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Friday
Apr152011

Guest Post: Roots of Birth Abuse

My dear friend Colleen Scarlett, a Licensed & Certified Professional Midwife in Miami, Florida and previously a midwife in Jamaica, wrote a comment to my Birth Abuse post that, I am sure, will be an eye-opener for many of us in birth. Surely there are others that have "seen" these reasons/causes for birth abuse, but I have never considered most of what Colleen says below. It is in this piece that I can finally see a glimmer of hope in erradicating all aspects of birth abuse.

Colleen says:

"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 their 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."

Simply amazing, Colleen. Thank you so, so much for articulating something I haven't been able to and bringing to light ideas I'd never even considered. Thank you, dear friend.

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Reader Comments (13)

Same reason auto mechanics speak to us like idiots.

This post sure put the emotion in me. I think the same thing happens to the elderly.

April 15, 2011 | Unregistered CommenterDawn

I wonder if some of these beliefs come from the days of Twilight Sleep, when women frequently DID go a little crazy. They would try to climb walls, scratch at doctors and nurses and screamed profanities at anyone near them. If birth attendants are approaching labor and delivery from this place/time where women frequently needed to be restrained to prevent her from injuring herself and others, it only makes sense that the care providers would believe laboring women are not in any state to have a rational conversation. That they can't be trusted to make a decision.

What do you ladies think?

April 15, 2011 | Unregistered CommenterDiana

Wow, Barb! I'm humbled you thought it was worthy of it's own post! and of course I have more thoughts, (you know me!)

I think it goes farther back than the 40's and 50's, probably hundreds of years ago, PROBABLY back to the spread of Christianity and the male-dominated church, or male-dominated religion, even more accurately. When men became in charge of spirituality, women became second class citizens, to be kept under her father, and then her husband's, thumb, to be kept in line and away from the temptation of the devil. Because they all KNEW women were just a hearbeat away from stripping off their clothes and dancing under the moonlight with the Horned One, lol. Birth was no longer a sacred event, but punishment for Eve tasting the apple. Midwives and healers were no longer valuable, esteemed members of the village, but witches who gathered their knowledge, not from her Grandmothers, but through Satan. We became weak, simple minded, susceptable to temptations, not to be trusted with the ability to read (because we would surely use it for evil) prone to histrionics and LUNACY! Ahhh, lunacy, that temporary insanity caused by the waxing and waning of the Moon, just like birth. We had our uteruses removed if we spoke out of turn, or too loudly, or exhibited behavior that was considered unseemly. We weren't even supposed to enjoy sex with our husbands, we put up with his advances because he owned us. Our job was to keep his house, have his babies, attend to his needs, and do it quietly and without complaint. And for God's sake, don't moan or move your hips when he procreated with you! You may get your clitoris removed to control your animal nature.
That raw power we exhibit during birth, that ONE THING men could not do and could not understand, was twisted into a punishment for one woman's sins, the noises we make became unspeakable suffering and proof of our animalistic tendencies, and it wouldn't be long until we needed Gentlemen of education, religion, and Good Breeding to get us weak, inherently sinful women through the births of our children. Anything even remotely primal, mammalian, instinctive, proof of our animalistic nature, was to be overcome with religion, self-sacrifice, good breeding, and etiquette, and if that didn't work, it could be beaten into submission.

How far have we evolved from that mentality? Not far enough. Women get blamed for their own rapes, and even feel incredible shame and guilt when they are assualted. Even those who should know better, police, physicians, judges and juries, will attempt to discover how SHE herself is to blame, her life examined, her past love affairs, and how many of them, brought to public scrutiny; her style of dressing, her make-up, where she hangs out on a Friday night, who she danced with, HOW she was dancing; all behaviors that, in the eyes of the public, may have contributed to her attack. The reasons so many women will not report their rape, but will suffer in silence, shame, and guilt.

We have been so well trained, through our own culture, that certain female behaviors are to be encouraged and fostered, and others to be shunned, so we will be treated by others in a respectful manner. Or rather, increase the chances that we will be treated with respect. We are conditioned to be compliant.

When we see dramatized images, on television (my husband calls it "tell-LIE-vision") or movies, of women in labour who are sweating, grunting, moaning, cursing, on all fours, squatting on the floor, pooping and peeing, completely out of control, all semblance of what is lady-like behavior gone out the window, most women, (and men!) become terrified of losing it that completely. A woman behaving so far from what is typical of her is frightening, and needs to be controlled, by medication, coaching, cajoling, coercing, shaming, by whatever means necessary, until she's back into a place WE are comfortable with.

Even the natural birth movement is not without blame.....women are taught how to breathe, the "correct" way to vocalize, how to relax, how to focus, so she won't become that feared and fearful primal being that sweats and grunts and moans. Women, fearful of how they will behave, sign up for pricey childbirth classes that guarantee they will NOT become loud and sweaty. We're shown videos of Zen-like women, sitting in lotus postition, 'OHM"-ing her baby out blissfully and without loss of control or her dignity, and more importantly, not making her attendents nervous or uncomfortbale. This is held up as the gold standard of birthing, and except for a very lucky few, not at all typical.

And those women who can so easily let go of that control, willingly and powerfully becoming that primal, roaring, active, labouring fierce Warrior, are shushed, hushed, admonished, forced to lie down, shamed into controlling her breathing, her tones, and if that doesn't work, she's medicated to the gills so her attendents can relax and do whatever they like to her.

Birth abuse, like rape and domestic violence, seems to be all about control. Controlling the labouring woman's behavior. Maintaining control over the situation. Making sure she KNOWS just who is in charge, here, so she will be compliant and obedient. Trying to control a scary, elemental, powerful force of nature so it's not so scary and unpredictable.

April 16, 2011 | Unregistered CommenterColleen, LM

Wow, Colleen! How astute and concise! Makes me rethink some of what I have been taught, and how to change how I respond to a laboring woman...thank you, and thank you Barb, for posting the original! :)

April 16, 2011 | Unregistered CommenterCathi

I talked to a primip this morning, talking about "coping" in labor and, for the first time, I implanted in a woman's head that she never, never, NEVER needed to apologize for anything she says or does in labor, that everything is exactly perfect and I am there as her witness. It seemed her spirit was lighter after our talk (which consisted of several other things, too, but that was an important one)... and I'll tell you what, *I* felt better telling a woman to BE in her labor.

I really don't know where to go... where to even *begin*... with this information Colleen shared. It is SO big, SO... what're the right words? It's so profound (understatement) that it's going to take some time to soak in. I don't know what's going to happen when things click together, but I hope it's a great shift in the consciousness of birthing women.

How do I get more people to read this new information? Do I need a catchy title? I want to have Colleen write a piece that we can use to educate. An L&D friend of mine is making copies of this post and is going to leave them lying around her L&D floor. I can't *wait* to hear the reaction!

What do we do, ladies? Help me move forward!

April 16, 2011 | Registered CommenterNavelgazing Midwife

Labouring women are so exquisitely open and aware of what is going on in the rooms around them. As we have seen from the comments in your original piece, Barb, they DO remember what happened during their labours, especially when it was hurtful. I find the term "labour-land" totally demeaning and frightening, as if she suddenly won't care about being naked or become completely unaware of what folks around her are doing when she arrives at that mystical, magical place. I remember mine, as if they were yesterday. I remember the sheer panic and terror I felt when I was having my first, almost 30 years ago, when was I suddenly, without warning, grabbed and pushed onto my back, my legs yanked up to my ears, as my baby came through my pelvis. Holy fuck! I'm positive this is why I had a terrible fear of pushing, even in my subsequent home births, and told my midwife NOT to tell me when to push. EVER. And she didn't, but I still remember the fear, during each of my pregnancies, of pushing.
I also remember, when I was having the most difficult time with my 5th baby, a friend of my mother's who just happened to come to the house when I had been pushing for nearly 5 hours already and was seriously panicking, just holding me, and looking in my eyes, and bringing me back to myself. I don't remember what she said, but I remember her being KIND.
I remember attending a first time mom in labour, as a student, and WOW did she get wild! She walked, stomped, swayed, moaned, yelled, dropped the F-bomb freely, pounded the walls, punched pillows, peed where ever she stood. And as she pushed, crouched on her haunches on the floor, she ROARED like a hungry Lioness! No body even TRIED to coach her, I think we were all a little afraid of her, in her wildness, we mostly stayed out of her way! When her baby was born, she laughed and cried and screamed "THAT was fucking AMAZING!"
How awesome, how wonderful, how powerful, to be who she needed to be as she birthed her baby! To not be told how to breathe, or keep her tones low, to not be ashamed of her bodily functions, to not have a script for birth. To just let go and BE in the moment.

I think the number one fear I hear, when talking to women about their upcoming births, is the fear of becoming that woman. Of losing control and being loud and primal. I tell women who voice this fear, that she is going to be working HARD, that her body is going to become a force of nature, like a hurricane, how do you expect to be silent? Look at Serena Williams, a big, powerful woman, when she hits that ball with her raquet, and hear her ROAR with the effort! And she's merely hitting a ball! No one is suggesting she breathe in her nose and out her mouth, or say "aaaaaahhhhhhhhhhhhhhhh!" or making her feel ashamed or un-lady-like for being loud. She could never hit the ball with such strength if she did.
(I am totally NOT saying that a relatively quiet birth isn't just as powerful, I've witnessed many, just that we should not be afraid nor ashamed of normal, instinctive, and involuntary reactions to the sensations of labour)

I think birth attendants fear feeling helpless to ease her suffering, and therefore do and say things meant to be of assistance, but ultimately cause shame, guilt, and sometimes pain. I think we truly believe, and sometimes correctly so, that that vaginal exam will provide useful information we can use to help her. That coaching her breathing will calm her down so she's more managable. That changing her position will help get the baby out. That coaching her pushing will get the baby out FASTER. I think, Barb, that you are absolutely correct when you say obtaining PERMISSION and giving an explanation is vitally important, and also apologizing to the woman when we have to do things that are potentially traumatic. It only takes a moment, but it's a moment that will be remembered, even after the baby is safely in her arms, even years later when she thinks back on her birth.

I think we, NBA's and hospitals, have an image of what the ideal birth should look like. Ironically, they're both pretty silent! The hospital woman silent with her epidural, the home birthing woman silent with her breathing and melodic toning. They're both pretty easy to take care of, they're both non-threatening, they're both behaving in a manner we can be comfortable with. The problem with this ideal is what we, as attendants, often do to get them either silent, or in control of themselves, or to get the birth over with as quickly as possible so she's no longer "suffering".

I'm sure they will be more later as I continue to mull this over and over in my mind. Thank you so much, Barb, from bringing this discussion up, it's HUGE and so important that we all become more aware of how we react to labouring women.

April 17, 2011 | Unregistered CommenterColleen, LM

So do we stop teaching childbirth classes? Do we create a whole new childbirth method called "Let It Loose?" Is teaching women to flail and holler and shit any better than teaching rebirthing breathing? (Serious question.)

April 17, 2011 | Registered CommenterNavelgazing Midwife

"Let It Loose!" I love it! No, CBE is still important, as is teaching coping methods. But we need to emphasize it's "OK" to Let It Loose, if that works for her. And especially, we as care providers, need to know it's ok if she does cut loose, and get to a place where we're comfortable with it, not imply she's doing it "wrong" or make her feel ashamed for letting it loose.

Women are so different in labour! There's no "one size fits all", no method that will be effective for everyone. Telling a mom that it's okay if she poops during pushing won't help her if she's truly horrified at the thought. An enema, however, might be just the ticket. Telling a woman it's ok if she hollers and curses won't help her if she really fears losing control, but a good Hypnobirthing class might give her the tools she needs to cope with relative calm. At the same time, she needs to know that she's SAFE to be as loud as she needs to be, and to not worry about what she does or how she looks, that there's NO judgement.

WE'RE the ones who need to be mindful that she is aware and DOES remember what we do to and for her. WE need to remember to ask permission, to offer an explanation, and except in emergencies, back off if she wants us too. Certainly redirection has it's place, we don't want anyone hyperventilating or getting worked up into a panic. And like you said, most of the time, if it's an emergency, most women are not traumatized by our actions. By the emergency itself, sure, but not when we do what we have to to keep her and her baby safe. ESPECIALLY if we take one brief moment to explain what we are about to do. EVERY woman will do what she has to to keep her baby safe (which is why, when presented with the dead baby card, they consent to surgery, inductions, or the myriad of interventions possible; Jesus, who wants a dead or damaged baby?) But when they are lied to about the severity of the situation, THAT is traumatizing and leaves them feeling that their trust was abused.

Explaining why we feel a VE might be helpful, and consenting to one, isn't traumatizing, but having your legs shoved open and told to "relax!" certainly feels a hell of a lot like rape.

I think WE, birth attendents, not labouring women, are the ones who need work! Especially those of us who work in hospitals where birth is institutionalized, but midwives too. We need to remember she's not out of her mind, she's not so far gone into Labourland that she doesn't care what we do to her, and that she WILL remember her emotions surrounding her birth. What we do and how we react to her labour can either leave her feeling proud and powerful, or abused and ashamed.

April 17, 2011 | Unregistered CommenterColleen, LM

Sarah and I talked about this for awhile today and I came up with the same thoughts... that, if a woman is presented with the range of cbe options, SHE gets to choose what fits her best. For the woman who needs control issues addressed, Hypnobabies can be just the ticket. For the woman working through her previous birth, Birthing From Within might be her right choice. Those of us who've been in birth for ages, know that there is no one class for everyone and perhaps I'll invent one more... well, not so much invent, but create a safe space where we can "practice" hollering and stomping... but I think we might save pooping while swaying for the actual birth if that's okay. ;)

(If we were going to be *really* picky, we could point out my own queasiness at defecation in the house [not in a toilet] and how my own judgmentalness about it might/could/does hinder a woman who might be inclined to do so in front of me while she's in labor. Good thing we aren't going to go all Freud on the point. ;))

I've said, "It's okay to lose control, just not to panic." I haven't said it in a very long time, though... think I need to say it a lot more often and a LOT louder. What do you think?

April 17, 2011 | Registered CommenterNavelgazing Midwife

My birth instructor before my first was born showed several coping strategies. She never suggested one was better than another. She did mention that she wasn't really into the big breathing patterns, but that it is good to have some strategies. I do not think it's wrong to give women strategies to cope with the pain. My class was more about informing me of each stage of labor and what happens, and ways to manage. Some women sat and rocked in a chair quietly, and it was pointed out that this was normal for this mom but not so much for other moms. Some would want medication, but there are ways to avoid medication.

I developed my own way in birth. I didn't want any breathing stuff the way they taught in some books I read, I didn't want to have to think about it. I didn't want to do yoga or meditate, not my style either...no focal point. What I did want was to move, and to be calm. Yes, I wanted to be a quiet person and not hurt my husband by saying mean things to him for no reason. I decided to treat contractions like hills. I had run in high school, and always took each hill one step at a time. I breathed like a runner in through the nose and out through the mouth. This helped keep me from getting stressed out in the pain. I also walked and paced and used the shower. I ate when I wanted at home, but stopped with my first in the hosital...I threw up all the things I did eat. I prayed out loud, and begged the baby to come. I did apologize with my first for sure...for any yelling out. When I did go through transition I remember feeling panicky, and the nurse told me to relax my shoulders. I was clenching my mouth, so she said, "just go hohoho heeee." I did it, and it helped. That was not a "control the woman, make her be quiet and not primal." It was helpful, and I didn't get lost in the fear of it all. I was able to control my environment somewhat by controlling myself and choosing how to get through without begging for medication. I felt so much accomplishment along with the love. I had done it! I was thankful for a safe birth with as little intervention as possible (almost, I did get an episiotomy and an IV...and did have monitoring on the bed every hour). But considering, I didn't feel put down with the first birth.

I think in education classes, it's best to show all the different styles and let moms know there is not one right position, one right way to do it. There are ways that are safer in certain situations, there are things that are probably known to work and are worth a try. Like anything physical we do (exercise, playing musical instruments, sex, whatever), there are variations with each and every person. It's important to have some idea of what can be done to distract or cope...but it's also important to know what can be done when it all goes wrong. In the end being prepared cannot hurt anyone, and can only help.

I personally am hesitant to call the oppression of women a mostly Christian thing, but I am a Christian. I hear awful things from well educated non-Christian people too about women. The comment that we have bigger babies because of evolution and women somehow are getting smaller pelvises...and using the death rate in very poor nations as proof, makes me cringe (read this recently in an article you posted Barb). If women are looked at as an animal who evolved beyond the ability to birth safely by an OB intervention will come and oppression will be present because she cannot possibly see her small bone structure and know, like the great doctor, how big that head will be. The mom is just another dumb animal who needs medical help to deliver safely. When in fact, poorer nations with young teens giving birth might just have the problem of small frames and large baby heads because of lack of nutrition when the mom was growing.

April 17, 2011 | Unregistered CommenterDawn

I'm LMAO about the poop.....I'm the same way about spitting, and working in a large Caribbean population, I get a lot of spitters. They even come to prenatal appts with a plastic cup to neatly spit in. I can't even look at it......UGGHHHHHHH! Makes me gaggy just thinking about it! Comforting to know women usually clean out their bowels before labour begins, though, isn't it? Can't do shit (haha! pun intended!) about the spitting.

I think we have some deep-rooted beliefs about women in birth that need to be addressed so we can be more mindful of the way we treat or even speak to them. Even the most well meaning words and deeds can be offensive.
I'm sort of working out in my head how this fear of /potential for abuse/shame/guilt caused, however inadvertently, by birth attendants may be adding fuel to the UC movement as well.

Lots of things to ponder!

April 18, 2011 | Unregistered CommenterColleen, LM

Sadly, many birth attendants that cause the issue are female OB's/nurses/midwives. Why do we females do this to each other?

I was thinking about it more and the one time I had a male OB, he actually said gently that I should be allowed to move when I had a baby in OP position. This man almost got a kiss from a half dressed woman who is very modest and uncomfortable with men in the room other than my husband. He was right, and the baby moved in ten minutes. During this birth I had women stretch my vagina into my rectum, I had women stretch my cervix (no reason), I had women tell me to get my leg out of the sterile plane and slap it when I was shaking it to cope, I had women tell me I had to stay on the bed because of monitoring, I had women tell me I couldn't use the restroom, couldn't drink, and couldn't use the shower. I had women not answer when I asked what was happening with my baby and not tell me how she was doing. I had women talk over me.

My husband, a man who has been with me for 7 births, has commented that it's hard to be in a room full of women in a birth. He says getting between me and a snippy nurse is annoying and he feels pushed back like he doesn't know squat. He feels, even when I had the wonderful midwife, that the birth room is almost not his place. He's my support, the one who has demanded I go to the bathroom, has privately spoken to nurses and doctors when my desires are being stifled, he's the one who has whispered the contradictions to the nurse's statements in my ear and told me I am doing well when they say obnoxious things. He is the one to run to see that the baby IS okay to reassure me because he can see my confusion and frustration. He also is the one who feels helpless. His manhood stripped by these overbearing women. Women who abuse women. Ugh.

April 19, 2011 | Unregistered CommenterDawn

This post hits home for me, I sobbed when I read it. Birth abuse is real and it can perpetrated even by midwives. I delivered with a CNM in hospital - while in my active phase she wouldn't stop touching my vuvla even in the middle of trying to push - I wanted to scream at her to STOP TOUCHING ME!!!

As a teen I was very sexually and physically abused and am very sensitive to anyone touching me 'below the belt' - that's my husband's job and no one else's. I couldn't even watch the vid of the birth of my daughter, just thinking about what I would see upset me. It took me 2 1/2 yrs to build up the courage to watch that vid and I still sobbed when I saw it - I had flashbacks of my abusive birth and the trauma I went through as a teen.

I do consider what happen to me somewhat my fault - I went to the hospital and I employed a CNM who was overwhelmed by Medicaid patients - I expected a level of trust and compassion that is almost impossible to get from someone who works in the American OB system.

But watching the vid of me laying there flat on my back unable to even help myself and stop the abuse I was going through - watching a whole 45 minutes of that disturbed me on so many levels. Her 30 minutes of rubbing my vuvla seemed to be for NO reason (she wasn't stretching me), during that time she inserted two fingers 4 times to gauge the baby's station but other than that she was touching me for no reasons except liability (she needed to be right there in case something 'happened').

As a victim of abuse I needed far more control for my birth and next time I will get it even if I have to do an Unassisted Childbirth at home alone.


Ps - The other hard part was knowing how many of family members were there to cheer me on yet not one of them knew enough, to know I was in distress and that I needed to be saved/helped. Even my husband didn't understand it until he saw the video and my reaction to it. It seemed like my family was only there to hold down my legs and arms and scream at me to push.
Next time will be different - I will not let another person (midwife or not) to abuse me while I labor again!

July 30, 2011 | Unregistered CommenterOubli

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