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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.


I'm Offensive...

... and oh, so proud!

I don't know about y'all, but when I find a blockade, I love to knock them down. See a warning about a site? Gotta know what's so dang bad (good? juicy!) about it!

American Prayer was sent to me this morning. Not just because I am (obviously) voting for Obama, but because Dr. Wonderful is in this star-studded video! 3/4 of the way through, after the homeless vet, right after Woopi Goldberg, Dr. Wonderful is holding a baby. He's also writing a book about birth (in the vein of "Babycatcher") and was supposed to be on an episode of Scrubs, but had a baby that night. That man's connected!

The issue of birth trauma (something that needs a label put on it if I ever heard one) came up over the weekend in two different types of articles. The first addresses birth trauma directly, the second, indirectly.

GUERILLA MOTHERING: Mama’s baby drama doesn’t have to cause trauma says,

"The Wall Street Journal recently ran an article about Post Traumatic Stress Disorder in new mothers. Evidently, traumatic hospital births with a lot of medical interventions are leaving moms severely emotionally scarred. Imagine that! Someone comes into your hospital room, you’re already half-naked, scared, and in pain, and tells you that the baby you’ve carried and dreamed of for so long might die if they don’t do a certain procedure right away-and even then, no guarantees you’re going home with your little one. Yeah, I’d call that a little traumatic."


"...he was born out of my numbed-to-the-point-of-paralysis body after a long night of drugs, having my water broken, and lying around practically tied to a hospital bed, as nervous as though a firing squad was waiting for me on the other side of labor. The very moment he was born, I held my arms out for him, desperate to hold him — but the Dr. took him away immediately to be examined on the other side of the room. I still tear up, just thinking about it, seven years and two additional births later. Is that a sign of trauma?"

And after her third, a homebirth,

"There he was. Healthy, serene, perfect. There is a photo of me, smiling, holding him in my arms, immediately after he was born. I had finally outrun those birth demons, and what a prize.

"It was the most beautiful thing I have ever done, and it truly changed my life. I went on to change careers, write a book, visit a monastery for a week, play roller derby — all kinds of things that I still think are not as cool as having a homebirth, but I would perhaps not have had the confidence to do, had I not named and claimed the birth of my third miracle child. That is the total opposite of trauma, without a doubt."

What's so sad to me is that she had to swing all the way to a homebirth to find the birth that empowered her the most. I am so frustrated, knowing Dr. Wonderful births, watching/hearing, over and over, the birthrape, birth trauma and birth abuse that happens in hospitals when it simply doesn't have to be that way. Keeping women and babies safe (the whole explosive reason/explanation for the massive amounts of technology and "inconvenience" to women in hospitals) just doesn't have to be so damned dramatic/traumatic! If I hadn't seen there could be other ways, I would never believe there could be other ways. But, I have - and there can.

Should We Push for Better Birth on Television as Well?, a blog post by the Massachussetts Friends of Midwives talks about how birth on tv is incredibly over-dramatized and how helpful it would be to see a variety of midwives in a variety of birth situations so women could see how birth can (and should!) be.

I wrote one of the most profound sentences in the comments section (if I do say so myself):

TRUE natural birth needs an agent.

The article speaks about the over-dramatization of birth shows, yet sings the praises of House of Babies, a show about a birth center in Miami, Florida. While the births are unmedicated and, compared to hospital births, the women are permitted free movement, the actual births are almost always in the lithotomy position (not flat on the back, but close to it) - even in the birth tub.

Shari Daniels trained and worked in El Paso where, for the most part, women birth on their backs. In fact, unless a woman precip'd, she delivered on her back. Easily 99% of the time. While on House of Babies it might seem the women are on their backs for good camera angles, I can hear the imploring of the midwives in almost the same words, English or Spanish, as the midwives in El Paso. I have long felt we are products of our training and experiences; it isn't unusual for Shari to nudge birth along at the end since it seems to work just fine. The urgency is just as palpable on House of Babies as it is on Babies: Special Delivery.

I wonder if I'd want a camera watching a birth I was doing. Talk about being judged for actions! Am I ashamed of what I do? Not at all. But I don't know if I could take the amount of scrutiny I know would happen. I wonder how many midwives would/could want Discovery cameras in their birth arenas.

I assisted at a birth once and the client permitted a camera woman who was photographing Rites of Passages in our culture. She not only took photos of that birth (and I purposefully took none), but also of a Bris of another midwife's client. The photographer, an intern for our San Diego paper, disappeared with the photos - never to be heard from again. I'm a tad wary of bringing in an outsider anymore.

Plus, watching Mindy's birth (Psalm and Zoya) be massacred on Discovery Health, it's hard to trust the media at all!

But, how do women get to see natural births? Is it really only through edited YouTube videos? How does the slow unfolding of birth get portrayed... the mundane-ness, the down-and-dirty boring reality of it all?

(And I don't mean I am bored. I mean that many labors plod along and that is perfectly normal and wonderful. It's one reason why I LOVE the Labor Day Birth Day on Discovery Health; one gets to see births in real time - and how many births really are drugged and end in cesareans. Natural birth can be hypnotizing in its contracting, moaning repetition.)

If women saw birth on its undramatic terms, would women be so afraid of the pain? I don't think so. Even the unmedicated women in hospitals are confined to beds; no wonder they scream! The women on House of Babies moan, but don't often holler.

If our culture could get the taboo issues regarding sexual expression and childbirth out of the way, labor would look much more delicious than painful. Reminding women that sex looks scary to the uninitiated (kids, for example), but really is a delightful journey that sometimes includes moaning and hollering. So, too, can birth be the same. I think our repressed society struggles with the sounds, smells and similarities of birth and sex, hence medicating, covering up with non-descript gowns and mechanizing the whole experience so we don't have to be reminded that our genitals are involved.

Hmmm... where did that come from?

Food for thought, though.

True natural birth does need an agent. Wonder who she is.


When Dogma Trumps Common Sense

I stumbled onto this blog post from someone who 1) seems to work in a hospital 2) hears great stories from friends who work in a hospital. You decide.

A birth plan, but no immediate mothering skills highlights the image of a rabid natural birth fanatic (and I use the term purposefully) as she moved from her planned homebirth into the hospital after she had ruptured membranes for 7 days and no labor to speak of.

(Those that know, know I also had 7 days between ROM and the birth of a baby, but I was under the care of myself and a sneaky group of CNMs. Don't know how tolerant I would be of another woman acting like I did! It'd need to be on a case-by-case basis, that's for sure.)

N E Way....

So the blog poster illuminates how stupid... er, strike that... ignorant? (not good either)... crazy? (probably a better word) an immobile natural birth advocate can sound when confronted with a change in plans.

(Edited for typos and attractiveness, not substance.)

(Begin quote)

- Her water broke 7 days before she ended up in the hospital. She had gone into a small town hospital (after the planned home birth didn't happen) that was not equipped to handle sections so was transferred to ours.

- She refused a section even though her baby was in DISTRESS; she had a birth plan and a section was NOT in her birth plan.

- She continued to refuse the section even though her baby was in IMMEDIATE DISTRESS because she wanted a natural birth.

- The doctor eventually had her agree to the section, not quite having to "hit her over the head with a hammer" as my friend so elequently put it.

- The baby was covered in meconium when born and even though he had not yet taken a breath she insisted he be placed on her chest.

- Couldn't happen becuase a) the baby wasn't breathing and b) her chest was in the sterile zone.

- They did place the baby on her chest immediately after he started breathing and the nurse stayed with them as the mother could't technically hold him.

- She refused to let the baby go to the nursery to be checked over while she was in recovery and wanted him left with her. As she had no partner and she was still somewhat drugged the ICN nurse had to stay as well, meaning she couldn't see to the other babies under her care in the nursery.

- When she was transferred to the maternity ward she had the baby lying on her stomach and the nurse suggested she lift the baby higher if she was looking to feed him. "Oh no, he will crawl to the breast if he is hungry." The two nurses say that newborns don't actually crawl to the breast and she says "Yes, they do! I saw it in a video." Editing, ya know.

- She refused to have a crib in her room and wanted the baby with her. When the nurse came in to do some bloodwork on the baby, the mom was sleeping and baby was nowhere to be seen. The nurse lifted up the blanket to find the baby with his face down in between her armpit and breast. Baby grey, no heartbeat, not breathing. Nurse rushes him out of room, all the while trying to get a heartbeat and breath. When in crib in hall, heart rate measures 40 (normal newborn in 100-160). If nurse had been 30 seconds later, baby would have been dead.

(end quote)

Even if we looked at the story through squinted eyes, believing some of this is exaggeration, I know this story is true because I have read/heard enough accounts from the fanatics themselves!

When you buy the hospital ticket, you go for the hospital ride.

As I recently said, hospitals have a huge responsibility to normalize birth within their walls, but for crying in a bucket, when there are complications, birth plans should be shredded by the women themselves.

When I have clients that move from home to hospital during their births, anything relating to the reason we are going there for now rests solely in the medical personnels' hands. It's what they're there for!

For example, if mom is laboring and there is lack of progress that sends us into the hospital, a birth plan that says, "No pitocin," isn't going to cut it. The part that says, "No erythromycin (in the baby's eyes)" is easy to adhere to because it isn't related to the reason for the transport.

Make sense?

If you have to move to the hospital because the baby has low heart tones, asking for intermittent monitoring is not only foolish, but dangerous.

Hmm. thinking

My frustration... let's see... part of it is it's embarrassing to have women be so adamently against something when that something can possibly save their lives or their babies' lives... all in the name of "natural childbirth." I'm not talking about the routine crap that goes on in hospitals, but the stuff that is really necessary when birth deviates from the norm.

Just like the hospital treating everyone the same and demanding that they stop doing that, it behooves natural birth advocates to stop seeing every intervention in birth as dangerous and weigh the risks with the benefits. Sometimes technology is fantastic!

The issue, of course, is how can you tell when the interventions are really necessary? So much of it depends on trust and distrust definitely sets the stage when there's mutual antagonism.

Walking in/being wheeled in with an open mind and heart can help tremendously.

Having an advocate... your midwife or a doula... not your partner (who is laboring right along with you) who can explain things to you as they unfold... a person you implicitely trust... someone with the experience to understand the hospital language, the interventions and their necessities... where was the woman's midwife in the above scenario? Was she UCing? (Sadly, it sounds like it from her rigid attitude towards birth and the hospital. Sad because UCers have a reputation that precedes them.)

And finally, believing that whatever happened was supposed to - for whatever reason. Lessons. The baby's choice. Destiny. Fate. However you are able to explain it to your psyche, it's important to integrate the experience so you are able to be a mother and a woman in your life.

None of this means there can't be distress in the experience, that women might not be coping with birth trauma or recovering from birth abuse, but integrating can mean the difference between immobilization and functioning.

Some women have found my The Gray/Grey Messenger: Recovery helpful when overcoming birth trauma.

It's a precarious place... needing to trust the hospital yet knowing many women are bulldozed into interventions they don't want/need.

Even though the medical folks tend to play the Dead Baby Card too often, it really is more important to err on the side of safety for both mother and baby.

I hope the mom in the above post is able to obtain some balance in her reality.

It's all any of us can ask for.


Birth as a Work of Art

I see it in my mind’s eye; hear it long before you, my readers, see it. I often start with a title – titles are one of my strengths. The bullet points come next and then I sit down to write and the words bubble forth, as if they’ve been sitting there, waiting to finally be put down, ending up as if they’d been there all the time.

I stop. And read it, correcting typos, changing this word or that, sometimes moving whole paragraphs around because they didn’t seem to fit the way they were sitting. I read it again, put it away and read it once or twice more before publishing it here on my blog. (I used to write IN Blogger, but after losing several posts, learned to write the piece in Word instead.)

Once it is available for your viewing pleasure, I leave it alone for about 12 hours, and then I go back and read it again, usually after someone has commented, and make a couple more last minute changes. It’s rare, after this point, that I’ll go and change something in the meat of the piece. I’ve added a paragraph here and there that clarifies, but not often.

We had The Red Tent on Monday night. Several women attended and shared their stories and it was good... no, it was powerful and wonderful. Lots of tears, some laughter and even more healing.

I witnessed the unveiling of women’s pieces of art. Some of the works were brand new while others were dusty with age. We all helped each other carry them in, especially the heavy ones, and then we sat quietly, studying, wondering, listening to each artist describe her piece.

Birth, too, starts as a thought. Should I have an epidural? A scheduled cesarean? A home waterbirth? Will I have a VBAC this time? Oftentimes, long before the words come out of our mouths about our desires, we’ve been studying, learning about our options and once we feel strong enough, confident enough, we’ll tentatively start mentioning what we’d like to do... almost testing the waters.

Will I be bold and noisy like Mappelthorpe ? Or will I sing softly like Sarah McLachlan . Will my brushstrokes be chunky and globbed with paint? Or will I create wisps with watercolor ink. To whom will I show my work? My partner first? Or my understanding friends?

The commonality between the women included wanting to share her story, wanting to share her story with others who have had difficult or challenging births, wanting to be heard and not judged, wanting a safe place to cry or be angry without someone telling her to get over it already and wanting to know she wasn’t alone. I believe the meeting accomplished that and more.

Listening to the stories, it was easy to see how much the women wanted and needed an understanding female at their births. Over and over, I heard tales of the husband or partner’s lack of involvement during the labor and birth. Women who thought they would be protected from the medical establishment were left to defend themselves – and we all know how little a laboring mom can defend herself, right? However, one of my clients even said she needed me more than I was there for her. I listened hard and with an open heart. I also apologized. So, even women who attend births can be distant and not what the mom needs her to be.

My favorite expression of the gathering came from one of the moms who’d birthed in the hospital, her husband not terribly involved and who had a cesarean delivery. When we were getting ready to adjourn for the night, she said, “What I get from all of this is even if I had a doula, even if I was going to have a homebirth, even if I had a midwife, I still could have ended up in the hospital with a cesarean! That makes me feel so much better!”

We all agreed to bring our art pieces back next Monday night. Some said they’d bring a friend along.

What a privilege to see the inner workings of how art is created!

I love that all of us has something to share.


The Gray, Grey Messenger - Gloria LeMay

These next three posts wind around and around. It's taken weeks to write them and while each can stand alone, I believe they are all entertwined.

I hope they make some sense to you readers. Thanks for your patience in sloshing through.

I re-published the “Sanguineous Shock” piece after reading what Gloria Lemay had to say about unassisted birth. You can read the entire response on dear Rixa's site - Gloria Lemay Responds... - but there are parts I simply must take to task.

Gloria says:

“First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING. Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough IV fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could. I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting."

"Think about it--would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes? I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up.”

So, just because Gloria hasn’t seen a mother bleed to death in 5 minutes means it doesn’t happen? Does a midwife have to SEE something happen before she believes it can occur? Does a mother? Father? Nurse? Doctor? How could she not have learned about – heard about Amniotic Fluid Embolisms? Disseminated Intravascular Coagulation?

“AFE is considered an unpredictable and unpreventable event with an unknown cause. In the national registry, 41% of patients had a history of allergies. “Reported risk factors for development of AFE include multiparity, advanced maternal age, male fetus, and trauma. In a retrospective review of a 12-year period encompassing 180 cases of AFE, of which 24 were fatal, medical induction of labor increased the risk of AFE.8 In the same study, AFE was positively associated with multiparity, cesarean section or operative vaginal delivery, abruption, placenta previa, and cervical laceration or uterine rupture.”

While a homebirth midwife wouldn’t be participating in any medical induction, cesarean, traumatic birth, forceps or vacuum, we do have women who have had more than one baby, women that have sons, women who are over 35, could have a uterine rupture or placental abruption, a cervical laceration and, if the woman hasn’t had a sono, possibly a placenta previa (although there are usually signs beforehand that the placenta is overlying the cervix). And, as we all know, there are going to be some women who don’t fit into these categories at all.

So, why would a homebirth midwife continue attending births even though she knows there is a risk of losing a woman in under 5 minutes? Why do I attend births knowing what I know – having seen what I saw 20 years ago?

When I first went to learn midwifery and left school with a license to practice, it was the birth in the poem that continually danced in front of my eyes. I kept thinking, “What if that happens when I am the care provider? How will I handle the death of a woman… or baby?”