Birth Rape

May 15, 2008 rooroo

In an ethics class I was once in, we were presented with a real-life situation that had happened in the hospital. It went something along the lines of:

You are a medical student witnessing a colonoscopy. The patient is still in a lot of pain despite the maximum amount of sedation/analgesia given. The patient then starts to shout, “Stop, please stop!” At which time, the surgeon sees the lesion that they want to biopsy. What should be done?

Our class came to the consensus that the doctor should have stopped what they were doing i.e. not progress with the colonoscopy, and explain to the patient that they have just seen the lesion, and could they have permission to continue and take the biopsy, given that the circumstances had changed. If the patient said no, then they were then to proceed with withdrawing the instruments.

At the end of the class, the teacher asked us, “Who would have gone in and taken the biopsy anyway?”

The majority of the class put their hands up.

————————————————————–

There’s a big debate going on at the moment on the subject of Birth Rape. The first time I heard of this term, it was through circles which advocate natural birth (I don’t advocate any sort of birthing process; that’s for the woman to decide provided she has all the facts, risks and benefits presented to her), then I went onto read stories written for the Birth Trauma Association and went to debates surrounding the ‘Too Posh to Push’ myth. The midwives and doctors who spoke at this conference suggested that given the birth trauma a lot of women experience, they are surprised the c-section rate isn’t higher than it is.

Then an article was written for the F-word entitled, “Not a happy birthday”. To me, it appears that there are two issues: procedures done without consent and the medicalisation of childbirth. Given the amount of money paid out to couples with infants who suffered hypoxia or other injury due to the team or doctor not intervening ‘sooner’, I don’t think medicalisation can be solely blamed on the idea that OBs/midwives want to do nasty things to women out of power/greed/sadism etc. Nor do I think the natural model is going to help matters or is the answer to birth trauma. Presenting the idea of birth to women as a natural, beautiful process doesn’t help those who then require intervention (I think 30% of homebirths in the UK result in a transfer, mainly for analgesia, but don’t quote me on that) and could leave someone with more trauma if they never prepared for the eventuality that they would need help. I see a lot of birth plans which are incredibly rigid and seem to assume that birth is something we have some control over if things were allowed to progress as in nature.

On the issue of consent, doing things to patients without their consent when they have the capacity to do so is assault and battery. Birth rape seems to have been born of experiences where women have been penetrated with fingers and/or objects and have either refused this or withdrawn consent and the doctor/midwife continued regardless. What whatever reasons I am still trying to work out, using the term birth rape makes me uncomfortable. What makes me even more uncomfortable is questioning this, as I was sexually assaulted when I was 15, so I should at least be gunning up with the Sisterhood. The assault had a lasting impact on me for a long time, in terms of triggering events, feelings of violation (3 years later I had my purse stolen from my handbag, oddly enough the same feelings came flooding back). Luckily it had no effect on the relationships that I made.

I want to do Obstetrics. I love women, I think the female reproductive system is awesome, and I want to help out those who have had high risk pregnancies or had a change of events in their labour. I don’t want to be perceived as a rapist, or even a potential rapist. But am I stuck between a rock and a hard place? If you refuse my intervention and I carried on, giving you a live healthy baby, will you look to me with contempt and lump me in with the rest of the Bad Doctors out there? If I respect your wishes, and something happens to your baby, will you do everything in your power to ensure I don’t practice medicine again?

The problem with obstetrics is that things can go very wrong, very quickly. When a friend gave birth, the baby’s head was crowning then suddenly the heart rate crashed. The baby needed to be out now, every second counted, time = brain cells, and there was no time to even ask for consent or discuss what was to be done – an episiotomy was cut, and the baby was resuscitated.

That case was pretty extreme and luckily doesn’t happen everyday. Slapping patients, humiliating and degrading them by words or force is pretty repulsive, and I question why those individuals entered the profession. But I think there needs to be some dialogue on both sides to find a way to improve outcomes, minimising birth trauma.

Does the term birth rape help this? I don’t think so. This is only my opinion, and I am not implying that what those women experienced was not rape, I don’t believe it’s anyone’s right to tell someone what they did or didn’t feel they experienced. I think it distracts from the issue of birth trauma, because as a very new term, and what it implies, it’s bound to be controversial.

What can help to minimise birth trauma? I believe communication, including full debriefings afterwards and opportunities for further meetings. On the patient’s part, considering a birth plan to plan for every eventuality – don’t act as if you are immune from a c-section just because you’ve read Ina May or have a positive mindset and positive affirmations. Face the fear: if you needed a c-section, do you want the operating surgeon to communicate with you with the same detail as they would talk to a medical student? Do you want them to shut up and get on with it? Do you want the screen up, or do you want the chance to see your baby being born? For professionals, don’t demean or ridicule what someone is feeling post-natally, ‘You have a healthy baby’ is all well and fine, but that baby still needs to be raised by a mother, and tends to do better when that mother feels healthy in herself.

In this case, the dialogue has been broken down. It seems a war of words has been started by the F word and Dr Crippen and no resolution will really occur. The medical professionals don’t want to be thought of as potential rapists, the women affected don’t want to be fobbed off and told they’re being hysterical.

I can see both sides of the issue. Being a gynaecologist is looking better all the time.

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6 Comments Add your own

  • 1. Kathy&hellip  | 

    I’ve read some pretty bad birth stories — stories that I would classify as “birth rape”. This is primarily due to how the woman feels about what happened to her. The term “rape” may be strong, but it definitely commands attention! I would be concerned about the term “rape” losing some of its impact, of diminishing in force, by overuse, or misuse; but for now I’m willing to call such stories “birth rape”.

  • 2. dommebell&hellip  | 

    Hi Kathy,

    I think that was partly my concern too. I don’t know where you are from but in the UK the conviction rate for rape is around about 6%. Within the profession I think a lot of the reactions will be similar to Dr Crippen’s, which worries me as I think the issue of birth trauma must be addressed and current practice looked at. At least it has got people talking!

  • 3. Kathy&hellip  | 

    Hi, I’m from the U.S. I just looked up some stats online, and found this website. It says that it’s estimated that only 16% of rapes are reported; but there’s a 54% conviction rate among those brought to trial. That puts the conviction rate about 8% of all estimated rapes. Pretty low stats!

    I just had to comment on the “just be glad your baby is healthy.” — I met a woman once who still cried every time she thought of how her baby was born, 6 months previously. The baby was healthy, and everybody told her “just be happy — what’s important is that the baby is healthy.” Well, certainly the health of her baby *was* important, but so was how she felt about the experience. She was basically railroaded into an induction that she felt was unnecessary, which then failed and led to a C-section. Although I’m sure she technically gave consent to everything, she felt like she didn’t have a choice. Maybe not “birth rape” but “birth assault.” How much power do you have when the only choice you’re allowed is to say “yes”?

    I’m glad you’re thinking about this now — having doctors understand that it’s not *all* about whether or not the baby lives or is healthy. That’s important, of course, but not when the mother’s experience and involvement in her birth is completely over-ridden. Giving women information is vital. They are thinking, feeling creatures, and deserve to understand what is happening to them and to their babies. But all too often, they are left in the dark as “the medical staff” do whatever it is they want. It may be completely necessary, but I think doctors and nurses should also remember that one other thing that is necessary is communicating these things to the patient.

    Pregnancy isn’t a disease; a woman giving birth isn’t sick — especially not in her mind! She can think and understand and process information, so treat her like that!

    Ok, stepping off of my soap-box now. 🙂

    As long as you remember to be compassionate to the human individual you are caring for at that moment, I’m sure you’ll be an awesome doctor!

  • 4. Evie&hellip  | 

    Hi, I’m from the US too, although I am currently an Australian resident. Last year, in Australia I experienced pack birth rape. I was lied to and told that my placenta was “failing”, and that my babies were in immediate danger of dying. I requested ultrasounds, and explanations and was told that it was so certain that corroborating tests were unnecessary. There is zero mention of any life threatening condition in my chart. In fact, it is written that I had a well and uneventful pregnancy. I was only 39 weeks along, and, according to hospital policy, induction is not to be “offered” until 41 weeks.

    I discussed an epidural with 4 hospital employees (2 dr’s and 2 anest.’s, and not a one told me I would be paralyzed and catheterized – not the walking epidural I believed I was receiving.

    The epidural was also not to be used during the second stage so I could push. It was wearing off, and I had a grand total of 4 pushes before the M/W ordered me to stop, forced me onto my back, and re-paralyzed me. This was done over my protest, and without explanation, and indeed there is no medical reason recorded anywhere in my chart for such action. I was forced to lie on my back for 1 1/4 hours, waiting for the “Dr” to arrive at the hospital. I repeatedly refused to be moved to the OR. I asked for another Dr. I was firm and controlled, and completely ignored. The “Dr.” refused to allow my husband into the OR unless I signed the consent form he thrust in my face. He spit on me. “Consent” was so quickly signed that the anest. began in the same minute as my arrival in the OR.

    The “emergency” c/s for “dystocia” was pure fraud. The “team” added 4 hours to the time of my labor to be able to justify surgery. 2 hours before labor started (this time discrepancy is in the chart) and 2 hours which were actually part of the second stage, of which 1 1/4 hours I spent forcibly restrained and flat on my back. Again, there was no medical reason for this behavior by the staff. This is particularly horrifying because I had an uncomplicated VB for my first child.

    Rape is a term most women do not use lightly, and is the term used by both myself and my husband for what happened in that hospital. I was repeatedly raped (ie. procedures performed without consent which were unnecessary and damaging, under false pretense, duress, and direct physical threats), and by different employees.

    There is a 2/3 surgical birth rate right now in Australia. That’s 66%. Take off 15% for necessary c/s, and 1% for true dystocia, and that’s a whopping 50% chance for any woman entering the hospital to have a preventable surgical birth. And who is benefitting from all of the interventions? Hospitals, Dr.s, and M/Ws. There is more money in interventions and surgery, coupled with shorter work weeks as babies are being forced into the world on Tues. and Thurs. instead of coming when they are ready. More and more babes are being delivered premature, and damaged as the surgical birth rate rises.

    I did not go to the hospital to be abused – I believed it would be a safe place to birth as I would have access to emergency care if necessary. I had not a clue that an emergency situation would be fabricated for me if I did not manifest my own.

    I believe that these situations (and falsifying medical reports can only mean that I’m not the only one) can be remedied by more direct governmental oversight. Put these sociopaths away! Give financial incentives to carers with the most satisfied patients!

    My advice to those women and families of childbearing age:

    Take your cell, and don’t be afraid to call the police if you are being abused.
    Take your video camera, and record your conversations with staff, especially if you are suspicious.
    Take an experienced birth attendant, as a green father is easily intimidated.
    Take all the information you can gather on your own before you go into hospital, as it will not usually be provided to you. Doubtful about this statement? Look at the current surgical birth statistics for the US, Australia, and Britian. How many mommies to be would agree to interventions that actually increase the dangers associated with birth for babies? Especially induction, syntocin, prostglandin, and Cytotec? Not many.

    Yes of course there are quality carers out there, but the chances of ending up with one are short. And I feel I can speak for all birthing families out there on this – if you are a maternity care provider and you are witness to patient abuse REPORT IT!

  • 5. Denise Punger&hellip  | 

    What an interesting post! I’ve always been intrigued by birth. As a physician-in-training, I didn’t feel right with the interventions I observed. It wasn’t till I had my own babies that I could appreciate giving birth from a mother’s perspective. Giving birth can be an incredibly empowering experiences. Most emergenicies are iatrogenic, both on the part of the provider and lack of preparation by the woman giving bith. I am glad to see that you have been able to see both sides while still training. if you continue reading both sides you are bound to provide a wonderful service and really be appreciated. What to read? Start with my blog and birth stories. Read all my links and suggested books. Attend a La Leche League meeting and an ICAN meeting (International Cesarean Awareness Network) to hear woman’s stories in real life. Learn from and listen to your patients. Get some experience at a birth center. Attend a homebirth while you are still in training. In other words make sure you keep learning from perspectives beyond the Obstertics Pint of veiw.

    Denise, Family Physician and IBCLC in Florida

  • 6. Donna&hellip  | 

    That’s quite the ethical question they presented to your class, and I’m glad you’re taking the time now to think about it now while you’re still in school.

    I had a complicated pregnancy, labor and delivery. When I was finally admitted to the hospital for an induction, the only thing I wanted was to walk out of there as a healthy mom with a healthy baby. I knew the birth I wanted, an un-medicated, spontaneous, vaginal delivery, wasn’t in the cards for me. The complications I was experiencing demanded a medicalized birth. Throughout the induction, I consented to procedures I didn’t want. When my blood pressure was high, I willingly consented to laying in bed to try and bring it down. When the doctor wanted me to have an epidural in hopes that it would lower my blood pressure I agreed. I even argued the anesthesiologist into submission when he didn’t want to give it to me because I wasn’t in “enough” pain. I consented to the catheter, and the IV pitocin. When I’d been pushing for an hour without making any progress, I asked for a vacuum assisted delivery. Not one of those procedures was a violation. I had either consented, or requested each of them. However, when the doctor decided to attempt manually removing the placenta without informing me that the placenta was stuck, the umbilical had torn off during cord traction, I was hemorrhaging, and it MIGHT be painful, I do consider that to be a violation. It only would have taken 30 seconds of communication to give me the information that I needed to process the procedure as a medical procedure and not a rape.

    For me, when I refer to my birth rape, it was just a few moments long. It doesn’t include holding my uterus inside my body because it was inverting. It doesn’t include the emergency D & C that was performed to remove all 20 pieces of the placenta. It doesn’t include the 8 IV lines they started to pump in fluids, antibiotics, heparin, nitroglycerin, or blood transfusions. I recognize that after the failed attempt at removing the placenta that the situation became emergent, and that I was incapable of consenting to the procedures.

    I think the most important thing to remember is that the patient needs to know what is happening to them. Keeping them in the dark might be a bit easier for the physician, but it’s devastating to the patient. Talk to them, not their cervix. Make eye contact. Don’t ignore them to talk to the nurse. If you think there may be a potential problem, take the time to discuss what procedure will be performed prior to it becoming emergent. (In my case the doctor had a 15 minute window when he was pretty sure the placenta wasn’t going to detach, and he didn’t take advantage of that opportunity to educate me.)

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