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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 (1)

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Reader Comments (64)

I am so grateful I stumbled upon this blog. My husband and I are TTC and I've been thinking about home births only. After reading this and so many other articles, I'm totally convinced. I also now understand that not all midwives are godsends (as some women have shared) so when I do look for a midwife, I will make sure to interview carefully and if she ever gets rough and I'm not gettng my point across, my husband is very loud mouthed so he will get the job done for me. My heart goes out to all these women who have experience such abusive births. Such an amazing and special experience is met with cruelty.

July 4, 2011 | Unregistered CommenterAshley

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

I called the Police when I got home. I was told that as it happened in a hospital, they would not act. I asked if they would act if it had happened on the street. they said yes, but refused to touch an assault charge in a hospital.

The NMC said that they were satisfied that the midwives had acted in my best interests durting an emergency delivery. It was not an emergency, and I had a six minute second stage - ventouse, yelling at and hair pulling for "FTP"... The NMC also said they had had letters from the midwives that explained their actions and if there was anything we wanted to refute they would look at it again - but as the midwives concerned refused their consent for me to see the letters, of course trhis didn't happen. I did write back to the NMC asking them to please explain where in their own codes of condcut any of my treatment was acceptable and they just replied that they were sorry I was disappointed - from listening to other local women, nothing has changed. This was Bedford Hospital UK.

July 7, 2011 | Unregistered CommenterJane

Thank YOU, Barbara!

What a GREAT piece!

I would LOVE to hear what Nicholas Fogelman MD would have to say about this GREAT and important perspective! I believe I will ask him to comment!

Kim Mosny, CPM
Home Birth Midwifery Service
Richmond, VA

July 7, 2011 | Unregistered CommenterKim Mosny, CPM

Jane: I hope that even though you're in the UK, you'll contact the lawyer mentioned at the beginning of the piece. She certainly can't help you legally, but your experience can, I am sure, help others. My heart breaks for you and what you were forced to endure. I am so, so sorry.

And Kim... thank you. :)

July 8, 2011 | Registered CommenterNavelgazing Midwife

I worked in a nursing home for many years and was drilled repeatedly about patient abuse. Many of the items on your list were covered during our instruction. Obviously things that are specific to obstetrics were not but de-humanization, being forced to wear hospital gowns, being touched without permission and physical force etc... were offenses that resulted in immediate termination and in one memorable case, prosecution. This treatment of patients is not tolerated in any other medical field. It should be no different for pregnant and laboring women.

July 9, 2011 | Unregistered Commentertara

Thank you for writing about this. I had a traumatic assisted delivery with my son. Initially, I was happy that the medical staff did what they had to, but over time I have become less and less so. But I feel embarrassed about seeking help. Why didn't I do so before? I don't really have an answer.

Of all the things that were done to me, the one that made me cry right after I got home was the one everyone else thought was stupidest. When they prepped me for a c/s in case the forceps failed, they explained what they were doing at every stage except for when a midwife shaved my pubic hair. She just started doing it without asking or explaining. I have never shaved there, and she laughed and said I was getting a free Brazilian. And every time I saw it as the hair grew back, I would feel awful.

It seems stupid, but it upset me even more than the recurring memories of the doctor ramming his hand up me to figure out what angle my baby's head was at, and that made me lift off the bed screaming. When that happened, my husband objected, and I told him to leave it, even though I had felt coerced into the VE, because I felt stupid complaining about something I had allowed. I was complicit in my own abuse. I think this happens to many, many people. That is why I fear using the term 'abuse', even though in other circumstances this physical act would clearly have been rape.

I have had an ongoing uterine infection for the last two years, as well as wounds that took over six months to heal, but no one can find out what is wrong with me because I cannot stand the cervical exams - I go into spasm, and it is absolute agony. Sex is also sometimes painful, and I am angry that I have ended up like this, but I don't feel that there is anyone to blame.

I have looked at the Birth Trauma Association's website, but because I don't have PTSD symptoms, I feel like my problems aren't really serious enough to warrant sympathy or attention.

So thank you for writing this. You have made a difference to me.

July 9, 2011 | Unregistered CommenterGrace

Wow! So many stories! I was a Doula and when I say I can't stomach hospital births and explain to people why I stopped they think I make things up or it must be an exaggeration. I've even been called a liar. By the way, you missed anesthesiologist in your list of abusive care providers. At one hospital I witnessed on more than one occasion the Anesthesiologist who came to do the epidural calling the laboring woman names such as "F**king B***h and berating her for it being "your own fault your in this situation!" Also refusing to wait to do the epidural until the contraction ended instead making them move in the middle of one. Apparently he wasn't getting paid enough per minuet to take the time to wait! Than a good chunk of women under his care that I either worked with or spoke to ended up with complications from spinal headaches, their own fault for moving around (I heard him say that to one woman and I SAW said epidural she did NOT move!), to on going back pain associated with the epidural. One woman with a VERY nice understanding doctor at a different hospital was being induced for PIH. She was so scared because of her previous experience of getting an epidural she asked the doctor if he needed to section her to give her a general. I explained to the doctor why and he asked if I could reassure her that it wouldn't be like that there. He later thought she could use one to get some rest after 45 hours of trying to get labor going. I happened to agree. She was so scared when the most gentle, caring, and quiet woman came in and sat for 15 min and spoke to her about anything but epidurals and than gave her the epidural. Not long after a good hard rest pit was restarted and baby was born- no section and no problems. Very happy mom! It shouldn't be that women are terrified of care providers or what at that point was necessary to allow mom some rest to avoid a section. Than there is the many times I've heard mom say "I don't want...IPC, IFM, AROM, VE or some other procedure and that very thing is the next thing done to her during a contraction! Or when mom ask, "What are you putting in my IV?" and is given the brush off, "Oh it is just something your doctor ordered." The mom wanting to know why the doctor was pulling on the cord instead of waiting for the placenta which caused a hemorrhage. Only to be told, "I wasn't pulling, I was giving it positive traction." Whatever! That mom is a friend and now jokes about "positive traction" with me whenever she can fit it in.
Than there is the young teenage mom who confides in me, "I know I'm young, black and poor but I'm human but I deserve to be treated better than this!" Later only to be allowed to briefly see her baby and not even hold her because, "we're real busy, we need the room more than you do. You'll get to see her when you get moved to the next floor." Than less than 10min after birth to be wheeled into a STORAGE CLOSET with no nurse until said room on said floor is ready. I had to repeatedly find nurses while she laid there for more than an hour by herself with no care! Apparently that was to be done by the next floor when they came and got her! Isn't this what you expect in a developing nation without "adequate modern" health care?
I've always wondered how bad things could get at hospitals if this is what happens when I'm there with a mom and have identified myself as a doula. My own experiences have led me to walk out AMA twice now and on more than one occasion be told I'm a BAD patient. As you might guess I tend to speak up. If that makes me a bad patient than let it. Be it the 3rd year med student who walks in sans introduction, white coat or name badge and ask for me to pull down my pants so he can do my group B strep test now. "HUH?" My response to him holding my hand out, "Hi, my names' Laura and I'm guessing that your not a pervert but a med student who has forgotten to at least put your name badge on after lunch. By the way, introductions are better way of doing things than just walking in and asking a woman to strip. For a second there I was thinking you thought I was a stripper or something. It is sort of disrespectful and demeaning. I'll speak up but other woman wont they'll just take it thinking they deserve it. This sort of thing is VERY unprofessional. You just need to learn that little things like introductions and name badges make women feel better and respected." He immediately introduced himself and apologized and started looking in his pockets for his badge only to discover he left it in his lab coat. He did retrieve his badge and show it to me before I left and apologized again. I'd like to think he'll be a better doctor because of it. However, I decided to not let him examine me and said I would have the Dr do it next week himself. The PA came in afterwords and dismissed my concerns about lack of introduction or credentials as me being a difficult patient. Than she start in on me for refusing to disrobe and let him now do the GBS test by playing the dead baby card, "You can get GBS from anything including from just shaking my hand! Your baby could get very sick and even die" I told her I hoped she washed her hands better than that. Another time a doctor wanted to induce me for LGA, except he wanted to use Cytotec . I told him he could induce but I had a j incision from a previous section 13 months prior please use cervidil. He sad no and we had an argument about 200mg oral of Cytotec every 4 hours augmented with pitocin being fine for my uterus. I told him I liked my uterus and at this point had further use for it. At some point he pulled out the old "and which medical school did you go to?" at which point I told him the term I knew without medical school was AMA. I was going to leave and have sex with my husband for a few days and than come back. He continued to berate me and said that sex was more likely to cause uterine rupture than Cytotec. I asked him to show me the research because I could find studies on Cytotec and c sections. He said there wasn't any. I left. I wonder what would have happened if I didn't know to speak up? I already have a slightly increased risk of uterine rupture due to the scare I have. I find myself playing the "dead baby " and mom card to myself.
These and many other experiences of my own have left me personally with an almost adversarial feeling toward medical professionals. I feel this makes me a BAD doula. I find it hard to keep my mouth shut when I see out right abuse and not just say something or intervene on behalf of the mother.
've had to remind myself that not all hospitals and medical professionals are like that. I'd like to encourage woman that there really are good hospitals, doctors, nurses, and midwives out there. Ask around. When you find them tell them what you've been through and why you are now scared and concerned. It can be very healing.

July 9, 2011 | Unregistered CommenterLaura

Laura: It's rather stunning the number of negative experiences you've seen and been a part of. It's clear you're attitude colors your perception of things.

Describing the Med Student who wanted to do the vaginal exam without an introduction? Good god, woman, do you *have* to come at him with knives a'blazing? Can't you teach him without stabbing him to death? Isn't there something to be said about honey instead of arsenic? Wow. I would *cringe* to have to give you care of any sort.

I hope you're able to re-group and find the good in what doulas offer in the hospital, but you are right... until then, not working in the hospital is a darn good idea.

July 10, 2011 | Registered CommenterNavelgazing Midwife

Colleen said: "What, on God's green earth, is the root cause of all this?"

That would be the patriarchy. Many people are afraid to see a birthing person in their full power, because cismen are unable to accomplish birth and are thus afraid of it and try to take control so that they can attempt to have power of the situation instead.


Navelgazing Midwife, will you please consider including "episiotomy" in "Birthrape"? It's a violent penetration as well.

I'm really glad that you included "Physically restraining a woman who is trying to change positions," in your definition of Birth Violence. I myself have experienced this. I couldn't figure out what it was besides being forced to power push that was making me feel off about my birth experience. My midwife made me move from my birth tub to my bed to push while baby was crowning since she couldn't find baby's HR while baby was in my birth canal. (Btw, isn't that normal??) This is my most vivid memory of my labour, unfortunately.

Thanks so much for writing this piece; it's so poignant and powerful!

July 10, 2011 | Unregistered CommenterUndisturbed Birth

Another nurse-midwifery student who just wanted to say that I hear you all loud and clear.

July 13, 2011 | Unregistered CommenterP.Tuscadero

P: Thank you. Women thank you. Doulas thank you.

Much good-luck in your career! Thanks for reading here, too.

July 13, 2011 | Registered CommenterNavelgazing Midwife

My birth abuse occurred during my miscarriage when they insisted on inserting a catheter in order to fill my bladder with fluid to take an accurate pelvic ultrasound. This was not an emergency and I was not given the opportunity to drink in order to fill my own bladder (this was after a 4 hr ER wait with nothing to eat or drink). I struggle because I *knew* better. I could have fought back and I didn't. I didn't. I just let them do it. I knew that it was bullshit that they had to use the catheter. I had had early transvaginal u/s and knew that I could drink several big glasses of water, wait 30-45 min and be good to go. This was pregnancy number 7 after two losses (one early and one late) and 4 births. I was/am a doula and a childbirth educator. I had already had two homebirths with a midwife who had shown me what respectful birth care looked like. There was no reason for me to allow it to happen and it was awful. Awful when it was happen and awful physically for days after.

I still don't know why I let them do it and I'm angry with myself for not being stronger (yeah I know all the stuff we say to women when they say that, but it doesn't help).

When I lost a baby at 26 weeks my OB felt it best to begin the induction quickly. I don't necessarily disagree with her, but there really wasn't any discussion about options. She also had information which led her to begin the process with 3 days of laminaria insertion into my cervix. It was so incredibly painful that I would cry out in her office as she did the procedure. Fortunately they did not shame me for this. But looking back I wish I would have been offered options.

Prior to all of this was an experience that I can't yet talk about. But was around my first loss. Each of my birth abuse scenarios could not be "excused" with well what's really important is a healthy baby because there never was a healthy baby.

As a doula I have witnessed birth abuse and birth rape. I was taught not to name it for the mother as it could potentially negatively color what had previously been a positive experience. I did not have follow-on contact after the first month or two with most mothers so do not know if it was something they struggled with later. I don't know how to find that balance as a doula.

As an IBCLC I think that overall I have been respectful of families. I do ask permission of both mother and baby before contact and do my best to be present with the goals and experiences of the family. I did, however, take note of calling the mother "mom" as being dehumanizing. I am just awful with names - and my own personal issue with intimacy lead me to be uncomfortable with strangers using my first name - so I do tend toward the use of a generic "mom" and "dad" when addressing parents. As I said I don't like my name being used so I feel uncomfortable using it for others, but I am certainly going to think on the issue more fully.

Thank you for pushing this dialogue forward. It is essential that we have this conversation.

July 21, 2011 | Unregistered Commenterjessica

Thank you for sharing this on your blog. I think you're doing good work by looking into the things you've done and seen & making personal changes in yourself!

I'm a firm believer in that a person can be as sorry as they want to be, but if they're not ACTUALLY looking at those things they're sorry for, to better themselves & make changes in their behavior, it won't help anyone- this is why I'm not sure getting care providers to apologize is worth it, other than to *hear* it for yourself. I think their behavior is such a norm to them, that any apology is just lip service. (I don't want this to seem directed at you, but in response to the part in your post about getting CPs to apologize after their traumatic behavior, or after it's been expressed that they traumatized a woman.)

As for me, I'm a struggling survivor of PTSD, due in large part to my birth experiences (& prior gynecological experiences & domestic abuse).
Related to my birth history, I trusted my first OB- first mistake. Personally I feel now, never trust your CP because it clouds your mind.
It's amazing how a perfectly normal pregnancy & very healthy baby could necessitate an "emergent c/s" because there happened to be an open slot in the OR. After a nurse trainee (later discovered) spent 20min TRYING to insert a urinary cath, I was escorted into the OR, holding my gown closed in back & holding my urine bag in the other hand. Sat on a narrow surfboard of an OR table, struggling to balance while the anesthetist barked for me to bend over more. There were about 10 staff in the room doing various things, they'd occasionally glance over at me sobbing & terrified on the table, but it wasn't until I made eye contact with, what looked to be a nurse in training, & begged her to come hold my hand, that anyone gave me a second thought. After they got the spinal in (after 9 unsuccessful attempts & amazing pain), I ceased to exist to them, except to mock me because I was terrified & sobbing.

The lack of control was quite apparent after they sent me to recovery when they promised to bring my HEALTHY baby to me for over 4hrs. When I got yelled at by an eye-rolling recovery nurse for throwing up on myself (after trying to get her to bring me a bucket).

It continued when I suffered from PPD and sought help from my 'trusted OB' who sent me to his hospital's ER to get help from a 'team of professionals trained in PPD'- YEAH, I almost got forcibly removed from my STRICTLY BFing baby & placed in psych because some out-of-county "crisis counselor" knee-jerked.

Baby 2 was going to be a HB with a really great MW who I loved but could never trust (see above). I had shadow care till I fired them at 20wks after being YELLED AT because I dared to question one of the partner's 'interpretation' of some ACOG guidance @@. Unfortunately after a perfectly (more than before even) healthy pregnancy & baby, we had a sudden unexplained stillbirth at 37wks. Thankfully it was my MW who confirmed it for us.
We opted for a hospital birth at this point because neither me or my husband could come to terms with a HB then. We were supported by our MW waiting until labor started, then we went to the hospital at 4-5cm & bulging BOW. Everything went quickly until the OB (the nicer partner of the fired shadow-OB practice no less!) came in. Actually argued with me about needing an epidural till he caught me in a contraction when I told him to "get the F out of my room!" Pushing out my baby's shoulders, I felt a familiar sting of a needle, only to jerk my eyes open & screaming at him to stop, he informed me he was giving me an epis because I "might tear". After a few profanities thrown his way, my husband told me later that he never put the scissors down, only hid them behind his back.
After they took baby to clean her up some, he forcibly removed my placenta (traction doesn't even begin to describe it!), then convinced me in my tired & emotionally 'done' state, that he had to digitally inspect my uterus for windows & rupture. FWIW, I only had a skid mark.

Baby 3 was another great pregnancy & healthy baby, another state, another OB practice who was proving to be a very patient-friendly & very respectful (& it takes a LOT for me to say that!!). 4 days after an NST & u/s (nearing EDD & based on the previous stillbirth), I was at home contracting, felt a lot of pressure & proceeded to the bathroom intending to check my cervix. Instead, before I got to the bathroom, I realized it was blood. Fastforward to a catastrophic complete placental abruption. Husband drove me to the hospital since it would be at least that long of a wait for EMS, blacking out every few seconds, etc etc.
It turned into a crash section and we lost this baby also, though, it's believed he died before we ever saw the blood (that he blocked off with his head).

The quarterbacking summary of each of these experiences are vastly different, but the only trauma I felt from #3 was due to the blacking out & drugs that caused huge holes in my memory that took a long time to fill in (still some left). the fear I felt seeing the blood & knowing what was happening & what was about to happen was really the only part that replayed in my head afterwards. Opposed to #1 & 2 where I relived the entire thing over & over daily.

I recently attended a best friend's birth of her first, with a CNM, that left me completely traumatized, mainly because I know what it SHOULD have been like & my utter disbelief that women think what actually happened is considered a normal "good" birth.
The relatively short time I had with my HBMW was on every front, an educational, powerful, empowering, 'I'm in control' experience. I desperately wish I could know what labor & birth would have been like with that atmosphere...

With respect to the PTSD, I spent years suffering from it from my various medpro & personal experiences, then of course my losses. I got the most help from a Godsend of a psychiatrist who does EDMR. I went into that expecting no help, as I'm very leery and not exactly excited at the thought of 'playing with my head'. I literally went back to him for a regular session & demanded to know what he did (lightheartedly) because in the previous week, my flashbacks, panic, nightmares, anxiety & tension had GREATLY faded! I'm now 2yrs out & don't have flashbacks, panic, nightmares, my anxiety overall is completely manageable, and my depression is now something that doesn't affect my life. I've even gone back to my last OB for annuals without cold sweats & panic attacks. (Just food for thought for anyone trying to find a way to deal with PTSD, it may just be worth a try.)

July 31, 2011 | Unregistered CommenterMH

I had to stop reading half way through everyone's stories. I feel so deeply for each and every woman who has to endure this kind of mistreatment :( I am grateful I am going into the field I am because it prepared me better for my own kids, so that I would not have to put up with this kind of abuse (and my worst fear was having to go to the hospital to deliver, which I did end up doing with my first - thankfully it wasn't horrific, though definitely not even close to the birth I wanted). I hope any of you hoping for more children are able to go on to have normal healthy, and peaceful births, with no more abuses.

November 17, 2011 | Unregistered CommenterJenn

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