affected the marriage, had no recourse. No lawyer would take the case; they would not even meet with the parents if there was no “permanent damage.” Apparently, sexual dysfunction, PTSD and terror of anything medical does not count as permanent. This is only my experience; there are many, many  (too many) others. 

Somehow, we have to find lawyers that will talk to women and judges that will hear the cases. 

We have to get the point across that, if a normal person in a normal situation experienced these behaviors or procedures, would they consider them abusive? Most assuredly so.

We have to create medical and midwifery boards that are not made up of peers that are also friends we socialize with. Incestuous midwifery communities must be required to parcel out the complaints so a woman is able to be heard fairly. National organizations should be required to study and implement a method of impartiality in order to serve women, not themselves. If we have to, midwifery board reviews need to occur outside the state of the complaint in order to find an impartial group of midwives to hear the case. The onus should not be on the woman to create fairness, nor should she have to suffer through hearings where she sees "sister midwives" blatantly supporting each other. It disgusts us when physicians do the Good Ol’ Boy network; the Yeah, Gal network is just as indecent. 

End of Tolerance for Abuse

It is baffling how women are expected to lie back and take the abuse from doctors, nurses and midwives. People would never tolerate being treated thusly from a lawyer, accountant or teacher! Can you imagine a lawyer shoving a woman’s legs apart? Or a lawyer mocking a client (picture a male client!) saying, “What law school did you go to?” I just can’t see us sitting quietly if our accountant went to our home, rifling through our personal things, saying, “If you don’t let me look through your underwear drawer, you’re going to go to prison for tax fraud.” And yet, these lame examples do not even come close to the massive violation slapped across women every single day in the name of medical and midwifery care. It has to stop. It. Simply. Has. To. Stop. 

My Hopes

I look forward to hearing others’ thoughts and I would love to see us create a list of demands so all women and babies are treated with respect and dignity, something far more comprehensive than the Pregnant Patient’s Bill of Rights. And legally binding. 

I dream of women calling the police during labor, reporting birth abuse, and being heard and action taken. 

I dream of women sitting in their therapists’ offices, learning how to report their perpetrators and knowing… knowing… they will be heard. 

I dream of medical and midwifery boards that are truly impartial. 

My ultimate dream is that medical and midwifery establishments “get” it and understand their behaviors as abusive and they take a collective vow to never cross the abuse lines again. 

I dream of Informed Consent… real informed consent. 

I dream that medical and midwifery professions learn to manage and control their own through workshops, seminars, research studies and peer pressure. 

I dream of medical and midwifery care providers asking women, always asking women, how they can avoid smashing their senses of Self. 

For it is the women themselves… we women ourselves… who are the determining factor in how we birth.

It is our birthright.

References (5)

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Reader Comments (64)

Wow. I finally have a name for the trauma I suffered during the birth of my only child 15 years ago.

I sought out the only CNM in my OB's practice, foolishly thinking a "midwife" would be more supportive. My planned natural birth, which I thought my "midwife" would surely support, was abandoned the moment they hooked me up to the Pitocin. Even now, I can still see her face behind her mask as she came into the room and, without saying a word, shoved open my legs and thrust a hand up inside me. When I cried out, she callously yelled at me to "shut up and labor like a grown-up woman." It was a downhill ride from there.

For years afterwards I tried without success to have another baby. A part of me grieves to this day that I never got the chance to have a better birth experience to wipe away the awful memories of the experience I did have.

April 13, 2011 | Unregistered CommenterAngela

Asked. Women need to be asked before touching, breaking water, massaging. I've had so many things just announced and done without being asked. I now realize my rectocile problem might have come from the nurse who insisted on stretching me into my rectal area without asking. This was baby #6, so WHY? That is damage I didn't have before, I did start having issues after that birth and then it was worse after the next.

I've experienced the lie too, telling me something outright untruthful. A triage nurse said, "we've talked to your midwife, she wants us to do the VE before she will come." I had spoken to my midwife before I left my house who said she'd be right there and we had already discussed no VE's unless I asked, but I was bribed..."we'll call AFTER the exam." I felt stupid, had wanted no VE's and but consented. Same thing with being told I could not drink in triage, though I said my midwife was okay with it, the nurse said, "anesthesia is not okay with it." I was already angry and had only been in the hospital 10 m inutes. The midwife walked in and could see the heat on my face, the frustration of being lied to and being pushed around already. This was baby #7.

The coersion is frustrating...the "no, you cannot get into the shower until I check you" and then after being checked, well, there's a reason you cannot get into the shower at all. "No you cannot get out of the bed with the IV and monitor" when in fact, a nurse can do things that allow her proceedures to go on and still allow mom to do what she needs to do. "No, you cannot use the restroom" (for over 4 hours...4 long hours). I was not offered a bed pan, I almost peed in the trash can. Why did I consent to this treatment? I don't know, I felt stupid, I felt frozen. VE's every 20 minutes, not really covering me, keeping her hand in me between contractions and stretching the perinium and the cervix while I was flat on my back...making me feel violated. I was also scared, I knew being flat backed could cause decels in my baby, and after a big decel early on, she still insisted. Then the comment, when I was curled up on my left side in bed (though I had argued to try to get out of bed), that baby "looks so good on the monitor since you're in this position" was like a hot poker to my gut. She wanted an "I told you so."

The difference between an abusive situation and a normal birth is the reaction afterward. I was so depressed right after my 6th was born. I was in tears, but nothing was wrong with my baby or with me physically. I was successfully breastfeeding, I had been so happy in pregnancy (very joyful and excited). At first I was angry at myself for feeling so down, weeping, trying to figure out what was going on. I didn't know it was the violation from the nurse (and no help from the OB) that caused me the trauma at first. Then, after a day, I figured it out. The nurse had been overbearing, had been manipulative, had lied. So, when I had baby #7 I chose a midwife. The triage nurse did attempt to ruin my day, but being with her only 15 mintues or so helped...the midwife came and got me out of that situation and what a difference. Being asked by the midwife for every little thing helped. Being apologized to when she was uncomfortable with decels and couldn't take the monitor off made me feel okay with it, after all, she was holding it on my belly for hours. She was giving me options and I was out of bed rocking and swaying as I wanted to be. The difference was, I was treated like a consumer, like a person with baby #7. If something was done that I had hoped would have been different, it was only my compliant nature that caused it to be allowed after being asked, not coersion. (water was broken by the midwife but she asked...and I consented even though I really didn't want it...but I was being a good patient...and it was silly...and the midwife didn't know this and cannot be held accountable for something in my own head that I never expressed...). The midwife was just doing offering options, and I went along with one I realized I should have left alone...but she was not at all pushing me or even trying to influence me. If I had said, "no" she would have nodded and agreed. No problem. With baby #6, the nurse argued with every question, told me some bogus reason, and continued right along with what she wanted to do.

Oh, and I am glad you included the after birth massage of the uterus. I mean, those nurses go all the way to my spine and I cannot figure out why? If I'm having bleeding issues, is that needed? The midwife or OB is not even there assessing anymore, but the women are lifting off the floor and pushing all the way to the spine. I had an umbilical hernia and worried they would hurt it. Yes, my boggy uterus was not clamping, maybe taking baby over to the table to warm and suction was a bad idea? And what's with not answering when I can hold my baby or if my baby is okay? Ugh.

Okay, yes, slight triggers here. And I don't feel I was really violated as badly as many. I mean, I had vaginal births, and for the most part small things happened to me in comparison. My husband was in the room with me supporting me...and sometimes discussing things with the nurses for me to try to get them to agree with what I wanted. If it was just my body and if I really knew things were safe, I would not have just let things happen to me. But I worried that if I didn't do what was asked, my baby could be at risk for some things. They can hold that over you without ever saying much more than, "you want a healthy baby right?"

April 13, 2011 | Unregistered CommenterDawn

Oh Angela,
I didn't even have it that bad. I was coerced but not forced for VE's. Ugh! I am very sorry. I have experienced births with great nurses and a wonderful midwife...and even some good doctors too. I hope you can find healing in telling your story here and find support if you need it. I really would not treat women like this if I were working as a midwife/ob...and sometimes wish I was younger so I could go work with women and when I say WITH I mean with...as a partner or as a helper not as a director.

April 13, 2011 | Unregistered CommenterDawn

I feel that some abuse occurred at my second birth where I was given perineal massage under the guise of helping to stretch tissue. This was a home birth, but I told the midwife to stop what she was doing due to it being painful. She did not stop and I did have skid marks after the birth. I really feel that this intrusion on my body really distracted me from the birthing process I need to focus on. I think providers need to leave our vaginas alone and just let us have our babies. I was able to move past the trauma, I insisted to the midwife during my last birth, that I did NOT want perineal massage, and she was very respectful and hands off during the birth, it really helped me to heal when I had such a respectful, powerful, ME/BABY centered birth.

April 13, 2011 | Unregistered CommenterGrace

I started reading this with the attitude of "I have dealt with all that", it is all way in the past for me, and I triumphed over it.

Right. Until Dawn's comment suddenly left me feeling faint, as if I couldn't take a breath, and then crying.

It was that last paragraph. It is not stuff so much as the helplessness induced by that fear for the baby that they use when you aren't sure you know better even though you feel that something is not right here. The way I felt waiting several hours alone on a gurney before my C section (not an emergency and they were waiting for AB- blood from a bigger hospital.) that I felt strongly that this wasn't necessary, that I would like to get up and leave, but I didn't have my clothes, was afraid someone would stop me, how could I walk even the few blocks home in a hospital gown, and if I somehow did make it, if I could maybe find where they kept the scrubs, wouldn't my husband make me go back, because he would believe them rather than my feelings, and I didn't have enough knowledge to support my feelings.

Just by putting people in those hospital gowns you take away their autonomy. Because if you see someone in one of those on the street, aren't they an escapee? They clearly don't belong there, there has to be something wrong, they have to be captured and brought back.

That's how I felt about it then, when I thought the ablity to give birth was being taken away from me forever, which is what I was told before the C section. I knew I would be having a lot of children and that this would mean many many C sections.

I am quite sure the doctors were acting according to their beliefs about what was in the baby's best interest, (I had had a high leak several days previously, but it had resealed itself by this time) but I didn't believe them, and I think I was right. He certainly had no infection when he was born. But I really had no choice to act according to my own assessment of risk, or according to my own values which said that some small risk now should be weighed against many many expensive surgeries for me. I had no choice...because of what Dawn said in the last paragraph.

The only thing rape like about this scenario was my total lack of control or autonomy. I didn't even fight.

Susan Peterson

April 13, 2011 | Unregistered CommenterSusan Peterson

I really related to the part about not knowing the words to use after experiencing a traumatc birth. The birth of my first daughter was traumatic and dehumanizing for a variety of reasons but I couldn't name them or understand why i felt so bad when we finally left the hosital. WHen I became pegnant with my current Pregnancy I began looking into birthing options and came across the concept of a traumatic birh. At first I was resistant to consider my daughter's birth traumatic, after all it was a successful VBAC. But I couldn't deny that when I thought of her labor and delivery I would nearly be in tears and in the start of this pregnancy would have panic attacks. I was afraid to go into the labor and delivery unit of the hospital. I was afraid of the l&d nurses and of OB/GYN's. Me fearless Momma was afraid. That was the kicker and I realized i had to look at her birth and figure out what went wrong, what went right, what I had power over to change with this birth.
Realizing I was a victim before, just as mch as when i was raped@ 14yrs old,has hepedwith acceptance. Accepting that I do not have to be a victim again has helped begin the healing. Making different choices and listening to my instincts has been hard butso far the pay off is worht it.

April 13, 2011 | Unregistered CommenterKendra

My first birth was at home with CPMs. The lead midwife had been pissy, impatient, and generally of an attitude that I was wasting her time since weeks before I even started laboring. In the last minutes of pushing, she gave me a "perineal massage" which basically amounted to cutting an episiotomy with her fingers. I have since had two c-sections, another natural labor to 10 cm, and I suffer from a chronic pain condition and migraines. Nothing of any of those things compares to the pain of what she did with her two fingers.

I screamed stop, stop you're hurting me, STOP, and screamed in pain and she yelled at me to "suck it up" and that "birth hurts" and asked if I wanted my baby to be born or not. I couldn't believe that she would do this to me, I was so utterly helpless not to mention speechless with both pain and the shock of betrayal.

I ended up with a second degree tear, and a messy one at that, jagged and all over the place. It STILL hurts sometimes, almost 5 years down the road, to have any kind of penetration no matter how gentle. The scar aches when I exercise.

Later she "helped' the placenta by yanking the cord. I ended up with a retained satellite lobe and a hemorrhage so bad it looked like someone had sacrified a bull in my bedroom. I am lucky I have my mom's high iron levels, I could have ended up in a coma. My records say I lost 450 ml at birth and 450 after, but based on my scientist husband's observations and comparing how it felt physically after losing more than that with my two subsquent surgical births, it had to be close to twice that much. I blacked out and had to be basically rolled in and out of bed.

I filed a complaint about this and other abuses with the state midwifery board. Nothing. Nothing. All they did was piss her off by demanding my files, then they let her off without so much as a slap on the wrist. The Sisterhood of homebirth midwives creepily circled their wagons around her, I am persona non grata with that crowd to this day. Because I dared to say one of their precious cronies was anything but perfect. It is toxic.

She's going to abuse more women. She's effed in the head.

Thank you for speaking about this. You have my permission to use part of my story if you ever want to. It's important that people know the truth.

April 13, 2011 | Unregistered CommenterBranwen Maeve

I want to thank you for taking the time to expound on such a difficult subject.

Although my own two births were not traumatic, I do work with women who've had traumatic births. I run a Yoga workshop "Healing From Traumatic Birth" The stories these mothers tell after each session is over makes me either sad, or angry or both. Most of them feel silenced. They had no voice during their births and now when they talk, they get the standard response of "at least you have a healthy baby".

For me, this post helps to give a clearer definition to the variates of birth abuse. I'm going to pass this on to my local ICAN group. We have a good few mothers who suffer from traumatic births.

Love and Light to all the mothers out there who have been hurt - and a voice to those who've been silenced.

April 13, 2011 | Unregistered CommenterDeena H Blumenfeld

This is an amazing post. Thank you for writing it. I wrote (much less extensively) about "Birth Violence" for International Women's Day last year. I submitted it to their website and it was supposed to be published there, but it didn't ever end up appearing.

ttp://talkbirth.wordpress.com/2010/03/06/birth-violence/

April 13, 2011 | Unregistered CommenterMolly

This is a great article Barb.

I'm wondering why you left manual dilation of the cervix off of the birthrape section? I think of this as the most common type of abuse done by midwives (both hospital and home based) and is usually done after obtaining permission to do a vaginal exam.

A lot of the other things you discussed here I could comment in length on. You covered so much! Maybe I will be back after I think about all this for awhile.

April 13, 2011 | Unregistered CommenterJennifer Z.

Because I MISSED IT! Adding it right now.

April 13, 2011 | Registered CommenterNavelgazing Midwife

Jennifer: Re: the amount of material I wrote... believe ME! I *know* there's too much information. I told Patricia this afternoon I could use a really good editor in order to get this to a more manageable level where the information is clear AND concise.

I cried when I finished the post. I had to take a shower and cry with relief that all those words were written down. They've been caught behind a thick veil for far too long.

I told Sarah tonight that I hoped it would be an important piece, but I hadn't even considered the birth stories that would come in the comments and my email. The tears I left in the shower have returned with each birth story told.

April 13, 2011 | Registered CommenterNavelgazing Midwife

Oh Barb... My heart goes out to you and any woman who has seen, participated in or experienced this. I am at a loss for words, but I want to thank you for putting your heart on the line for the sake of ending the abuse. I'm not sure I could have done the same.

April 13, 2011 | Unregistered CommenterDiana

I read a paper on Birth Rape a few years ago and I knew then that this would have to be dealt with as it is so prevalent. HIS IS MY STORY. I need to tell my birth rape story too,

April 14, 2011 | Unregistered CommenterLynn Reed

We're listening.

April 14, 2011 | Registered CommenterNavelgazing Midwife

Molly, do you want to do a Guest Post with your great piece? I would be honored if you wanted to put it up here. It'd be a great companion piece.

April 14, 2011 | Registered CommenterNavelgazing Midwife

During my daughter's birth I consented to a vaginal exam. I was being induced and had been contracting all night due to the cervidil. What I did NOT consent to was to be handled so roughly that I bled. It absolutely ruined my birth experience. As a woman with a history of childhood sexual abuse this experience was immensely triggering and sent me reeling. What I find equally disturbing is that the "doctor" who did this to me was a woman. Thank you for bringing this to light and for telling women, like me, we aren't crazy. Because of the "authority" doctors have over us in those situations it is so easy to feel like I blew it out of proportion and was being "too sensitive."

April 14, 2011 | Unregistered CommenterHavinbaby2011

Branwen: Have you written your story anywhere? Do you want to write a Guest Post? Your story... I'm so, so sorry.

You're the 7th non-nurse midwife birth abuse story I've been told in the last 6 years.

I'm so sorry.

April 14, 2011 | Registered CommenterNavelgazing Midwife

Bimanual compression here. It's the closest thing to a violent sexual assault I ever hope to experience - they had to hold me down so he could do it, and I just remember screaming uncontrollably. The pain was out of this world; it felt as if he was punching me inside, over and over. I'd always thought that the worst pain was over once the baby was out, but no, that was definitely the worst bit. And they kept trying to put the baby on my breasts, and I kept sobbing 'No, no, take it away!' because I could not stop fighting to get up and away from the doctor and the nurses holding me down. I'm ashamed just typing that. I didn't know that placing the baby on the breasts can help the uterus start to contract and slow the haemorrhage; I thought they were out of their minds trying to give me my baby while they were doing that to me. My midwife apologised later for the doctor's manner. I had nightmares for months.

Tip for all healthcare professionals: when you are helping a woman by providing a lifesaving (if physically violent and invasive) procedure, you either need to a) explain what you're doing at the time, or b) return to debrief her later. And oh yes, don't pack up your equipment and leave her there alone shellshocked and shaking so badly that her baby is perilously close to falling off her chest, without even pointing out where the call button is. And finally, if she tries to ask you what the FUCK happened later on, don't fob her off with that 'You've got a nice healthy baby and that's all that matters' line, because if nothing else, there's a good chance that she won't ever be able to submit to a pap smear in the same way again.

Eventually, months and months later, the gynaecologist I saw about repairing the physical damage from the birth took the time to explain gently exactly what they'd done and why. I still don't know why nobody bothered to explain that to me soon afterwards. I got a uterine infection which wasn't picked up until eight days postpartum (trainee midwife palpating my abdomen for a few days) and which sent me straight back to bed with a fever. I'm guessing that that fist going into a raw uterus was probably the cause of that one.

April 14, 2011 | Unregistered CommenterT

I cannot, for the life of me, figure out why someone didn't talk to you... especially the midwife who said something to you right after! I am so, so sorry you had to suffer for so long, T. My heart breaks for your terror. And please, PLEASE try to forgive yourself about the baby on your chest part... nursing, while effective for clamping down the uterus, would (imo) not be nearly as effective as the meds they were surely pumping into you. I think it was ludicrous to try and get you to hold your baby.

Have you gotten your records to see what meds they gave you? Have you read what they wrote happened? Have you had another baby since? (I can totally understand if you haven't.)

Thank you for telling me your story of bimanual compression. I *knew* we needed to hear from others.

April 14, 2011 | Registered CommenterNavelgazing Midwife

I've put off reading this post due to its length, but WOW am I ever glad I got around to it! This describes exactly what I am afraid of happening -- what I am afraid already is happening. My comment is equally long, and you don't have to publish it. I just want to rant a bit and say thank you for helping me see where things are going. I really love your blog. :)

I am 27w1d pregnant now. I didn't realize that in my community (the medical hub of central South Dakota), I would be locked into seeing one particular OB. Because I was high-risk (obese, with a history of taking fertility drugs and three prior miscarriages), every other provider in town refused to take on my care. And this doctor is a ripe, stinky asshole.

Prior to pregnancy I had blood pressures in the borderline range at the office that were better at home. (Gee, I wonder why my BP is elevated when I go into the building where I learned of my last two pregnancies failing?) I was willing to start Aldomet and have stayed on it despite the awful side effects. The problem is that despite several dose increases, my BP keeps creeping upward -- combined with swelling, headaches, and blurred vision and floaters. But because I have a pelvic kidney that was releasing protein at my first 24 hour catch at 8 weeks, he says he won't even consider that I might be developing superimposed preeclampsia until my platelets and liver enzymes come back abnormal.

He told me it didn't matter that I was throwing up several times a day and was too nauseated to eat "because you have ample reserves, you'll be fine with just water." When I had lost 7% of my weight within a month, he finally backed down and agreed to write for nausea medication. And yet even today he continues to get on my case for not gaining appropriately (I am still 15 pounds down from my prepregnancy weight).

He berated me for ten minutes at my next office visit when, at 12 weeks, I went to the hospital for cramping with heavy red bleeding and clots. This was on a Saturday, at 7 AM -- FYI, his medical group does not handle anything that does not occur during business hours and specifically leaves instructions to call L&D with any issues during that time. He only shut up when I told him that I had called the hospital first and THEY had told me to come in. Even though the bleeding continued with physical exertion, he refused to prescribe bedrest, saying that "we'll worry about things like this IF you hit 24 weeks and the fetus is viable." I put myself on modified bedrest and the bleeding stopped by 18 weeks. Fortunately my employer was more open-minded than my practitioner!

He ignored my complaints of a week long stomach bug at 20 weeks. I actually had to wait until he was out of the office (every Friday, conveniently) so I could have a consult with a nurse practitioner who realized that I was severely dehydrated. Those diarrhea cramps that were getting worse and worse? Were actually preterm labor that stopped after receiving IV fluids.

At 23 weeks, he berated me again for not coming in sooner, "because with the fat patients, I like to get the glucose screen done earlier than this." I agreed to the screen, which as you may know has a cutoff for abnormal at 140 mg/dl, after which a woman requires the three hour glucose tolerance test. After the screen, I vomited up recognizable chunks of the granola bar I had had for breakfast and I knew there was going to be a problem. Sure enough, the screen came back at 142 mg/dl. He told me I was "dangerously diabetic", but refused to order the 3 hour glucose tolerance test that would actually DIAGNOSE gestational diabetes.

I finally stood up for myself and told him that I know the cutoffs for the glucose screen, that my result was barely elevated (and likely with good reason), and most importantly that it is improper to make a diagnosis without running a diagnostic test and if I saw the word "diabetes" in my chart I would sue him for improper care. He had a fit and told me that "he's the doctor, not me" and that if I don't like how he practices medicine, I can just find someone else to take care of me and hope I can do it before the baby dies. He reminded me that I'd need to move across the state to have access to a tertiary care facility. He also added that he would like to terminate my care at 30 weeks (knowing I'm on Medicaid and unable to just pick up and move without doing some serious damage to my family's living situation).

I keep putting off my prenatal appointments, despite knowing that my condition needs extra monitoring, simply because I cannot stand to be around this man. I don't want him to touch me. I sure as hell don't want him delivering my child. But I do think that I am too high-risk to consider a UC, which is my only option for homebirth. I would prefer to deliver in a hospital, but I am the family driver and I just don't think that I will be able to drive myself the 226 miles to the tertiary care facility while in labor (not to mention all the false starts!). Do you maybe have any suggestions for me on how to keep this bad situation from becoming worse?

April 15, 2011 | Unregistered CommenterManapan

Is there any other field of medicine so rife with the potential for abuse than obstetrics/midwifery? Is it because she's, for the most part, naked? Lying on her back? Legs spread? Is it because she's carrying a baby, and we forget that SHE is just as important as her passenger? Because we think a labouring woman is temporarily stupid and incapable of thinking or feeling? Do we really think she "forgets all about it" when the baby is laying in her arms?
Why is it that doctors, nurses, and midwives assume it's ok to be rough, yell, push, pounce upon, belittle a woman in labour?

Can you imagine an oncologist walking into a room and saying, "I'm just hanging this bag of medicine, don't worry about it, it will make you feel better" without discussing the risks/benefits and obtaining informed consent? Can you imagine a proctologist shoving his fingers up someone's rectum without introduction or permission? Yet it happens with labouring women every minute of the day, in every hospital, in every city and town.

When you work in birth, you get to witness it all...all the abuse, both physical and verbal. You get to witness the misogynist OB cut an episiotomy with a disgusting smirk on his face while the mother screams and begs him not to. You get to listen to a midwife berate a woman having a difficult labour, telling her it's "all in her head" that she should get over herself and have the baby, already. You get to see her legs shoved open, grabbed and put into stirrups or up by her ears, you get to see fingers put in places only lovers should go, and sometimes, you get to perpetrate these acts yourself.

What, on God's green earth, is the root cause of all this? Why is it we think it's ok to do this to labouring women? If we're going to put a stop to it, we need to figure it out. It's a prevailing attitude, perpetuated by the media in film and television, that pregnant and labouring women, or even women in general, are raving lunatics incapable of making rational decisions, who, like disobedient children, need an authoritarian firm hand to guide them, and even discipline them, in order to get their babies out quickly and safely. And like parenting, for some, discipline equals punishment.

And even women, like victims of domestic violence and child abuse, accept the blame for their treatment. How many times have we heard a newly postpartum mother apologize, APOLOGIZE! for her behavior during labour? For not pushing hard enough when being coached to PUUUUUUUUSSSSHHHHH! For making loud noises while being admonished to "breeeeaaaattttthhhhh!". For trying to escape probing fingers and painful exams while being told to "RELAX! You're making it harder on yourself!".

We've been so brainwashed into thinking women completely lose thier minds during labour it makes it easy to abuse them. How can you have a rational discussion with an irrational being? It's easier to just do what you have to do to them and not bother with trying to get them to understand what you're saying. If you think women are so out of it that they can't even hear you, much less comprehend what you're saying, and "won't remember a thing when the baby is in their arms" anyway, it makes it all justifiable. And if women believe, no, FEAR, that they are going to become crazed, violent lunatics who spew profanities, sweat, groan, grunt, roar, bite their partners and shit on the bed, we become even more susceptable to those who use our fears to abuse, coerce, and degrade us.

April 15, 2011 | Unregistered CommenterColleen, LM

My heart aches for you.

I'm sitting here trouble-shooting this with Sarah, trying to figure a way for me to come and be your Monitrice and driver, but there is no way I could do it. Can you see the tears rolling down my face?

Ideas to consider:
- Find a new friend in the city where the other hospital is and go there when you get the first twinges of losing your mucous plug. Stay until you've had the baby and are a week or so postpartum in case postpartum PIH/PE kicks up.
- Find a doula to drive you to the other hospital. This is probably the most feasible answer.
- Sarah insists on you recording this asshole OB and turning him in to the Medical Board of your state. She said to figure out how to record him on your phone, too. You could also consider bringing a witness with you to each appointment.

If I think of other ideas, I will totally let you know. Omg... I am just distraught for you. I know my distress is a fraction of yours... what a way to grow a baby, right? *giant hugs*

April 15, 2011 | Registered CommenterNavelgazing Midwife

Colleen. You are fucking amazing. I'm making your comment a post. Don't think you'll mind.

Sarah said you are a sister from another mother. :) She loves you as much as I do.

April 15, 2011 | Registered CommenterNavelgazing Midwife

I appreciate you bring this issue up. There are ways to many people talking about it, even less acknowledging it. Birth rape does not seem to exist in the OB/GYN world (I am including L&D personell, midwives, etc here). For some reason everybody just wants to do what they think is best. However, I have the idea regularly it is forgotten for whom this might be the best solution (for the woman or rather for the provider in order to cover their butt for potential lawsuits, etc. - defensive and in fact unjustified practice of medicine) and the woman seem to be forgotten during the labor process. It is like woman often don't count (it's all about the baby) and are not treated as a patient that can and should be involved in informed decision making about their body and the baby as well.

My birth experience was extremely terrifying. Actually the birth itself wasn't. But I had to be transferred to the ER as my placenta did not detach. I have to admit that I am a survivor of sexual child abuse which my partner told the staff upon my arrival. When I arrived at the ER, they first decided that they had to cut off my shirt even though I rejected! and have me fully exposed (there were about 22 people around me that officially took care of me but were mostly looking and staring at me). When I noticed that I was not given any chance but forced to take off my shirt, I offered to take off my shirt myself (no idea why I had to remove my shirt after all, there was no trauma on my upper body!!!) but they just cut it off. I requested that access staff which was just standing around and not having specific tasks should leave as they made me extremely anxious and uncomfortable and my partner asked that too - ONE member of the 22 nurses, technicians and Dr left. The doctor FORCED my legs apart, however stopped to continue after I told her that I did not allow her to touch me or I would sue for harassment otherwise (not that I really want to sue anyone, but I was just soooo terrified, I thought this was my only way to make her stop). I kept telling them that I feel perfectly fine and they only told me "you are not, so shut up about that" (I really felt perfectly fine, physically - my vitals were far off, but I did not know) Nobody of the 21 people did take even a few seconds to talk to me (other than demanding to 'open those legs and let us do our job', 'cooperate', 'don't behave like a complete fool'.), reassure me that I was safe and explain what was going on and what they would need to do.

I really wanted to leave and head over to the women's hospital next door where I thought I might be treated with more respect (again, I physically felt fine) but was too scared that they would drug me through the various IV's they had running and make me unable to make any more decisions if I'd decide to leave AMA. For over ten minutes they did not continue to treat me since I refused and fought them. (Later in my medical file it said that after repeated(!) explanations of what was going on and the needed procedures and the risks, I was cooperative - NOT ONCE did they tell me what was going on with the exception that I was not fine and my partner confirmed it to me later on that there was no communication whatsoever from their side).

Eventually I could not keep up fighting anymore, my anxiety was extremely high but neither fight nor flight was an option and I was becoming a rack doll. The dr. used the opportunity and forced her way into my vagina and uterus, gave the most excruciating uterus massage and I had three people press on my abdomen like plain idiots. I was screaming in agony due to pain and fear while a dozen people just stared between my legs and not one single nurse was trying to explain what was going on or to somewhat calm me.

I honestly think they completely overreacted. I did not have a significant amount of blood loss, I responded well to the saline solution which stabilized my vitals, no drugs nor blood transfusions were needed even though the placenta was only delivered about an hour past the birth of my child.

Even though everybody knew about my traumatic past, nobody seemed to care at all. Everybody was just focusing on one specific task they had (even though that could just be staring at my vagina!) and they did not care at all about the patient as a person. It was like I was a dummy they were practicing on.

I know they just wanted to make sure that I don't end up dying from PPH, however as a dr or nurse you should be able to see the patient as a whole and not just a certain body part. And they should take the time to tell what is going on and what they are doing (or had to do if there is really no time). Nobody talked to me, even AFTER things were done. The fact that those are doctors (a resident in my case) and nurses does NOT give them the right to just do whatever they think is right. Things need to be done under informed consent.

It has been over a year and I still cannot sleep at night, I have to think about this ER visit each and every night and I am awake for hours and am miserable. When I sleep I have nightmares. A female health check-up is completely impossible for me to do now. My husband can hardly touch me and when my kids touch me unexpectedly, I am freaking out. This experience changed me for the worse!

For me, having been sexually abused and raped tens of dozens of times, this was very similar to a rape experience (even though, I am aware they did not intend any harm).
Those aspects in particular
- removal of clothes forcefully and without consent
- unwanted exposure and voyeurism
- forcing legs apart
- unnecessary staff present
- language used towards me, demanding and forceful , top-down (not sure how to describe it well
- doing procedures on me (after babies birth, so the 'baby card' is no excuse here) which I have clearly not consented to and which I denied
- not caring for 'me' as a person at all just a plain interest in my female organs.

Sorry for the long post, it was somehow nice to vent and get this 'secret' out.

April 15, 2011 | Unregistered CommenterJen

I forgot to mention lack in treating me/women with respect and dignity as one of the things that reminded me of abusive behavior / birth rape.

April 15, 2011 | Unregistered CommenterJen

The thing is, I can't help but shy away from the term 'birthrape'. Rape carries with it a huge social stigma (still, even today) which violent, unwarranted medical interventions do not. Women who've undergone unwanted, unpermitted interventions during birth just do not face the hugely tangled burden of social expectations and prejudices which inevitably affect the survivors of sexual abuse. And does the intent of the perpetrator must make a difference..? I can acknowledge that there are similarities in terms that both violations involve an abuse of power manifested through the invasion of body boundaries, but rapists are not trained, as doctors must be, to believe that the forceful invasion of body boundaries is necessary in order to save lives...

Personally, I know that I see my body very differently now; childbirth let me know that what I'd considered precious and inviolable was not. That could happen to me. It DID happen to me. It could happen again. I inhabit my body more cautiously now. I think of it as separate to me-myself; perhaps because I'm now aware that the integrity of those boundaries can be so easily ruptured, that I can be violently breached without my permission. It's not a safe place to site my personal identity.

I did have another child, incidentally, but he came via caesarean. I signed permission forms for everything they did to me, and the surgeon talked to me as if I were a person. There were no nightmares afterwards.

April 16, 2011 | Unregistered CommenterT

Thank you! I never knew there was such a thing as birth abuse. But after the still birth of my first daughter I felt so violated!

It was the most horrible experience. I had to be induced at 21 weeks when my water broke, knowing that my baby would die when born. The male doctor showed his hand up my vagina 3 times to try to pull her out by her leg/legs. She had been breech with one leg stuck down my cervix. The pain was horrible, but the feeling of being raped even worse. And my baby, what was she feeling?

Later, midwives were pulling so hard at the cord it snapped and they tried to remove my placenta manually for what felt like an hour. It was horrible and I was bleeding so much. The female doctor said 'you are lucky I got small hands". I felt very lucky indeed, I had just delivered a stillborn baby. In the end I had to be put under to have the placenta removed and I needed blood transfusions for the blood loss.

And I had hoped delivering my baby would be dignified, respectful and peaceful experience. I knew she wouldn't survive and by the time she was born she had passed away, I always wonder what it was like for her.

April 17, 2011 | Unregistered CommenterKristin

Thanks for this very thought-provoking post. It should be on the required reading list of all student midwives and obstetricians.

April 17, 2011 | Unregistered CommenterMidwifeThinkinig

The birth of our last child, 29 months ago, was horribly traumatic. My husband agrees that what I was subjected to was sheer abuse. But, the doctor wouldn't listen, the 10 nurses screaming profanities at me laughed at me when I complained, and the hospital is known for not taking this stuff seriously. What recourse to I have? It's been 29 months, and I REALLY want justice for what I endured and was subjected to...including the fact that my husband and I refuse to have another child because I refuse to endure what I was subjected to. IS there anything I can legally do against the doctor, nursing staff, and hospital?

April 17, 2011 | Unregistered CommenterGen

I frequently reply in rebuttal to things on SOB, and I was directed here because someone mentioned you were "pathological" about your response to your c/s.. (whatever that means?)

Anyway, this post spoke to me....

I don't care about the name given to it. Rape, assault, whatever. (I was molested as a child so I do have that context)

I feel I was HURT during my birth. I was also given crap care..

I don't understand why they don't debrief women after long, traumatic, experiences like 20 hours at a hospital (after 2 days of labor at home) with an infection, an episode of extremely high BP (200+/120+), excrutiating back labor with pit, and excessive bleeding? Or why they don't own up to simple mistakes, like, giving you too much fluids? No one's explained to me why the high BP, what happened with the fluid overload, why the pit kept getting cranked, etc.

I just don't get it. I developed PTSD and I'm still struggling to sleep and to stop thinking about it. They didn't think I was "there". So, I had a fever. So? I could still hear everything they said and knew what they were doing to me!

So, I 'm pushing without a lot of yelling, after I'd screamed for hours beforehand, a lot of which was about food because I was STARVING after about 10 hours no-food, some of which was about them touching me without me knowing who they were or why they were touching me, (they also didn't give me glucose or anything.. they told me "sprite" was good enough) and just didn't have any more screaming left inside of me for a bit.. that means I've got an epidural (that they never gave me) and can't feel her trying to rip my vagina to "give my baby more room", or yanking like hell on the cord and I keep saying STOP THAT but she says she's not doing anything, or when she is sewing the stitches because she ripped me into my clit "making room with "gentle perineal massage"" so no lidocaine or whatever is necessary and then to suggest that a cath is a good idea because my uterus is a bit boggy because my bladder is overfull and I could just get up, greatest suggestion ever to be never made, but try to cath me with a swollen-to-hell area anyway?! Take 10 minutes trying to do that with me finally screaming again, horrific screaming, to me to finally say "I can GET UP AND PEE IF THAT IS OKAY" and they say "Oh! Okay! Why didn't you say you could get up?"

That's not to mention some of the comments that were made to me. One of which burned forever to my memory that I just don't get was somethign along the lines of "Why are you concerned about THAT right now?" when I was screeching "what are you doing to me? STOP THAT" when she was ripping at my vag and later again when she was yanking at the cord furiously. I also was yelling "What is going on with my baby?" inbetween those screeches but apparently no question deserved an answer. (My son was having trouble breathing AFTER they deep-suctioned him because he pooh'd on his way out of me and also had an irregular heartbeat due to a potassium deficiency at birth.. None of which was info I was apparently privvy to til HOURS after my son's birth.. they didn't tell me ANYTHING, I asked .. and asked ... and he'd been stable for a long time before they finally told me I could see him, and didn't tell me what happened).

Really? They thought I would just forget all of that because I had a fever?

And that isn't even everything that happened. It'd be a long, long, story.

A story that I hate. And apparently I'm just too self-obsessed to see that it shouldn't matter... because "all that matters is you are both healthy now!" He might be, after his week long NICU stay that was hellish and filled with errors and gives me as many nightmares as his birth, but I was and am not healthy.

I just wish people in that field could stop and see what they are doing to some women.... So they'd stop doing it. Names aside. Stop doing that.

April 17, 2011 | Unregistered CommenterElElRi

Oh and, I'm sorry my first reply doesn't contain more "I agree with you on the legal and ehtical aspects"... reply.

I do agree with you and I did digest all of what you wrote... I'm just struggling emotionally with my own story and this post absolutely triggered that... Triggered my hurt and anger ...

Yes. We need more representation for women who are hurt.. hurt at home.. hurt at centers.. hurt at hospitals. HURT. They need louder, better, less biased voices and better, less biased resources to turn to when things go wrong for one reason or another ( be it an incompetent CPM or a psychotic CNM at a hospital or an OB with a god-complex).

Women need better. Far better.

April 17, 2011 | Unregistered CommenterElElRi

I feel so many things reading your post and the comments below. I will be starting my midwifery training in September and can safely say I have learnt so much reading this; sadly in my work as a midwifery assistant I have seen what can only be described as birth abuse - "informed consent" that isn't informed, women told they just need to relax when they are closing their legs and asking for the dr/midwife to stop, lack of communication when doing a procedure or during/after an emergency. I could go on, but its upsetting to suddenly realize the things you've seen are abuse.

I will carry the thoughts of this blog with me through my training and beyond, and will never treat my women the way your commenters describe.

April 18, 2011 | Unregistered CommenterDawn

EIEIRi: Hrm... interesting that I'm "pathalogical" about my c/s... especially since I've never HAD a c/s.

And all of y'all sharing your stories. I'm just shaking my head in disgust at your treatment and wishing there were enough words to express sadness about your on-going trials. It's so not fair.

Dawn (Stone): Your comment is *exactly* why I write. Thank you for helping me to feel I have done something good today. (It's been a long night that ended in a c/s with complications. I wasn't responsible for either, but still feel very sad for the family that tried so amazingly hard to have a beautiful natural birth. Thank you for your kind words.)

April 18, 2011 | Registered CommenterNavelgazing Midwife

ROFL, pathological response about a c/s you never had! I didn't know ;) Sorry, I guess I'd need to read more about you. It would've been a good response if I'd realized that.

April 18, 2011 | Unregistered CommenterElElRi

My heart breaks reading this post. And the fury surges too. I resisted midwifery apprenticeship because of these issues. It seems to me that modern midwifery routinely hurts mamas and babies. All the position suggestions, vaginal checks, AROM, placenta obsessing, and frickin picture taking, the patronizing dietary recommendations for GD, and all the "management" crap!

I had a very traumatic birth with midwives and they were "great midwives," home-birth midwives. How could they be so lost? It has taken years to process it and I am still working it out. Our second birth was unassisted with a "guest midwife" - who still managed to insert herself between me and my baby during the hour she was there! It was overall an amazing, empowering, cosmic rite of passage nonetheless!!!

Now, I work with mother's who want to prevent and heal from birth trauma using Somatic Experiencing developed by Peter Levine. It has changed my life and also opened my eyes to the amount of trauma we carry with us day to day from our own births - when we came in. Nearly ALL of our mothers were subjected to inhumane treatment and we, in our most vulnerable moments as newborns, were manhandled and abused.

AND, we have an amazing opportunity to take birth back from this sick witch hunt!

Thank you for your authenticity, rigor, and courage. I am now a raving fan!

Krista

April 18, 2011 | Unregistered CommenterKrista Arias

Krista: Thank you for your support... and thank you for your healing work, too. I'll have to look into the Somatic Experiencing... I'm not familiar with that. And yes, I absolutely agree, the great grand majority of us, probably around the world, have been birth traumatized and, far too many, birth abused. Again, thank you for your work.

April 18, 2011 | Registered CommenterNavelgazing Midwife

Thank you for writing this post. I first heard about birth rape a few months ago and was skepticle about the name...not that it doesn't happen just the name...but I really like the way you broke it down. I like the use of birth abuse. I would never tell a woman that she is wrong designating her birth abuse as birth rape. Because it is how she feels that is important.
I haven't experienced birth abuse myself but I know a few people who have.
My close friend didn't have birth abuse but rather prenatal abuse when she was pregnant with her first. She didn't know anything about what was normal so her male ob gave her breast exams and vaginal exams at every appointment her entire pregnancy! Oh how I wished she had told me! I've wanted to be a midwife for as long as I can remember so I knew even though I didn't conceive my first child until a month after she gave birth, that that was WRONG! I didn't find out until she was pregnant with her second.
My best friend's mother was told by her ob to 'shut up it doesn't hurt' and smacked her thigh, while he was stitching up an episiotomy with no numbing agent moments after delivering her 3rd child. This was caught on tape!
I have more stories like this, which is exactly why I decided to birth at a maternity center...I wanted a home birth but the thought terrified my husband (not exaggerating) so we compromised. He would be fine with it this time around except our insurance won't pay for it, and we can't afford to pay out of pocket. On top of the fact that we now live in a tiny apartment with very thin walls, I wouldn't feel I could relax and be as vocal as I needed, so hopefully all these factors will have changed by the time we decide to have baby #3.

April 25, 2011 | Unregistered CommenterCyndel J

Women DO deserve better. By comparison to everyone else, I had very little abuse in my birth history. But, I had some, and it was enough to change how I did things as a midwife forever.

My first birth, in the hospital, the Dr (a woman) walked into the room, laid the bed flat and announced to me "you're laying down, we're gonna have this kid today". Yep, cause you want to go home for dinner huh? She pulled the baby out causing a tear, forgot to let my husband cut the cord, stitched a first degree tear all while I was saying 'please don't suture me' and 'I can feel you (no epidural)!'. She invited her med students in to watch my natural birth, then took my APGAR 9 baby so they could examine an unmedicated baby. All I could see from my bed were the backs of the blue scrubs. And all I could hear was my screaming baby.

My second birth was a DEM attended homebirth. Midwife was with us 9 minutes before the baby arrived. No problem. We were ecstatic. This was how birth should be.

We invited the same midwife back for our third birth. She arrived half an hour before our baby. Things were fine until she decided she needed to stretch the perineum. This was my third baby?! It hurt a lot. I asked her to stop, She said 'No, I have to do this.' No, no you don't. When you touch a woman and she says "stop", you had better STOP. She was not invited to attend babies 4 or 5.

As a provider, the letters after your name are not indicative of whether or not you will abuse a birthing woman. She is not your project, your victory or your property. She owns her body. It is your honor, your privilege, to be present to assist her in any way you can. With very rare exception if you have time to DO you have time to ASK FIRST.

April 26, 2011 | Unregistered CommenterErika

I always get a little ...annoyed? when I see the word "birthrape" as I am a rape survivor and it's hard to visualize what happened to me, with what could happen during birth to call it 'rape'. I know rape is about power, not sex, but still somehow, I'm still having trouble with it.
When my son was born, he had suddenly gone into distress. THe door flew open, people flew in, mask was thrown on my face, my legs parted, etc. The doctor did an episiotomy and then used his fingers in my son's ears, as forceps. Not much was said to me at all, but I never felt traumatized by it. I DID however, get mad later, looking back, on how the nurses wouldn't let me push--I got to 10cm and had no urge to push, so the dr. "ordered" an epidural, then left the hospital. The anest. was in an emergancy surgery with no estimated time to finish. THEN, I started to feel like pushing, but no one would "let me" until I got the epidural (3 hours later).
It's interesting--and I'm SO glad you mention this--that different women respond differently to things...what's abuse to one might not be seen that way to another. I got more mad that my OB pushed my hand away than I did when he suddenly gave me post-birth IV.

I think humiliation and power trips are an issue in MANY aspects of medicine. I've recently gotten it from my endocrinologist too.

April 28, 2011 | Unregistered CommenterTracyKM

This is the first place where I have ever seen that perineal massage/stretching is not looked on with favor by everyone in the NCB community. Could you elaborate or point me to a another source or an article you have written about it? I only ask because I had a stupendous homebirth with my first child, and am about to hopefully repeat the experience again. However, I am reevaluating things that happened to see if there is anything I can do to lessen the chance of tearing again. We (hubby and I) did gentle PM in the weeks leading up to the birth, and my CNM had me slow down towards the end of pushing and did some stretching, through about 3 contractions, to try to prevent tearing. My DDs head was 95th percentile, and born with nuchal arm, so not sure if tearing was inevitable or not. My birthing position may not have been the best to avoid tearing, I am evaluating that. But I need to know more about perineal massage and stretching...

Have been enjoying reading through many of your blog posts, and especially the interactions you have with people in the comments sections. Very distressed by the trauma that happens to people during birth, as highlighted by this specific post.

April 28, 2011 | Unregistered Commenterkatie in va

Mine was pitocin.

I was pressured into inducing at 40 weeks (fought, they wanted 38 weeks) with a Bishop score of 0 due to GDM. They turned the pit up SO HIGH that I was having clustered contractions that lasted 5 minutes with 2-3 peaks each with about 30 seconds between. I was hoping for a natural childbirth - but was on continuous monitors due to the pit and couldnt move around - I did NOT have an epidural.

I told them to turn it down, it was too high (and btw, I AM an MD, not an OB, but I am a pedi and have spent many hours in L&D), and they outright refused. I asked to have help with positioning differently (not on my back) - refused. 19 hours later, I caved and asked for an epidural - which didnt work, and all of this ended up with a c-section that came after 28 hours of transition-level labor that I FELT b/c the epirudral (on #3 by that point) didnt work. I refused to let them put me out, though.

Im 20+5 right now, new hospital, new OB...planning a VBAC. Im too chicken to do a homebirth or birth center - not for ME but b/c of no NICU access....I know too much...

May 3, 2011 | Unregistered CommenterStarflyr

A local doula, who happened to by my Bradley teacher posted this on Facebook. I was fortunate to have two peaceful, beautiful and for the most part uneventful births. My midwives were respectful, loving and guided me through a terrifying, but incredibly empowering experience both times.

My heart breaks for these women. I can't even fathom having my dignity robbed from me in the way so many of the women who have commented on here have, in the way I hear lots of women on my birth board speak of their labors and deliveries, and in the way that seems to be becoming more and more the norm.

My son was born gray and needed to be whisked away to NICU. My midwife sent my husband with him, and the nurse stayed with me until I fell asleep and checked in every fifteen minutes for the mandatory recovery time. As soon as it was allowed I was cleaned up and escorted to the NICU unit with my husband and newborn. Even in emergency situations women should be informed, talked to, and made part of the decision making process.

I hope this movement gains the strength and power necessary to reform birth and to return the POWER back to the laboring woman, where it belongs.

May 11, 2011 | Unregistered CommenterMariah Engel

"My ultimate dream is that medical and midwifery establishments “get” it and understand their behaviors as abusive and they take a collective vow to never cross the abuse lines again."

I'm in the UK where there is less recourse to litigation but a standard complaints procedure for the NHS. I made a formal complaint about my birth experience which traumatised me so much it contributed to me being detained for 3 months in a psychiatric hospital. Initially the complaint was taken seriously and apologies were made, however the abuse I experienced was carried out during surgery a couple of hours after giving birth to repair a 3rd degree tear and was considered 'routine' and therefore acceptable.

I was belittled when I expressed concern that pain relief wasn't effective, disbelieved when I said I could still feel my legs, strapped down agaist my wishes with no time taken to reassure - just a statement that it was necessary, ignored and treated as an object during the hour long procedure when I was exposed, the staff gossiped to each other, and unintroduced people walked in and out of the room to examine, probe and stare at my intimate parts, and later, dismissed with a referral for 3 months time and no further information or support offered when it became clear I was utterly dually incontinent.

They knew from my notes and birth plan that I had mental health issues - my baby was having to be monitored because of the psychiatric medications I'd been on. They knew I was exhausted and in pain from a labour spanning 3 days and a mechanical delivery. They knew I was a highly anxious individual due to previous medical trauma - I'd been sure to tell everyone and write it all over my birth plans - my birth partner had also told them... yet they made no effort to treat me as anything but a 'case of 3rd degree tear' and force me to conform with the routine hospital procedures without taking my own (mental) needs into account. And for this they made no apology because it is simply the way that it is.

It isn't recognised that their 'routine' actions contributed towards horrendous personal consequences for me and my baby. I have no recourse to gain compensation of any sort for the loss of 3 months of my liberty and 2 years (so far) of mental health, the career I have lost (I'm a single mum and am now reliant on welfare benefit as I am incapable of working at present), the savings and my family's money I have had to spend on my own care (there being no NHS facilities to provide adequate psychological therapy) or the fact that I am not able to have the further surgery recommended to recify the ongoing incontinence because my mental state is too vulnerable as a result of the trauma - hell, I can't even face a smear test or a trip to the dentist.

It makes me angry that the medical profession seem incapable of understanding that what is routine for them is not for their patients and that mental fall out, if recognised at all, is an inevitable and unavoidable part of the process. The only reaction seems to be: "Well, you're OK and your baby is OK, what's the problem?" Yes, physically I'm alive, but I nearly died from the suicide attempt and I'm still dually incontinent - does that count as being 'OK'?

It's this paternalistic attitude towards healthcare which needs revising, and 'do no harm' needs to apply mentally as well as physically.

May 15, 2011 | Unregistered CommenterJenny (UK)

Jenny... I am so sorry. There are no words adequate, so please know how sorry I truly am. If you email me, I can put you in touch with another woman who had a similar experience and was finally, after *years*, able to have the reconstructive surgery she needed. And not that it really matters because abuse is abuse is abuse, but her butchering came from a well-respected CPM. NO obstetric professional is immune. And sadly, neither are we.

May 15, 2011 | Registered CommenterNavelgazing Midwife

Thank you... You/We are no alone. A devastating birth story has just flooded my area and so many doulas are effected by it let alone this poor family who had so much stolen from them. I am angry... confused of my doula role... and wanting something more for women in this country.

May 26, 2011 | Unregistered CommenterShanon P

If you need someone to talk to privately, let me know. I'm glad to help women process... doulas, too. I'm sorry you're having such a hard time. *hugs*

May 26, 2011 | Registered CommenterNavelgazing Midwife

Each of my three births has some form of Birth Abuse. OBs, nurses, midwife - it doesn't matter. The perpetrators do come in all different genders, sizes, backgrounds, education, etc. As I was reading this I even realized I was more violated my last birth than I wanted to admit. It has been in the back of my mind but this post just validates everything I instinctively felt about my experience. And women need that! We need validation. We don't need to be told we're emotional and crazy and dramatic.

I've had my uterus "massaged" (errr pummeled by a nurse), I've had my placenta tugged on while being pummeled in the gut by a nurse, I was told I had to drain an entire bag of Pitocin when I asked for them to take if off (after baby was born, no signs of hemorrhage, etc.), I've had my baby's head pulled on instead of being allowed to birth her which caused a broken clavicle (report stated NO shoulder dystocia), I've been given perineal stitches without local anesthesia, I've been yelled and screamed at to push while being told I had to hold my breath (against instinct), I've had vaginal exams (including manual cervical dilation) while expressly telling the midwife "NO!", there have been membrane sweeps and my water broken without consent. It's a long list and I'm sure there may be more, more subtle things I may not have been focused enough to see or hear. But my husband and his mom were there; they saw things done that should not have been done.

And those doctors and that midwife were not necessarily "bad" people. But their approach is wrong, wrong, wrong and a lot of women are being hurt daily under their care.

If a doctor came up to a man and pulled his legs apart to give him a rectal exam without a word, without any kindness, without consent - do you think that man would have taken that? But women (AND their babies) are subjected to all forms of abuse and a medical license covers it all up in court. It has to change!

And I just wanted to tell you that I was at first shocked to learn you are a former perpetrator and writing all of this - but you can't even begin to know how much it means to women who've been through Birth Abuse to see someone come to the knowledge of things they did wrong and strive to make a difference! I can't imagine the sorrow you feel for the things you were taught to do and I can only say how happy I am for you that you're on the "other side of the fence" so to speak. How many more midwives, nurses and even OBs are being trained and taught that what they do is okay? We have to speak up, we have to be heard.

You or Patricia are free to message me for more information if you want. I'm not entirely sure what to write to either of you unless there are specifics to ask me. My email is in my profile. I will most likely miss any responses on this thread so emailing me is the way to get ahold of me.

May 26, 2011 | Unregistered CommenterJoy

Manapan - where do you live? I am a doula in Mitchell, SD and would love to help you if I can. Navelgazing Midwife, is there a way you can get Manapan my info - at least my email address?

May 26, 2011 | Unregistered CommenterEvie

It's here in your post. Thank you for your kind offer... it is so wonderful of you to do so.

Joy: I am so sorry for all your pain. 3 births? Just so unfair. I'm so sorry.

May 26, 2011 | Registered CommenterNavelgazing Midwife

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