2. Obstetric Violence - What Is It and How Can We Avoid It?
Did your birth leave you feeling unsatisfied? Maybe you felt downright traumatized. Well, you’re not alone. This happens more often than you would think in our overly medicalized modern age. Doctors assume they know better than the patient and will use coercive tactics in order to get the patient to agree to do things their way or they will just forcibly perform procedures that have been outright rejected. According to the Lancet, “Obstetric violence refers to harm inflicted during or in relation to pregnancy, childbearing, and the post-partum period.” Whether that harm is physical, mental, emotional, or spiritual, statistics show that 1 in every 3 women may experience trauma during their birth. Would that number be higher if women knew what was being done to them without their consent during what should be the happiest event of their lives? With maternal mortality rates on the rise in the US, how can women stop this from happening to them?
Just after childbirth, women are often euphoric, finally holding their new baby that they’ve been waiting 9 months to meet. Typically, a cocktail of Pitocin and epidural drugs is still running through their bodies. Nurses and doctors busily rub down the baby, push on mom’s belly, tear out the placenta, put in stitches, and administer meds. All of this happens without a word of informed consent from mom. Did you have a hospital birth and consent to Pitocin to help you birth your placenta? No? Well, I can almost guarantee they gave it to you. Even if you didn’t have Pitocin in order to birth your baby, they often sneak it into your IV in the third stage when your body births the placenta. Doctors and nurses routinely ignore informed consent in the labor and delivery room, and they get away with it because we as a society have normalized it because the MDs and RNs know better than you and as long as you have a healthy baby, what do you really have to complain about? Right? Uh, NO.
This normalization of medicalized birth is literally killing us. Women in America have one of the highest rates of maternal mortality and it’s NOT because of the 1% of American women that birth at home, or the fraction of that 1% that free birth. If we make it through birth, many of us have to deal with the traumas that these medicalized births cause, which can range from postpartum depression to paralysis. The ways this trauma can happen are endless, so let’s go over what obstetric violence can look like. Obvious examples of physical obstetric violence are cervical checks and fingers in your vagina while you’re pushing. Some OBs even use baby shampoo inside the vagina. WTF. Routine use of episiotomies still occurs even though ACOG only prescribes the use of them when completely necessary. We may have to recover from other physical traumas like a 4th degree tear caused by coached pushing, or uterine prolapse from cord traction before the placenta had detached from the uterine wall, or the unnecessary cesarean we were coerced into that can lead to life long harm and difficulty bearing another child. We could suffer mental trauma from our births. There is a known causal link between postpartum depression and Pitocin use. Maybe we were emotionally abused by the OB and the nurses. Maybe their coercion tactics traumatized us or they threatened to call CPS if we didn’t adhere to their routine newborn medications. From ACOG itself, “ACOG believes that it is unethical for medical practitioners to use manipulation, coercion, or threats of criminalization to compel patients toward a particular medical decision or treatment, including during pregnancy and the postpartum period.” It’s too bad they don’t practice what they preach. Were we spiritually harmed? Perhaps the MD didn’t respect our wishes when we asked for a quiet room for scripture to be read or another sort of ritual we wanted to be performed. No matter which type of abuse happens to us, it can greatly affect our role as a mother to our new baby. If we aren’t physically, mentally, emotionally, or spiritually whole, how can we be expected to care for a new life that is completely dependent on us 24/7?
To hell with all of that. Let’s normalize informed consent. TRUE informed consent, where laboring women hear the benefits AND RISKS of the procedures that the medical staff want to push on us. Women need to take back their bodily autonomy from the medical establishment that took it from us over a hundred years ago, all because they were looking for a quick buck. So if taking back your autonomy means that you want to have a home birth, then I think you’re on the right track. Some want to or feel they have to birth in a hospital and if that’s you, then you need to take extra steps in order to prepare yourself and your birth team for the onslaught of procedures that the hospital staff will try to perform on you and your new baby often without your consent. It is up to every single one of us to take the responsibility and decision making back and to stop letting medical authorities decide what is right for us. I mean, we all remember what they did to us these past 3 years, right?
We all want to think we’re doing enough, and women will think they’re preparing themselves for a safe hospital birth by writing up a birth plan, which is obviously an important task to complete during pregnancy, but it takes more than that to make sure that it is followed as closely as possible. Many times, mothers will think they’re in the clear because they handed that birth plan over to their nurse and doctor and will even explicitly tell the hospital staff that she doesn’t want something performed, but the doctor or nurse will do it anyway saying they have to or saying nothing at all, which completely violates informed consent laws and the woman’s bodily autonomy.
So how can we avoid obstetric violence in the hospital? Well, number one would be don’t go, but if you must, your second best choice is educating yourself and choosing your birth team. You cannot expect to learn what you need to know through a hospital childbirth education course. Those are only held in order to teach you how to be a good hospital patient and to nod and smile when the doctor tells you something. I suggest attending a thorough out-of-hospital childbirth education class from a childbirth educator or researching hospital interventions on your own. Childbirth education AND your birth team must go hand in hand. You can’t educate yourself but have inadequate advocacy while you’re in the throes of labor and you can’t have a birth team that doesn’t have a solid knowledge of what hospital birth interventions look like and what your wishes in regard to each one.
Having a birth team by your side that you trust to advocate for you is PARAMOUNT. Your best bet would be to have at least two people with you at your birth if it’s attended by an OB or midwife, typically your partner and either another loved one you trust or a doula. Not only do you need these people with you, but if you plan on going through a childbirth education course, they should go through it with you as well in order to learn about the medical procedures, and why they’re performed. Your birth team needs to be paying attention to everything that is going on in the room because things happen fast and if something is being done that hasn’t been discussed or has been previously rejected by you, that is the exact moment that you, your doula, or your partner should say, “STOP!” and bring a halt to everything happening in the room. If you’re crowning and your OB gets out his scissors for an unconsented episiotomy, your birth team needs to look for that and be ready to say something.
Challenging people who we perceive as medical authorities can be extremely difficult, even as confident, mature adults, but this is your BIRTH we are talking about here. Your BIRTH, your BODY and your BABY. YOU hold the cards. YOU have the power. YOU can say no to any damn thing you feel like, for any reason, so speak up! Tell your birth team that you want them to speak up! Make sure your doula is an ADVOCATE doula. Not one who doesn’t think that’s in her job description.
What can you do if you experienced obstetric violence? I wish I had better news for you, but not much. Unfortunately, challenging these doctors and hospital systems rarely results in a victory for the mother. The medical system has an entire legal department at its disposal with endless funds ready to protect its bottom line, which is why PREVENTING obstetric violence from happening in the first place is key.
Educate yourself.
Prep your birth team.
Or…
Birth at home.
None of this is medical advice. I’d say talk to your doctor, but instead, I’d suggest you educate yourself and tune into your intuition to decide what is right for you.
