Sunday, April 06, 2008

Birth Abuse

I've been reading on the blogs lately some entries about 'birth rape.' http://www.birthactivist.com/node/226 and http://www.thefword.org.uk/features/2008/03/not_a_happy_bir
Birth rape seems to define an emotionally and or physically traumatic birth that leaves the mother feeling violated and traumatized. As someone who worked briefly as a sexual assault nurse, I hestitate to use the word rape out of deference to what happened to the women I saw, and prefer abuse instead. At the same time I'm not trying to belittle what birth-abused women have experienced. I've experienced it myself. But even worse- I have been an abuser. That is much harder to live with. That is one reason I feel so strongly about not returning to hospital nursing. It is to be perpetually torn. On one hand it is beat into your head that you must be the patient's advocate in the healthcare system. On the other hand, you are to be allies with your healthcare colleagues and there is an unspoken 'code' that you do not betray them- you protect them, and they will protect you, presumably from the patient. This was a line I could not walk. I abused patients at the doctor's will. I abused doctors in every conceivable underhanded sneaky way I could to make myself feel better about being coerced into abusing patients. After some time, I came to despise both camps because I could not do right by either. I cannot have a healthy relationship with birthing women or my physician colleagues in a hospital setting. The power is too unbalanced and I must pick a side. Sweetly coerce the patient into things she doesn't want done, or face down the ire of the doctor- and I did face down the ire. I was yelled at, cursed at, had things thrown at me, written up, complained about, asked to be replaced by another nurse. I also tried to empower women to fight for themselves. Once when a mother of six came in to deliver, she was stunned to find out she would be getting a cesarean because she had one with her second birth and her physician group had just banned vbacs. Now HER physician had promised her a vbac, but of course HER physician was no where to be found when she came in to deliver. When I was alone with her, I took a major risk by telling her she did not have to have the cesarean, she could ask for a different doctor. But later when the doctor reentered the room to get her decision, she simply resigned herself to it- even though she had initially been very angry about it. This story exemplifies birth abuse in all its glory- and yes I helped to cut her open without a medical provocation- just on account of a fear-based policy (litigation fear at that). I remember being angry with everyone that night, the patient, the doctor who promised something she couldn't deliver, the doctor who cut her, and myself. I cannot divorce hospital birth from birth abuse. It happens every day in a million mundane ways- here where I used to practice it is nearly ubiquitous.

151 comments:

mamasara said...

I know the feelings you describe, Sherry. Even as a doula, I am sometimes resigned to stepping aside as a trauma-in-the-making occurs. I have limited ability to speak up when the mother agrees to interventions I know she does not want. Once, when a doctor was inducing a teen mother I was working with due to "high blood pressure" (which only occurred when he was in the room), I did speak up. I convinced her mother to remove her from the hospital before her uterus ruptured from the pit, or worse. I got her transferred to another care provider at another hospital, where she birthed her baby unmedicated a week later. I like to think this helps to erase some of the other guilt I feel when I can't halt a trauma as it's happening. If moms could only know the peace of a homebirth, they would never set foot in a hospital to birth.

Laborpayne said...

AMEN to that. I won't be setting foot in another hospital to bear witness to birth abuse. Have you ever wondered why people don't hire nurses to be at homebirths? My theory is that a nurse's primary role in the hospital is to manage technology and manage risk. There are no machines to watch go beep at a homebirth, and less of a need for a 'record keeper' recording every moment by moment event. What, you didn't know that was 90% of a labor nurse's job? Should litagation occur, the entire labor is supposed to be able to be reconstructed from the labor nurse's notes and the fetal monitor strip- which the nurse is also in charge of recording. This is why they want women on the monitor non-stop- for record keeping purposes.

Mary the Birth Goddess said...

Wow- I can't believe I am just now learning about you Ms Payne! I can't wait to catch up on you by reading your blog. I just ended my career as an L&D nurse last year, April of 07. I agree 100% with you that I just couldn't reconcile myself as an intact woman with integrity and with what an L&D nurse HAS TO DO to "play the game" in OB. I have witnessed so much birth abuse, but I have contributed to it as well by being a silent witness/accomplice. It's a difficult legacy to leave, which is why I have just recently started blogging about it. I want to let the puss out of the wound, so to speak!

Laborpayne said...

Mary,
and where have YOU been all my life? Your blog is more straightfoward than mine has ever been. Please keep writing and telling the truth and so will I. I know our voices will be heard. Thank you for making me aware of you presence in the blogosphere.

Sheryl Lyon said...

I was the victim of birthrape by my midwife and I will call it rape because that is exactly what it was.

Her fingers couldn't reach my cervix and prior to labor she would ask me to tilt my pelvis but in the heat of a contraction she simply rammed her hand into me violently and repeatedly while she made me labor on all fours.

She still never reached my cervix because her knuckles kept ramming into my pelvic bones and she couldn't get her hand any further in which seemed to really upset her.

It was much more forceful and violent than any sexual experience I have ever had. If there was a headboard it would have been broken. All I could say to myself was "why are they doing this to me?" over and over again.

Then she proceeded to "stretch me out" by hooking both index fingers inside my vagina and yanking her arms as hard as she could in each direction.

Incidentally, the pitocin was so high and relentless that despite my cries for mercy to stop turning it up and despite my daughter's dangerously low heartbeat, she kept increasing it. That is why I didn't argue or fight back while she was raping me. She did it during the contractions and I honestly thought I was going to die.

I call the specifically unwanted episiotomy, unnecessary induction, unnecessary pelvic exams, episiotomy repair with no numbing, demeaning talk and other such horrors "birth abuse". What that monster did to my vagina would send any stranger to jail for a long time. She not only got away with it, she got paid for it.

Laborpayne said...

Sheryl,
You make a compelling case. I often had the thought while I was standing bedside with a woman, if this were being done to her by a stranger, they could be charged with a crime. In fact, I wonder if legally a case could be made for assault and battery in some of these cases. I'll ask my friend Kevin, who is a med-mal attorney.

I remember assisting with a birth with parents I'm sure thought they did everything right. They hired a sweet family practice doc to do their delivery. When the fp doc got spooked at delivery, she called in her backup ob. The ob proceeded to use the vascum AND forceps on this woman's vagina, and then finally ended the horror with a cesarean. When I transported this couple over to the postpartum unit after recovery, they looked shell-shocked. I'll never forget the looks on thier faces- so haunting. They had the look of PTSD. They kept asking me, "what happened to us, when will we get our baby?" (NICU of course, after all that trauma).

Another time I saw a 400lb doc (he was HUGE) shove his entire arm up to the forearm into the vagina of this tiny asian woman. I'll never forget that image either. The asian ladies were famous for their stoicism in birth. On this occassion I watched this woman throw her head back, open her mouth, squeeze her eyes shut, roll her head from side to side and scream, except no sound came out. Every vein in her neck was bulging, but no sound. A silent scream. I knew she was in horrible pain and that fat bastard was tearing her vagina up. We do need to bring greater awareness to providers of the impact of birth violence. There's nothing quite like litagation to get their attention. But perhaps they'll just argue that they did what they needed to do to save mother and or baby. Here's a question: as a nurse I could not question the doc's preferred practice protocols, but can we as paying consumers?

Laborpayne said...

Talked to Kevin,
my favorite med-mal attorney. According to him, these kinds of cases would be nearly impossible to litigate. The legal question is basically, was this reasonable, routine, medical practice that was called for by the necessity of the situation? Since docs DO have a code (meaning they stick up for one another- even if one is a misogynistic psychopath) it wouldn't be too hard to get another doc or midwife to say- yes, reasonable action was taken given the gravity of the situation blah, blah, blah, and then there goes your case. I'm stymied, I don't know what can be done about this level of birth rape/abuse? Kevin didn't even know what it was-I had to define it. He said he's never seen such a case- and he does this stuff all day long.

Sheryl Lyon said...

I consulted an attorney friend of mine after my daughter's birth and he told me the exact same thing as you friend Kevin told you.

That is exactly why I will never, ever consider giving birth in a hospital ever again (unless I have a clear medical need).

Apparently, they can do whatever they want in there and get away with it.

Laborpayne said...

Sheryl,
This is indeed a travesty. What other recource is there for women who do not feel safe in the hospital?

I am a Monkey's Mama said...

I was birth raped.

I call it that because my reaction afterwards was almost identical to that of a sexual rape victim.

It began when I was coerced out of my clothes through my protests over "hospital protocols" that I must wear a gown, then onto the four tries it took to get an IV into me that I flat out refused, moved on to having my waters broken and being told that was happening as an arm was in my vagina, and then finally told that I must have surgery against my will due to my daughter's non-reassuring fetal heart tones that were perfect as soon as the pit was turned off. That is not even mentioning the many vaginal exams I had that were entirely against my will and done without my permission. I was told "sorry honey, you already signed the consent", "sorry honey, your contractions stopped", "sorry honey, the OR is already waiting for you". My voice DID NOT matter.

I suffered from nightmares, flashbacks, avoidance behaviors, hypervigilance (still do), anger, fear, frustration, being misunderstood by nearly every single person I know, and of course the humiliation of all of that happened right in front of my husband.

So, yeah. I'd say I was raped.

The only reason I will go near a hospital this time around is if my baby or I are in dire straights. And that is the ONLY reason.

Laborpayne said...

Thank you for sharing your story Monkey Mama. I appreciate your thoughts. Reading your blog reminds me of how helpless I feel talking to first timers. If I tell them what can happen, they have no point of reference to believe me. I have to shock them, spoil their innocence- and still run the risk of them not believing me.

FiannaHeather said...

I can't believe that I have not come across your blog before now. I am not a big blog reader, but I will definitely be keeping up on yours!

This entry is particularly meaningful for me. I was abused during my pregnancy and labor and delivery. It was awful and I was especially hurt, angry, and offended over the female resident who was fully on board with everything and my passive nurse.

I am going to start a BSN program in the fall with the hope of working in OB and I am scared to death of having the experience you have had. For me, it is the necessary evil that will get me where I need to be...midwifery school. I want to be part of the solution to this problem by becoming a midwife. I hope that my experiences will help me remember what I wanted and needed when I was having my babies.

Thanks for writing about this important subject!

FiannaHeather said...

P.S. You are a lovely lady!

Anonymous said...

Why do women think saving the baby is worth being traumatized for life? I think the trauma of a baby dying during birth might be much less than the trauma of a C-section forced on you against your will. What do you think?

Anonymous said...

Anonymous said...
Why do women think saving the baby is worth being traumatized for life? I think the trauma of a baby dying during birth might be much less than the trauma of a C-section forced on you against your will. What do you think?

I am responding to THIS comment above by Anonymous. I think any one who would say this statement is an idiot. I suggest people like you stay home to have your babies and don't come rushing in at the end to have the medical professionals save you or your dead baby. Enjoy your dangerous home births.....

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