However, in researching my Denialism post, I stumbled upon a blog entitled Science-Based Medicine, whose subtitle is “Exploring issues and controversies in the relationship between science and medicine.” Curious, I started reading and lo and behold, who else but Dr. Amy was regurgitating her homebirthdebate posts. I rolled my eyes, skimming the first post and then moved down to the comments. 

I sat upright. The science-minded blogsters began tearing her theories/posts/comments apart. As someone said, it was like Christmas. Over and over, her writings were demonstrated to be much more opinion than science-based fact and, the most recent post from her has (at last count) 194 comments that spank her for her hatred of natural birth (which they force her to define scientifically over and over again) and her extremely interventive beliefs, a few of the members having had Hypnobirthing births or empowering births, pushing her against the wall in a way none of us have ever been able to do. (I find almost everyone frustratingly gives up trying to explain things to her.)

 I cannot exclaim my glee in seeing her opinions questioned so deeply by people she thought were going to embrace her. If scientists can see her craziness, there is hope that she will eventually exhaust herself and vanish from sight. 

One can only hope.

Mark Hoofnagle is one of three authors who write the “Denialism Blog.” (Chris Hoofnagle and PalMD are the other two.) Hoofnagle’s bio says, “Mark Hoofnagle has a(n) MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.” I like the subtitle of the blog: “Don’t mistake denialism for debate.”

Hoofnagle has outlined six tactics that might be used to maintain the appearance of legitimate controversy;

1. Conspiracy - Suggesting opponents have some ulterior motive for their position or they are part of some conspiracy.
2. Cherry picking – Picking apart a critical paper supporting their idea, or famously discredited or flawed papers meant to make the opponents look like they are based on weak research.
3. Contextomy - Using a statement out of context to further their position.
4. False Experts - Paying an expert in the field, or another field, to lend supporting evidence or credibility.
5. Moving the goalpost - The use of the absence of complete and absolute knowledge to prevent implementation of sound policies, or acceptance of an idea or a theory.
6. Other logical fallacies - Usually one or more of false analogy, appeal to consequences, straw man or red herring.

Denialism is spreading in our country. From the “birthers” who don’t believe Obama is an American citizen to the continued denial of the Holocaust, standing on the moon and that HIV doesn’t cause AIDS. Depending on where you stand, the other side looks foolish, if not downright stupid, to believe in such absurd ideas. Denialism isn’t just not believing something, but not believing in the face of scientific, hands-on, well-studied and multi-checked facts.

This begs the question, whose facts are to be believed?

In the birth world, denialism meets evidenced-based medicine.

Evidence-based practice is a common request from those in the natural birth arena. We want an end to continuous fetal heart monitoring and keeping women from eating or drinking in labor because numerous studies show they do not improve outcomes. What if the research counters what the natural birth community believes and wants to continue doing? Many different studies have proven that the Active Management of Third Stage is safer for women, yet midwives and their clients insist on the Physiological approach. Natural birth advocates get all up-in-arms about allopathy continuing routines that have been disproven over and over, yet we do the exact same thing. Who’s in the wrong then?

There is no scientific evidence that homeopathy works. Yet midwives embrace it wholeheartedly. There is no scientific evidence that says keeping a woman in bed improves outcomes, yet hospitals continue with this practice… even when there is contrary evidence saying it might be detrimental. Why do we expect them to accept our quirks if we aren’t able to accept theirs?

Shifting sideways some, denialism takes a different form when discussed in the natural birth context. To me, one of the greatest forms of denialism comes from the Unassisted Childbirth (UC) faction. While no studies show the dangers of a UC (reporting would be self-disclosing and therefore difficult to measure), anecdotally, one simply needs to look at the UC boards at MotheringDotCom (MDC) to see the extremely high rate of affected babies to come to the logical conclusion that perhaps UCing isn’t such a good idea after all. In my own life, I have known of two babies that died during a UC. I have never known of a baby that died from the lack of a medical team’s care (meaning from a baby being left to perish without a team working to keep the baby alive). When babies die in the hospital, it is almost always because of congenital or prematurity issues. Rarely, full-term, pregnancy-healthy babies die. There are stillborns in each category, but monitoring absolutely can alert a care provider to act to help a baby birth alive. (And not just continuous monitoring.) When tragic things happen on MDC, the women  soothe each other, finding ethereal reasons for the tragedy; she didn’t think positively enough, it would have happened in the hospital anyway or it was the baby’s time. It’s heretical to say, “Maybe you should have gone to the hospital sooner” or even, “I wonder what would have happened if you’d had a midwife there.” Women go out of their way to help a mother not feel guilty for her choice, believing she already feels guilty enough, but in their comforting, they are leading the acolytes to believe it would have happened no matter where the woman was.

Of course the medical folks use these same arguments with homebirthers, saying that it’s a risk to deliver at home without continuous monitoring and the capability of an operating room to facilitate a cesarean in the case of the rare emergency. They surely believe Natural Birth Advocates (NBAs) are denialists, too. They point to studies that demonstrate that homebirth is absolutely more dangerous for babies. The major study, sometimes referred to as The Pang Study, has been de-bunked by several professional NBAs, yet is still quoted by med folks. When studies support homebirth as a viable option, factions of researchers and physicians attack methodology. NBAs do the exact same thing; it’s a war of the statistics. What’s amusing to me is when the study benefits either side and is hailed as the latest proof that they are right. No consideration is made regarding methodology then; it’s obvious the study is perfect when the beneficiary needs it to.

Denialism takes many forms… depending on your viewpoint. Pick any hot button issue and you find divisiveness that accuses its counterpoint of denialism: Homebirth/Hospital birth (including UC), ultrasounds, vaccinations, circumcision, naturopathic remedies/medications, television, cell phones, microwave ovens, shampoo, global warming… and on and on. (Interestingly, I hardly hear about a computer’s possible negative effects.) As mentioned above, a plethora of studies demonstrate the scientists’ point of view regarding controversial topics; a few studies do the same for the natural community. Each believes they are right and the other is wrong. Who is right? How do we separate the wheat from the chaff? Do we tend to be on one side or the other depending on how we were raised (similar to choosing religion or political parties)? Did homes that fostered individual thinking produce open minds that can embrace alternatives even when they have no scientific proof? Are there personalities that lean one way or the other? Are left-brained thinkers more apt to live a scientific life? (Of course there is a range from far left-brained to far right-brained folks.) I would love to see a study about this.

Does denialism equal lying to oneself? Or might it be simply looking at a topic, squinting and turning your head sideways to justify your thoughts.

I tend to be somewhat balanced between the two poles. (At least I like to think I am.) Looking at me from the natural vantage point, I am sometimes considered a medwife. I do not struggle with “interventions” when they are called for. I don’t hesitate to send a woman in for medications if she can heal quickly from them. Yet, I also advise natural methods of healing –from supplements to acupuncture- things that are often poo poo’d by the medical community. To them, since I am a homebirth midwife, I am seen as a kook. It’s definitely a balance walking between the two. I often joke about being the tie-dye and Birkenstock-wearing midwife who wears make-up tested on animals and who’s been known to eat too much McDonald’s. I love that I have a wide range of friends… from Christy Funk who owns the natural mom and baby store Belly Sprout to the most medicalized CNMs and family members. I believe walking on both sides of the line helps keep me balanced, looking at both sides of most issues and forcing me to keep an open mind.

Yes, as we all know, it’s the open mind that can pull our pendulum hard towards one direction or the other. A conundrum we all struggle with… and rarely perfect.

It's obviously a progressive hospital (as hospitals go).

I wonder how long I'll watch. (I'm acting like I've never seen a birth before!)

I've heard whispers of the Vitamin D Theory, but this is the first organized article that explains why and even dosages. The advised dose by our government is 400 IU every day. However, we continue being deficient, sometimes extremely so, in Vitamin D. Our indoor culture and sunscreen use when outside contributes to the cause of the deficiency. I take 8000 IU every day.

The article Swine flu deaths: What You Need to Know will share a good deal of information regarding our children, but this is the very important part I want to make sure people read:

Can we use vitamin D to prevent H1N1 flu or H1N1 flu death?

"...Cannell has reported on Sept 16 in his newsletter that two physicians, one in Wisconsin and the other in Georgia, suggested that vitamin D supplementation can be the key to H1N1 flu prevention.

"Norris Glick, M.D. of Central Wisconsin Center in Madison told Cannell in his email that 274 residents at his health care facility took vitamin D supplements and were monitored regularly for their plasma vitamin D levels; as a result, only two residents developed influenza-like illness and had positive tests for H1N1 during a period of observation. This compares to 103 of 800 staff members during the same period who were not required for the supplementation. This huge difference may be due likely to use of vitamin D supplements.

"Dr. Ellie Campbell, who also responded to Cannell's vitamin D theory, told Dr. Cannell in an email of a similar observation.   She said she told her patients to take 2,000 to 5,000 IU of vitamin D regularly and monitored their serum levels to make sure her patients had sufficient Vitamin D in their blood.  Campbell shared office with another physician. Her office mate did not do the same thing to his patients.  When H1N1 hit George, none of her patients came to see her for H1N1 virus infection while the other physician was seeing one to 10 cases per week of influenza-like illness."

Please, please supplement yourself and your children. Even if you choose to vaccinate, Vitamin D supplementation could very well save your life.

I write this because one of my on-line doula friends lost her sister-in-law... sick one day and dead two days later. I don't want to know any more.

Barbara E. Herrera, LM, CPM

Case History 

Being a homebirth midwife who sees women throughout their pregnancies, births and on into postpartum, I am familiar with the way these experiences and how they affect women and their families. 

So, when I was asked to assist a woman choosing obstetric care with a doctor and, once labor began, to deliver in the hospital, I never knew what lay ahead. 

Starting at the beginning of her care, Myrtle’s (not her real name and the details are slightly altered to protect her privacy) vitals were taken by a nurse and she only saw her doctor for five to seven minutes at each visit, although for her initial appointment, she saw him for ten. And, at that first appointment, she met the doctor naked! Myrtle was covered by a paper drape, but, not having met this man before, she felt vulnerable and very uncomfortable. After that visit, she was sent to the lab for blood work and was called two weeks later telling her she was extremely anemic and needed to take prescription iron supplements. She learned through reading on the Internet that her constipation was from the supplements and waited for five days for the nurse to call her back to tell her what she could do to help with the problem. 

At visit number one, Myrtle was told she had to have chorionic villi sampling and was scheduled for the next day. She was not told the risks of miscarriage after CVS, but was excited to know if the baby had any birth defects. When she presented the next day, she first had an extensive ultrasound (unexpectedly!) and then had the procedure which caused her discomfort and, again, she had to disrobe for a stranger. When the results came back normal, she breathed a sigh of relief. 

But when she was sixteen weeks, Myrtle had her blood drawn again (by another stranger; this time, a lab technician) for the Quad Screen, a screen to determine a woman’s risk of delivering a baby with either Down Syndrome or neural tube defects. When she told the nurse at her prenatal appointment she’d had CVS, the nurse couldn’t find that information in her chart and told her to go to the lab appointment anyway. The Quad Screen came back showing her risk of having a baby with neural tube defects was 1:25 and she was scheduled for the diagnostic testing, both a Level 3 ultrasound and an amniocentesis. At the prenatal appointment when she learned she would need further testing, she told both the nurse and the doctor she just met that  she’d had CVS and it came back normal, they both said it was important to have the test, so she followed the orders and had both the ultrasound and amniocentesis.

The ultrasound showed problems with the kidney and heart, but did show there was no problem with the baby’s spine – so far, they said. Myrtle worried every day that her baby was severely deformed and she and her husband debated keeping the baby or terminating the pregnancy. Waiting for the amniocentesis results was excruciating, both physically and emotionally. The procedure caused internal bleeding and she was put on bed rest for the two weeks she had to wait for the results. She lost time at work and, therefore, income for her already strapped family. The results were normal for Down Syndrome and neural tube defects, but she still had the heart and kidney problems to contend with. 

At 28 weeks, Myrtle was sent to the lab after her appointment (where she met another doctor in the practice) to do the Glucose Screen, checking for Gestational Diabetes. When she drank the 50 grams of glucose, she became extremely dizzy, fainting in the bathroom where she was found 45 minutes after she drank the glucola. Taken to the emergency room in an ambulance, she was given a lengthy ultrasound and an MRI to check the baby and her brain, had an IV put in and remained overnight to make sure she did not have a concussion. While she was in the hospital, she had to drink the glucola yet again, felt extremely dizzy and nauseated, but was told if she threw up she would have to drink it again, so she forced the liquid to stay down. She felt horrible for two days afterwards. No one had asked her how her diet was before sending her to the screen, did not talk about any alternatives to the glucose drink, but did tell her if the screen was positive, she would have to drink twice that amount and have her blood drawn four times. Terrified while she waited, she did not hear that her results were normal until her next prenatal appointment two weeks later. 

At Myrtle’s 34-week appointment, she saw yet another doctor and he measured her fundal height two centimeters larger than her dates, so was sent for an ultrasound. The amniotic fluid volume was slightly elevated, so was scheduled to have an ultrasound each week to watch the problem. At this sono appointment, the baby still had the heart and kidney problems; she was told the baby might need surgery after the birth and to be prepared to have a scheduled cesarean if the baby was still showing dangerous signs near birth. The OB explained that sometimes when the baby has defects, there is more amniotic fluid; she was sick to her stomach with worry every waking moment, having to leave work on early disability because she could not focus and do her job. 

Myrtle saw the doctor she’d chosen originally at her 36-week prenatal visit and even though he measured her fundal height as size equal to dates, he said it wouldn’t be a bad idea to keep going to the sono appointments, becoming Biophysical Profiles after 38 weeks. The technician who strapped her in never shared information about the testing she was doing, causing her to wait in agony for someone to call. Often, she called the office herself to see how the baby was doing. 

When Myrtle was 39 weeks, the OB she saw told her she had to be induced in one week if she didn’t go into labor before then. The female OB said, “We’ll just put a little pill inside and you’ll have your baby that day!” Myrtle was excited and scared all at once. She was going to have her baby! But what if he needed surgery. 

A week later, she entered the hospital at 5:30am but had to wait until 11:00am to be checked in and get a bed. She changed into a hospital gown, naked underneath, was strapped to the fetal heart monitor, had an IV inserted, and then the nurse (who she had just met 25 minutes earlier) did a vaginal exam. Myrtle was told she was “long, closed and posterior.” What did that mean? she asked. The nurse told her it didn’t matter and left the room. 

The nurse came back an hour later with the little pill (Cytotec), did another vaginal exam and pushed the pill onto Myrtle’s cervix. Within the hour, she was writhing in pain and the nurse asked her if she was “ready for her epidural”; she said she was, but the anesthesiologist had two cesareans to do first. He arrived two and a half hours later. Myrtle was in excruciating pain, but the nurse kept telling her, “This isn’t anything yet! Wait until you are really in labor.” 

The external monitor showed the contractions were barely peaking above early labor contractions, but because Myrtle was screaming so much (still waiting for the anesthesiologist), the decision was to begin pitocin instead of inserting another pill. She kept saying the contractions were one on top of the other, but because the monitor said they were erratic and mild, the nurse ignored the request to hurry and get the anesthesiologist. Repeatedly, she was told he was busy and she would have to wait. 

When the doctor finally arrived, he tried to get the catheter into Myrtle’s spine five times before hitting the right spot. He told her she would feel relief in 15 minutes or so and complete relief in 30. She waited and waited, but the pain never abated, the anesthesiologist having to come back and try again. When he was successful with the placement, the epidural only took on half her body; hardly any relief at all. 

The nurse told her she was really complaining a lot about the contractions so she felt her fundus and left to go get the doctor. When he came in (a doctor in the practice she had yet to meet), he inserted an internal monitor so the contractions could be read more closely. The monitor showed Myrtle’s contractions as tetanic – extremely hard and extremely long – exactly what she had been saying for two and a half hours. The pitocin was turned off immediately and the doctor told her she was now three centimeters dilated and she had to have her baby by 10:00pm or she would have a cesarean… that women cannot be on pitocin that long. 

It didn’t take that long to have the baby because the fetus could not tolerate the tetanic contractions, his heart rate going down into the 90’s. She had an oxygen mask put on and moved to her left side, where she remained until the birth. We watched as the baby’s heart rate went from 70 to 90 before, during and after contractions. No one seemed alarmed. The OB had just stepped into a cesarean, but said he would check back when he was done in 45 minutes or so. All she could do was wait. 

The nurse started bringing more paperwork for Myrtle to sign, telling her it was “just in case” she had a cesarean. Worried, she asked if that was what was happening and the nurse told her, “Not yet.” 

The baby’s heart rate never got above 100 and when the doctor came back an hour later, he said it was time to “get the baby out of there.” I was told to leave, but Myrtle told me what happened next. She was wheeled down a hallway and told it was an emergency to get the baby out. Because her epidural only worked halfway, she was going to have general anesthesia and wouldn’t be awake to see her baby. Her husband also wouldn’t be allowed in the operating room. She said she cried and the nurse told her to stop it, she had to get control of herself or the anesthesia could go the wrong way and cause problems. 

Once Myrtle was in the operating room, she had another mask put over her face and went to sleep. When she awoke, she was very groggy and didn’t know where she was. A nurse injected something in the IV she had in her hand and she went to sleep again. By the time someone told her she had had her baby, he was already eight hours old. One of the medications she was given during the surgery caused an allergic reaction – a medication she’d repeatedly told the nurses and doctors she was allergic to – so she was sedated and intubated until the reaction wore off. 

Her son was 15 hours old before she saw him. He was in the NICU being tested, checking his heart and kidneys because of the prenatal testing’s findings. He was hooked up to several monitors, had an IV in his head and Myrtle wasn’t permitted to hold him until the testing was complete. She was told she might upset him and that would make testing harder for them to do. 30 hours after the birth, all the test results showed there was nothing wrong with his organs and Myrtle was finally permitted to breastfeed her baby. He’d already gotten bottles for more than a day, so her attempts failed and she cried because she’d wanted to nurse so badly. The nurse in the Nursery told her it was easier to bottle feed anyway, that her baby would sleep more and “not bug her at night.” 

Case Outcome 

Myrtle left the hospital six days after her cesarean, taking with her a staph infection that required cleaning and packing for three months and a colicky baby who, she later learned, was allergic to most formulas. She was in pain for a year and didn’t have sex for 14 months because of her fear of getting pregnant again. She seriously considered tying her tubes. 

This story haunted me for years. How could the doctor miss a normal pregnancy, labor, birth and postpartum period? How could he pathologize such a normal part of a woman’s life? How could so many things be missed, incorrectly diagnosed, over-diagnosed and, dare I say, negligent? Is there anything we can do to help women see the path where medical care leads?  How do those of us who work with natural birth every day tolerate such things? Is there an avenue of discussion where we can process our experiences together? 

Do we even want to?

Hospitals May Face Severe Disruption From Swine Flu – “Swine flu may hospitalize 1.8 million patients in the U.S. this year, filling intensive care units to capacity and causing “severe disruptions” during a fall resurgence, scientific advisors  to the White House warned.” 

Hospitals May Ban Visits to Newborns Due to Swine Flu – “With a potential outbreak of swine flu on the horizon, many hospitals are becoming more cautious when it comes to protecting newborn babies and their mothers -- fears that have prompted a complete ban of children from areas of one hospital where newborns and their mothers are cared for -- and that have caused more intense deliberations about the issue in other facilities.

‘For pregnant women, there is a much higher risk associated with H1N1, and they wanted to err on the side of safety for pregnant women,’ said Mike Green, the chief executive officer of Concord Hospital in New Hampshire, which imposed the outright ban.”

81 U.S. healthcare workers found to have H1N1 virus - “At least 81 U.S. healthcare workers have contracted laboratory-confirmed cases of the novel H1N1 influenza virus and about half caught the bug on the job, the Centers for Disease Control and Prevention said today.

The finding is worrisome because it suggests that hospitals and workers are not taking sufficient preventive measures to limit spread of the virus. If a large-scale outbreak of the virus recurs this fall, a similar infection rate could cause significant problems -- not only because it would limit the number of workers available to care for the sick, but also because the infected nurses, doctors and others could transmit the virus to debilitated patients before their own symptoms become apparent. Already-ill patients would be more likely to develop life-threatening side effects from the flu.” 

Does this scare you? It should.

While balancing the information you get from medical and holistic sources is crucial and each family needs to make their own decisions regarding vaccinations or nutritional support, the one clear truth is: those that are the sickest with H1N1 (“swine flu”) will be in hospitals. Considering and choosing a homebirth takes on an urgency not previously needed.

Women who have thought homebirths were for hippies and counter-culture crunchies now find themselves thinking hard about having one of their own. If you are one of the women who have thought a homebirth might be a good idea, but you were not sure of the safety aspects, it is time to fill in the information gaps. Wouldn’t it be wonderful to not have to worry that the person holding your newborn might be carrying a virus that can seriously harm you and your newborn? 

Having a baby at home is for healthy women having uncomplicated pregnancies. If you fit that description, you are already on your way to taking healthy control of your upcoming birth. But, where do you begin learning about the safety of homebirths, finding a midwife and how to prepare? 

The Internet abounds with information regarding birthing in one’s own home. Search “homebirth,” “home birth,” “waterbirth,” “midwife,” add your city to those terms, too, and you will find local resources. If you add “safety” to the terms, you will find yourself reading study after study that speaks highly of the safety of birthing at home with an experienced/educated midwife. A great place to start is the McMaster Study which, in part says, “Almost 6,700 planned home births in Ontario were assessed in the study. Results indicated that newborns and mothers were no more likely to suffer complications than their counterparts in a clinical setting.” 

It is important to have a midwife that is experienced with homebirth and most midwives in the United States are licensed or certified; be sure to ask when you interview a midwife. Midwives are well-prepared for emergencies, carrying medications for hemorrhage, being certified in neonatal resuscitation and being able to repair any tearing. 

While pain medications are not offered in the home setting, women are mobile and use a variety of pain coping techniques including massage, positioning and even immersion in water (which is often called the midwife’s epidural). Women birthing at home who have also had hospital births will say their homebirth was much more comfortable than the hospital birth, even without an epidural or narcotics. 

If a situation arises that moves out of the scope of practice for a midwife, whether it is a non-emergent (such as malposition of the baby’s head that does not resolve) or emergent (such as a hemorrhage that does not stop with basic medications), the midwife does not hesitate to move into the hospital. Even when we are trying to stay out of the hospital because of the H1N1 virus, weighing the pros and cons of going in are crucial and, when absolutely necessary, the pros outweigh the cons. 

For those women who cannot avoid the hospital during the birthing process, perhaps staying home as absolutely long as possible and then going home as soon as is safe can also help lower the risk of obtaining the virus. The less time you are in the hospital, the less chance of getting ill. 

But, when everything unfolds in the natural way birth is designed to do, staying home will definitely lower your risk of acquiring the H1N1 virus. You have control over who comes in your house and if they are sick, they do not come in. You can make sure everyone, including your own family, washes their hands regularly and remind people how to cover their mouths and noses with their sleeves should a sneeze overtake them. You can have your family take nutritional supplements that support the immune system; you will also do this for you and the baby. By taking control over the environment and keeping healthy family and friends close, you are minimizing the places you could get sick. 

So, if you have ever thought about a homebirth or if it never even crossed your mind, this might be the time to do so. Over and over, we hear in the news, “Stay out of the hospital unless you are extremely ill because there will be so many infected people there.” While we do not always believe what we hear, this might be one thing we really need to listen to. 

For more information about homebirth and homebirth midwifery, Search “Midwife,” “your state (or city),” “homebirth” and you will find several options. Whoever licenses midwives in your state will also have a list of those that carry certification or a license. In the states that do not have midwifery regulation, perhaps now is the time to get involved to make it possible in your state. Even in un-regulated states, Certified Professional Midwives might be in your area and worth talking to. 

Choosing a homebirth is a deeply personal decision and one that needs to be considered seriously and completely. For those that decide staying home and out of the line of the H1N1 fire, their births can be a way to remain well with a large dose of incredible.

Reading around the Net, women have written about birth traumas and abuses, including birthrape.  Kathy shares information from Rixa Freeze’s doctoral dissertation about how some women choose to deliver unassisted because of their past experiences with medical or midwifery care. Interestingly, Rixa and Kathy used my own description of the abuses I participated in as I was learning to be a midwife. I’ve written about my sadness and sincere apologies to the women I have hurt (emotionally and physically) and that, in speaking about exactly this, I could find a place of peace inside myself. (Reference the post I wrote in 2004 above.) 

Back in 2004, I listened to the words women used to describe their pain and was told about actions that did, indeed, sound extremely coercive, manipulative and even pushing women to do things completely against their will. I went to Sarah who at the time was a Deputy Sheriff and I read through her official code book that defined things like “assault,” “battery” and “rape.”

Legalese regarding the definition of assault includes (emphasis mine and my comments in parenthesis):

“… the essential elements of assault consist of an act intended to cause an apprehension of harmful or offensive contact that causes apprehension of such contact in the victim. (“You need to have a cesarean or I will get a court order to make you have one.”)

The act required for an assault must be overt. Although words alone are insufficient, they might create an assault when coupled with some action that indicates the ability to carry out the threat. (“Open your legs. I’m going to do a vaginal exam.” And the woman tells the practitioner that she doesn’t want an exam or tries to close her legs before the exam begins.)

Intent is an essential element of assault. … the intent element is satisfied if it is substantially certain, to a reasonable person, that the act will cause the result. In all cases, intent to kill or harm is irrelevant. (I’m going to give you an episiotomy.” “No!”)

There can be no assault if the act does not produce a true apprehension of harm in the victim. There must be a reasonable fear of injury. The usual test applied is whether the act would induce such apprehension in the mind of a reasonable person. The status of the victim is taken into account. A threat made to a child might be sufficient to constitute an assault, while an identical threat made to an adult might not.”

Battery definitions include: “The act must result in one of two forms of contact. Causing any physical harm or injury to the victim—such as a cut, a burn, or a bullet wound (episiotomy, cesarean, IV, internal monitors, IV antibiotics, etc.) —could constitute battery, but actual injury is not required. Even though there is no apparent bruise following harmful contact, the defendant can still be guilty of battery; occurrence of a physical illness subsequent to the contact may also be actionable (a post-cesarean infection, systemic yeast after IV antibiotics, etc.). The second type of contact that may constitute battery causes no actual physical harm but is, instead, offensive or insulting to the victim. Examples include spitting in someone's face or offensively touching someone against his or her will.

Intent: Although the contact must be intended, there is no requirement that the defendant intend to harm or injure the victim. (This allows for the belief of doctors and nurses that the procedure/intervention is helpful, but the woman sees it in a completely different light.)

Intent is not negated if the aim of the contact was a joke. As with all torts, however, consent is a defense. Under certain circumstances consent to a battery is assumed. A person who walks in a crowded area impliedly consents to a degree of contact that is inevitable and reasonable. Consent may also be assumed if the parties had a prior relationship unless the victim gave the defendant a previous warning.”

Still, my biggest quibble is with the term “birthrape” because most definitions connote rape with sexual intercourse or genital to genital contact.

Among the common definitions of “Rape,” we find this: “Forced sexual intercourse; sexual assault; sexual intercourse between an adult and a minor. Rape may be heterosexual (involving members of opposite sexes) or homosexual (involving members of the same sex). Rape involves insertion of an erect penis or an inanimate object into the female vagina (gloved hand, speculum, internal monitors, amniohook, etc.) or the male anus. Legal definitions of rape may also include forced oral sex and other sexual acts.

Victims of rape suffer physical and mental trauma. Physical trauma may include cuts, bruises and abrasions in the pelvic area as well as elsewhere on the body. Mental trauma may include overwhelming feelings of humiliation, embarrassment and defilement (classic signs of PTSD). Rape victims should seek treatment at a hospital. There, doctors and nurses can treat the injuries (eek! Not for birth traumatized women), administer antibiotics to prevent sexually- transmitted diseases, and provide counseling or any other additional therapy (mental or physical) that the patient requires. The hospital team's evaluation and report will help document the condition of the patient for legal purposes.”

These legal descriptions of rape do not take into account birth trauma/abuse and trying to use these definitions to prove it would be very challenging (I suspect). I know that the majority of people reading the definition of rape and attempting to apply it to birth trauma will feel it is a stretch to do so. It took decades to believe that rape occurred in marriage or that women could be rapists, too, so expanding the definition to include birth might take a very long time and, I am sure, many, many years and a slew of failed lawsuits before anyone in the legal system recognizes birth traumas/abuses, much less birthrape. In fact, I have known of women to talk to lawyers as they consider suing their care provider and the lawyers won’t even discuss it. The typical proof of “lasting physical harm” is even abandoned as some women have had to have reconstructive surgery to repair the damage caused by their doctor or midwife. What is a traumatized woman supposed to do? I think we all know it takes an extremely powerful woman to even think about bringing a lawsuit against a perpetrator and the aftermath of trauma is not the most conducive time to do this.

I believe this is where a support system can take a major role. Women who have been traditionally raped or assaulted, including domestic abuse, have dozens of places to turn to for help and support. The hurt woman may not realize this or know how to find those resources, but they are there. I know the Internet has changed the face of helping hands, although women in domestic abuse situations still have to be careful lest their Net records be looked at. For those who are not in fear for their lives, but for their mental stabilities, the Net can be a haven for the women who need it. One former birth traumatized mom started Solace for Mothers. An organization in the United Kingdom, the Birth Trauma Association, began at the same time I learned about birthrape/birth trauma in 2004. I’ve corresponded with several of the women who keep that organization going and they are just as committed to helping women as the newer groups here in the US.

Look at that. 2004. Only 5 years of the realization of birth trauma. But, how many decades (centuries?) before were women living with the painful and scary memories of their births?

Above, I alluded to the challenge of trying to get anyone to understand the reality of birth trauma… that people will roll their eyes and think, “Why is she being so dramatic? Women have been having babies for eons.”

When I began talking to my mom about this a couple of years ago, she told me about my own birth in 1961. She said that when she went for prenatals, all the women went into the bathroom, peed in a cup and put their underwear in their purses. They would then have to sit for hours together in a hot room waiting for their few minute appointments with the doctor. When they went into the exam room, they were put in stirrups and left there until the doctor walked in, did a vaginal exam, listened to the baby and sent mom on her way. When she was in labor with me, there were four women to a labor room and when she started pushing, they moved her to the Delivery Room, put her in the lithotomy position, legs buckled into stirrups, arms put in constraints and left until someone came in to catch the baby. She remembers how horrified she was that a very young man (black, something that was an important factor in that time) kept looking at her perineum to see if I was coming out. My mom is so shy I have never seen her naked. She can’t even pee in a public place, so being stared at was, for her, humiliating.

As I asked her how she felt about the birth, she matter of factly told me that that was just the way it was. No one questioned it. She said it was always good to hear other women’s stories at baby showers, that it was affirming of her own experience, but she was too busy to consider the experience as much more than having her first child.

Women birthing in the United States have it really easy compared to some women around the world. We don’t have 1 in 8 women die at births. We don’t lose our babies like too many other countries. We don’t labor on the floor with rats and roaches, sitting in the blood of a hundred other women who birthed before us. We don’t give birth as mortar shells explode outside the window. We don’t really have to worry that our children probably won’t make it to their first year’s birthday. Women in other countries can labor for a week before someone gathers the few dollars it takes to get her to a hospital hundreds of miles away, only to know the baby has already died and the mom now at serious risk of dying from hemorrhage or infection.

Do these women have PTSD? Or do they live in some sort of Traumatic Stress every moment of their lives? Do stressors have ratings? The stress of trying to staying alive much higher on the scale than having a mother-in-law that won’t allow you to go to the hospital? What would these women think of us who are saying they have PTSD for being touched where we said we didn’t want to be touched? Would they think we are absurd? Would they think we are so privileged and take for granted aspects of life they cannot even fathom a woman would be granted.

Is Postpartum Post-Traumatic Stress Disorder (PPPTSD) an illness of luxury? If we were huddled in a migrant camp, would we really be concerned that the doctor pushed our legs apart to do a vaginal exam? Or would the multi-rape experiences overshadow the minimal intrusion the roaming doctor or midwife does.

Is PPPTSD judged by societal norms?

When I was in sexual assault self-help groups (almost always led by therapists), there was a tendency among the women to rate the abuse, almost always minimizing their own. “Well, I was just sexually abused at twelve from the guy next door. She was six and it was her brother. She had it much worse than I did.” Over and over, we had to remind each other (and be reminded) that rating the abuse discounted our own. We had to really work to learn that the measuring stick with which we measured was created by our own hearts. Continuing on that path, it is important for women to take their own experiences and not judge them, comparing them to others. “I just had my membranes stripped without permission… she had an episiotomy!” Your own trauma is just as valid as the next woman’s. I like what Jennifer Zimmerman says: “But, rape is rape. One woman may label it that way, one woman may not, but it is what it is. …if a women has her membranes stripped without her knowledge or consent, that act is a violation no matter what the woman feels about it. If she was not offered informed consent, it doesn't matter whether she is thrilled that she went into labor a day later, she was still not offered informed consent and that makes it wrong for the provider to have done it.” 

So do we start telling women who loved their births that their births really sucked? Do we burst the bubbles of those great stories we hear all around us? Were we elected to Name the Abuse of every woman we meet? 

When I had Tristan (and you can read his story here), I thought the birth experience was so great I wrote a letter to the doctor, nurses and hospital administrator thanking them for the great birth I had in their hospital. When I was pregnant with Meghann, I was talking to a group of Bradley mamas, most of whom had had homebirths. I proudly showed Tristan’s birth pictures, all green draped, lithotomy, oxygen masked, baby across the room… all the things we know now are awful! The women never said a word to me about how horrified they were looking at the pictures. It wasn’t until the whole experience was re-framed by Bradley standards that I began to see the experience as sucky and blech. Even today, the feeling of joy far outweighs the supposed-to-be horrible, angry emotions I should have had back then. It was others that used their knowledge, given to me, pulled into my own psyche, that gave the first experience the shadow it now carries. I asked the Bradley moms how come they didn’t wince and cringe when I so proudly showed Tristan’s pictures off and the Bradley teacher said, “We knew you would figure it out yourself when you were ready.”

The dilemma, of course, is what do we do? 

I say we write and speak our realities. I want women to write in blogs, write articles and get them published, write the hospital, write the doctor, write the nurses. I vacillate between asking women to write filled with their anger and sadness or if they should wait until the anger has subsided and they can write in a voice that will be heard more than a shrill postpartum patient. Angry letters are often dismissed. I think they are fabulous to write and hang onto for awhile before sending them, re-vamping them as time passes, but I’m not sure how helpful the highly charged letters are. If it is a serious part of your healing, then I say go for it. But, know that you may not get any response. If you do write, speak as unemotionally as you can. Speak of specific actions, not a blanket “She sucked” kind of way. Ask someone else to read it to see if it makes sense, flows well and isn’t defamatory. Please don’t threaten the doctor with, “And I’m going to tell everyone I know how awful you are” because you can find yourself in court for defamation of character.thrilled that she went into labor a day later, she was still not offered informed consent and that makes it wrong for the provider to have done it. 

For the women too traumatized to write, draw. If you can read (I could not in my depressions), get Birthing From Within and work through the art suggestions. They can be very telling and very healing. Showing your pain on paper can help those around you “see” what you are talking about. 

Clay is another outlet. I used to do collages. I went to used bookstores and got dozens of magazines and pieced together a collage that spoke my pain in words and pictures. I still have a couple of them. You can also do a collage of what you hope to be/look like after you pass through the storm. Painting… deep, dark colors… the canvas holding the pain through brushstrokes and pallet clumps. 

Find your own outlet. Therapy, of course. Find a therapist who gets it, though. It really is hard to have to teach a therapist about birth trauma before you can get to the meat of the healing. You shouldn’t be the teacher, you are the client. There are many different types of therapy for PTSD. These include talk therapy, medications (temporary or long-term), holistic treatments, dietary changes, acupuncture, hypnosis (although that can be felt as a loss of control to some women – unacceptable), EMDR (Eye movement desensitization and reprocessing), and more. I wish there were Group Therapy groups, but I haven’t heard of any. There certainly are enough women to get dozens going. It really is important in self-help groups to not just be in a place of “poor, poor pitiful me,” but to actively work towards healing and a whole life with the trauma assimilated into the grand scheme of a woman’s life. With the acknowledgement of PPTSD, I believe women are more apt to begin their healing. 

Oftentimes, the therapy includes telling the perpetrator how the woman feels. I’ve seen letters, heard of throwing clay/dough around the room (at his/her hands or face), speaking to the abuser as s/he sits invisibly in a chair and, for many, eventually finding the power to be able to speak to the person face to face or through a letter or email that goes beyond the write & burn stage. It can be freeing to tell the perpetrator your feelings, but really, only if the person acknowledges their culpability in the experience. I remind women that most care providers will act defensively and even put some (all?) of the blame back on her. A woman has to be incredibly sure she can withstand a firestorm before she confronts her provider in person. I believe it is much easier to accuse and confront in writing, at least in the early stages of healing. 

As a healthcare provider, it is imperative for me to listen to women, believe them when they tell me about their abuse/trauma/rape whether it was someone else who did it or even if it was me. And after my 2004 disclosure of the past abuses I participated in, I have been involved in other women’s traumas, albeit accidently. It pains me knowing my actions have hurt another. I am definitely more aware of what I do and say, but there are times when situations create a ripe atmosphere for hurt and anger.  

My wish is that all providers find a place where they can listen –and hear- those that have been hurt, whether it was us or someone else. Until we all can hear, women must keep talking, writing, photographing and screaming about birth trauma. Providers can do the same.

Maybe then, someday soon, we will all be heard.

So, I am working on it, but it's taking time. I write a little, stop to think/process, then write some more. I keep sighing and Sarah asks what is wrong. I tell her it's just a heavy piece I'm writing. As I research, I am reading all sorts of yucky things about assault, battery, rape and then birth Post-Traumatic Stress Disorder (aka Post-Traumatic Birth Disorder). Not zippy, happy topics, no matter from which angle you look at it. It's hard, sometimes, to remember that birth isn't always so happy.

I'm not on another writing strike; just taking time to write this piece (unnamed at the moment). Thanks for your patience!

Hope it's done today.