Increasing access to childbirth education

Earlier this week, a Los Angeles Times article condemned women for not educating themselves on childbirth options and therefore being at fault for allowing the Cesarean rate to be so high and for the interventions that happen to them when they trust their providers. 

My reaction to this article when it came out was that 1) expecting families are actively discouraged from being informed about childbirth options (by their care providers) and 2) expecting families see how pointless childbirth education is when it doesn't matter what they learn/want/say, their providers in general aren't respecting their desires and choices and in many cases actively working against the goals of the families. I also see that childbirth education is a costly expense and inconvenience in the lives of pregnant families and many women probably feel their time is better spent resting and taking care of themselves than rushing to another set of appointments.

Childbirth educators are important, don't get me wrong, but their delivery system is lacking and in many cases they are missing the collaborative relationships with care providers.

I think I had a really good idea that could address all of these issues and I'd love to talk about the feasibility of it with others.

Medical groups, doctor's offices, clinics, and insurance companies could hire childbirth educators to work in office. Their job would be to spend 10-15 minutes each appointment with families during prenatal appointments to go over options and to educate women on the process of childbirth. Rather than an additional appointment that takes 1-2 hours, short educational opportunities could be available like many clinics have dieticians and social workers.

I say get the insurers involved and require that these educators are on staff in order to make sure that providers allow them to be there. Some providers will not be difficult to convince on the virtues of this proposal but many others would. Its the ones in private practice that would be the hardest to work with.

This idea came from my midwifery training where I am basically being trained to offer short lessons in childbirth education to clients. I can see how providers themselves don't have the time to do this (and also the will) but they can contract with people who are trained and passionate about informed decision making. This is my vision for how childbirth educators can make it mainstream and break that 30% barrier.

Often that barrier is caused in part to economic factors of the families. Childbirth education is still a privilege available to those who can afford it (mainly middle-to-upper-middle-class white people). The article is flawed in saying that the blame can be put on women by ignoring the institutional and economic factors involved.

What actions would need to be taken to get this happening across the country? Who are the stakeholders who have the clout to make this happen? Grassroots advocates, childbirth educators, policymakers?

Honoring our Veterans

Disclosure statement: this is not your typical Veterans Day message. I do appreciate the service of my ancestors, relatives, friends and fellow Americans in the armed forces and recognize the sacrifices that families throughout the world make when their nations and people engage in war. This post will be highlighting the fight that women find in the battlefields of their lives.

The authors of "Half the Sky: Turning Oppression into Opportunity for Women Worldwide" cite a statistic that in the years during World War I, more women died in childbirth than men died in battle. An even more interesting and galvanizing statistic would be comparing the number of women who have died in childbirth compared to the number of men who have died as a result of war in the course of history.

Another recognized fact is that a woman dies in childbirth somewhere in the world every minute which is over half a million a year. In addition to deaths, one in three women throughout the world experience the surgical removal of the fetus. The trauma rates of childbirth, expressing itself as PTSD up to 6% of the time, is also about one in three. This trauma can be caused from fear of losing the baby, intense physical pain and even violence perpetrated by health professionals. The number of abortions that take place through the world is upward of 40 million a year and spontaneous miscarriages and stillbirths are known to happen in approximately 30% of pregnancies. In countries where rape is used as a weapon of war, many babies are conceived in trauma and horror. In the Unites States were one in three girls experience sexual assault or molestation in their lives, childbirth can be a triggering event leading them to recall their assault. That's a lot of death, grief, trauma and loss caused by or experience in a normal event and that's not quantifying the childbirth injuries or complications like obstetric fistula, nerve damage, postpartum hemorrhage, etc.

Its not just a developing world issue, women in the developing world face the same possibilities though in some cases with reduced risks.

I think its safe to say that giving birth is the woman's war. Its the battle between life and death coalescing into a brief period of time ranging from a couple hours to a couple of days and it can happen a number of times in a woman's life. Though the total fertility rate is around 1.7 in many developed countries, some women give birth many more times than that in their lifetime.

And every woman has her birth story. That she often remembers in great detail throughout her life and into old age.

Childbirth has been an intensely fulfilling, peaceful, joyful and safe experience. While men can beat their swords into plowshares and refrain from war, women cannot stop bearing children (if we want our species to survive). Yet we can make childbirth safer, more fulfilling and joyful for women around the world. By ignoring, and allowing the governments of our planet to overlook childbirth issues, we are saying that a war on women ought to continue.

Each woman who has given birth is a veteran. Whether she bears the physical scars of a C-section, episiotomy and stretch marks or the psychological scars of a traumatic birth experience or she can returned home the victor after an orgasmic birth experience, she has survived and come out the other side of an intense battle for autonomy, confidence, life and attachment.

Today may be a day to recognize Veterans of wars and armed forces, but my remembrance is called up to my mothers and sisters who give birth.

Any remembrance post that is calling attention to an important topic needs a How-To address this issue. I'll refer you to the appendix in Half the Sky as the authors have created an impressive lists of ways to address global issues impacting women.

Three years later, we get some answers

You know those questions that linger in your mind for years and one day you come along to the answer? That happened to me the other day while reading Holistic Midwifery by Anne Frey.

In my first pregnancy, one of the most upsetting events was being inaccurately diagnosed with pregnancy induced hypertension. At a 34 week prenatal appointment, my blood pressure at the start of the appointment was 160/89. That is a higher reading than my normal which was closer to 140/70. It also just happened to be a particularly stressful day where I was having a hard time holding down food, was late to my appointment by a traffic jam on the freeway and parked a half mile from the clinic and walked/ran to get there as soon as possible, all after facilitating a class for 14 2 year olds for the morning.

In researching the clinical diagnosis standards of PIH (pregnancy induced hypertension), I found that its only diagnosable after two systolic (the bottom number) readings over 90. First, it wasn't over 90 and second, it didn't happen twice. But regardless that was enough for the midwives in the practice to tell me in no uncertain terms that I needed to go on bedrest immediately.

In trying to understand the statistical risks of increasing blood pressure in pregnancy, I couldn't get very clear information from my providers. Not on what causes it, what it means and what the chances were of a poor outcome to occur, or effective ways of lowering blood pressure, what my physical needs were at that point in pregnancy. My husband and I were both frustrated but decided that bedrest might not be a terrible thing since it would give me time to work on my masters degree before the baby was born. At the time, we figured that we were hedging our bets and being more safe than sorry.

The side effects of bedrest could be a whole other post, actually. But to what I learned about high blood pressure and what it had to do with my pregnancy.

Anne Frye taught me that it was pretty obvious that I was malnourished during my pregnancy.

"Liver-related demands increase as pregnancy advances. Maintaining lifer function at peak efficiency requires a well-balanced diet with enough protein, calories, vitamins, salt, other minerals and fluids to meet the demands of increased metabolic activity. The liver can only make albumin (maintains blood volume through attracting an appropriate amount of fluid into the bloodstream) from dietary protein. If the diet in inadequate in an essential nutrient, the pregnancy suffers. If calories are inadequately supplies in the mother's diet, she will burn protein for her energy needs. Malnutrition due to a lack of either calories or high quality proteins can result in many complications of pregnancy...[including toxemia or blood pressure issues]. (p, 195)."

Because of the increased blood volume of pregnancy (+50-60%!), the liver must work harder to meet the requirements of the baby and placenta. The kidneys respond when there is not adequate blood volume by reabsorbing larger amounts of water and salt as they filter the blood and/or by producing a substance called renin which constricts the blood vessels. When the blood volume is low and the blood vessels constrict around the available fluid, blood pressure is increased and it can be seen in blood pressure changes like what I experienced.

Its no surprise that day I was feeling terrible with dehydration and lack of food!

It wasn't just an isolated day that led up to it. Throughout my second and third trimesters, I was exhausted most of the time and really struggled eating enough. I would get home from work, eat a can of prepared soup and then take a 2-3 hour nap. I felt like I couldn't get enough protein no matter how hard I tried. Even carrying around snacks and eating often, I was either too busy working or too tired from working that I didn't have enough energy to prepare food for myself. I frequently skipped or did not have a good breakfast and then my insubstantial lunch.

With this information, I'm able to make sense of why I was so tired. Working while pregnant, though not a terrible decision, placed stress on me that I did not prepare or compensate for very well. There has been some research that shows that pregnant women working can predict high blood pressure and preeclampsia, which could also be its own post...

The bottom line is that I struggled to eat well during that pregnancy. I even remember a time that I was so weak and tired that I called a woman from my church who came and brought me food. Eventually it negatively affected my pregnancy.

Unfortunately, its pretty common for providers to not understand the physiology and connection between nutrition, blood volume and PIH. My husband also appreciates learning this because it finally filled in the missing information we wished we had and struggled to access at the time.

Anne Frey's calls this blindness in the medical community a political as well as feminist issue. It is very important to understand the cause of increased blood pressure in pregnancy instead of treating it after when it becomes preeclampsia and a woman is experiencing seizures.

Responses to Survey on Unnecessary Medical Treatment

The Safe Patient Project is soliciting stories of medical overtreatment and medically unnecessary treatment. The Consumer Union asks:

Have you or a loved one had tests, surgeries, procedures or medications that you thought were unnecessary? If so, we would like to hear your story. We'd also like to know if you declined tests or treatments offered to you that you thought were unnecessary and found a medically appropriate alternative. Thanks for taking the time to do this. Your personal experience can really help us stop unnecessary and inappropriate medical care in the future, and improve the quality of care for patients.

One of the the areas in which medical overtreatment is done most is in maternity care. Its a multi-billion dollar business where each delivery costs almost triple than it otherwise could. There is evidence to suggest that childbirth in a hospital after a low-risk is overtreatment. Midwives are able to safely assist women in birthing their babies in their homes in the vast majority of pregnancies at the fraction of the cost. Choosing to birth without a medical attendant is also a valid option given preparation, planning and access to emergency services.

If you, one of my readers, have a story to tell about unnecessary medical treatment during your child's pregnancy, labor and birth, the Consumer's Union Safe Patient Project is giving you the opportunity to tell about your experiences. If your experiences were traumatic reporting on it may be triggering. There is a chance that your story will make a difference in maternity care and you'll face better and more appropriate treatment the next time you have a baby. You may also be making maternity care better for other mothers and their babies. The URL for the survey is: http://cu.convio.net/site/PageServer?pagename=spp_unnecessary_care

The following is the story I told. I'm including my responses to the question. I tried to explain as clearly as I could that I feel like the admission to the hospital in early labor was medical overtreatment. I recognize that in the big picture and in comparison to other birth experiences I may have had, its a small thing. But as I learned, it can and did have strong consequences.

1. Question - What type of medical overtreatment did you experience?

Answered: Other

2. Question - In what kind of facility did the event occur?

Answered: Hospital

3. Question - Describe your medical overtreatment experience in your own words (the space below allows you to include as much detail as you like):

I was admitted to the hospital in early labor (38 weeks pregnant) where the midwives proceeded to attempt a induction. This strategy is sometimes called a "backdoor induction" because it misleads the pregnant patient into believing that her labor is more progressed than reality and that a hospital admission is warranted. In response to this question, I'm considering the hospital admission medical overtreatment. There was no need to be admitted to the hospital at that time. The result of the admission was stress in response to the coercion used by the midwife on duty who attempted to get me to consent to an induction that was unnecessary. I felt bullied, manipulated and scared for my health and my unborn baby. I experienced PTSD as a result from what I feel like was fighting off a potential rape of my body.

4. Question - Did you report this incident to your state's Medical Board or other licensing agency?

Answered: Yes

5. Question - If yes, what was the Medical Board or Licensing Agency response?

Answered: None

6. Question - Your experience or that of a loved one resulted in:

Answered: minor injury or minor disabling condition

7. Additional Comments:

I explained above that I experienced PTSD as a result of overtreatment in my pregnancy. Often the psychological response is not classed as "morbidity" but considering how debilitating it was for me, I consider it a minor condition that had far reaching effects on my life. I still suffer the effects of the emotional trauma but felt recovered enough to not longer need treatment after 1 year.

8. Question - If you or your loved one experienced medical harm from overuse, how long did it take to fully recover from the incident?

Answered: More than a year


9. Question - Did the medical professional fully inform you of the risks of the procedure or treatment.

Answered: Did not provide full information about the risks

10. Question - Please describe additional information that you received about the risk or found out after the procedure from another source.

I was not informed that the risk of early admission to the hospital was increased intervention that could lead to a hasty attempt at induction which is associated with a higher likelihood of c-section, mortality for mother and baby, respiratory distress for the baby and NICU stay. If I had know that quickly, upon admission to the hospital that an induction of active labor would have been suggested, I would not have consented to being admitted.

It was later that I found out about backdoor induction from a labor and delivery nurse who blogged about it at:http://nursingbirth.com/2009/04/13/don%E2%80%99t-let-this-happen-to-you-24-part-1-of-2-jessica-jason%E2%80%99s-back-door-induction/

11. Question - Were there unanticipated costs associated with the medical procedure or treatment?

Answered: Yes (therapy, an extra day of hospitalization)

12. Question - Did your health insurance company pay for expenses associated with this care?

Answered: No (not the therapy)

13. Question - If you declined medical care you thought was unnecessary, what tests or treatments were offered to you that you declined?

Answered: Other

14. Question - Please describe why you thought the tests or treatment were unnecessary and declined them.

I declined the induction that the midwife attempted to force on me. She lied to me telling that she wanted to augment my labor. I after learned that using pitocin and breaking water before 4 cm dilation (and active labor) is a complete induction.

I also declined the morphine and sleep aids that I was offered. I felt that the midwife was attempting to coerce to me take them and that she did it with the intent of knocking me out so she wouldn't have to deal with me. When a woman is coping well with her established labor pattern and is not expressing any exhaustion or discomfort, the offer for pain relief or sleep aid is unnecessary.

15. Did you seek a second opinion?

Answered: Yes

16. Question - What did you do?

Answered: Pursued another treatment

17. Additional Information:

Because I was told that there was a good reason to be admitted to the hospital, I was very confused why I was then rudely told to leave the hospital when I declined the offered procedures and drugs. I continued laboring and progressed to active labor after being kicked out of the hospital for my lack of cooperation. I was then afraid of going back to the hospital fearing that I would be told to leave again, forced into intervention I knew to be unnecessary or that I would be lied to regarding the health and well-being of my baby.

In the hospital, I considered trying to switch providers to one of the OBs on staff and I learned that the OB supported and was going to sustain the midwife's plan for my labor. When I was told that I would not consent, the OB told me to leave.

At home I considered the options of not seeking further treatment or consulting with another hospital or maternity care provider. Because I was in labor and the baby would be born within hours, I could not bring myself to go to a different hospital and provider that I had not planned on working with. I was very fearful that if I even tried another hospital would not admit me. That left my other option of giving birth at home unattended by a medical professional or calling a homebirth midwife to attend me which I did not think a midwife would be willing to do without a prior working relationship with me. I was worried about the legal implications of birthing unassisted and thought perhaps my child could be taken away from me because of my neglect is obtaining proper medical attendance for his birth. I felt like my only option was to return to the hospital where I had been treated badly and hope for the best in spite of my fear.

Upon returning to the hospital, labor progressed easily and I birthed my baby unmedicated and without further intervention within 6 hours. By that time the midwife who had troubled me the day before was off shift and I didn't have to deal with her anymore. No further attempts to alter my labor were made though AROM was done with my consent. It was unnecessary at the time too but I did consent to it and did not feel pressured to do so.

In effect, the treatment I pursued was "the tincture of time." I knew that a first time labor could be slow to establish an active labor pattern that with the supportive emotional and physical assistance I could bear the labor as it progressed and that in time, the baby would be born without difficulty.

My story does not highlight the most egregious ethical lapses of a maternity care provider but yet, her treatment and tactics still were not right, not in line with the midwifery model of care and unfortunately indicative of the greater obstetric culture where its just fine for providers to withhold and manipulate information to hurry births along. I can only speculate on the motivations for why they do it and even with an explanation, the "care" cannot be excused. I truly hope that my story and others will have an impact on how patients are treated and that they are given the respect they deserve to make completely informed decisions.

Do Birth Workers Know What Women are Reading?

Rixa at Stand and Deliver blogged recently about how obstetricians come to their beliefs about homebirth which reminded me of a question I asked myself a few months back.

Do obstetricians and L&D nurses know what women are reading about birth?

And, if they did, how would that change their practice?

Beyond the texts recommended by obstetricians and What to Expect When You're Expecting, it appears to me that many women planning hospital births are reading information on natural childbirth with books like:

Ina May's Guide to Childbirth
The Birth Partner
Hypnobirthing
A Thinking Woman's Guide to a Better Birth
Gentle Birth, Gentle Mothering
My Best Birth
The Birth Book
Birthing From Within
Spiritual Midwifery

A common thread of these books is arguments against using obstetric intervention through replacing interventions with simple strategies employed by the mother and her support people. Most of these strategies require advance preparation and knowledge regarding them though gaining this knowledge really doesn't take much time. Simply reading about it in a book, or even a website makes one qualified to change positions or to breathe deeply or soften one's jaw. It even qualifies someone present to suggest it to a laboring woman.

Now this is where I think this plays into Rixa's discussion. I'm going to theorize that one reason hospital birth workers are not supportive of homebirth (in addition the other reasons suggested by Rixa and her readers) is that homebirth is the epitome of natural birth where it becomes clear how very little knowledge and expertise is needed (except for when it is). This idea would feel like a threat to their livelihood, their career choice and might breed just a little bit of resentment towards other professionals who have not slaved through the initiation rite of medical school and residency to end up doing very similar work.

Doctors might shy away from asking themselves the question: "If birth were simple and reading a few books qualified a person to attend births, then what was the point of all that education? It can't possibly be as easy as these books say it is."

And then, as I continue on this pretend inner-monologue, perhaps hospital workers then would get frustrated with their female patients: "How could they possibly think they know enough and think that reading some silly books are going to qualify them?"

But, now I'm dreaming, what would happen if hospital birth workers read these books with an open mind? Would they be compelled to try some of these strategies or to suggest them during a woman's labor?

Are these books written compellingly enough to convince an obstetrician that maybe hands and knees for pushing is worth the try?


Or--now I'm really dreaming--what if these books became required reading for OB residents and L&D nursing students? Just so they knew what "fluff" pregnant women are filling their minds with as they prepare for birth. Perhaps, the assignment could be given with the intent to debunk the misinformation and to encourage doctors to reflect and prepare for how they will respond when women present these ideas in prenatal appointment.


And, if the less academic, popular press reading is too unpalatable for our esteemed birth workers, perhaps the expose of childbirth in America written by journalist Jennifer Block "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" could be recommended first as it provides thoughtful insights into each side of the topic.

In any degree, from a pregnant woman's perspective, this would be more beneficial from dismissing them all together or pretending like they don't exist. Not recognizing their influence creates a vacuum of information, a empty divide where patient and doctor are trying to yell across but the message keeps getting lost.

However, I would hazard to guess that, if hospital birth workers could open their minds a little bit, many of them could recognize the value of the information and see how the paradigm fits together to make the idea of homebirth and non-interventive, unmedicated birth plausible and attainable in relation to relative risk and safety.

Or at least perhaps, we could stop talking past each and be on the same page.

Birth Trauma Round Up

I've been meaning to get around to this for awhile. Each day when I read news articles and blogs, I'll bookmark it if its something I want to come back to or if I have something to say about it, or agree its important and needs to be said again and again until the right people listen. Generally, the articles that stand out to me are on the topic of birth trauma. So here is an anthology of birth trauma related articles over the past few months. On analogies: Keyboard Revolutionary: An Interesting Parallel

So what does it mean when another wielder of authority says, "Do what I say or your baby will die"? Are they looking out for your best interest....or are they a bully, a rapist, an abuser, deliberately playing on your unignorable instinct to protect the ones you love in order to get what they want from you?

And when its seen like this, how obvious is it that a mother can come away from her birth experience with PTSD?

Raising My Boychick: Just Like Athletics: Exploring a Childbirth Analogy

Rather than coerce with stick or carrot, what we do in athletics (again, thinking especially of charity racing; a particularly apt comparison to birth as it is physical effort that benefits another) is cheer, support, encourage, commiserate. No one stands at the sidelines of a charity marathon yelling “give up! it’s not worth it! stop trying to be a martyr! you’re not going to win a medal!” Nobody whispers in their ear when they’re doubting, “take these drugs [that will actually make running harder], let us drive you to the finish [we'll tie you behind the car], finish in five minutes or we’ll whisk you away for surgery [for a torn ligament you don't actually have].” No one tells an athlete she can only have a “trial” of running if she has no food or drink, if she’s hooked up to machines that purport to measure how hard her muscles are working, that take her blood pressure and heart rate and temperature and send it all to the medics’ station and meanwhile are hindering her movement and reminding her she’s on a clock and she’s not running fast enough (or running too fast and they’ll “have to” stop her “for her own good”.

The analogy works well. What would happen if hospital birth attendants had this analogy called to their attention? It seems so simple, yet a strong paradigm shift is engendered in it.

On feminist activism:

Courtroom Mama: Feminism Behind the Veil

[How many women] suddenly realized that grown-ass people in a medical office were calling them “mommy” and telling them what to do as though they themselves were children. And the fact is, for a number of women of relative privilege (cis-gendered, heterosexual, middle-class, etc.), the journey into motherhood might very well be the first point of friction with patriarchy. Many of us lucky enough to not feel the weight of oppression can manage to skate by with just our carryon baggage, but add a pregnancy or a child to the mix, and suddenly you’re “actually” a woman, or rather “just” a woman.

Fertile Feminism: Mainstream Feminism and Motherhood

That’s why I’m so pleased to have discovered all the feminist mother blogs that have been springing up recently, and why I want to work with feminist mothers to help bring your voices and battles and mainstream feminism together. It’s been all too easy for childless feminists to ignore motherhood, and it really, really shouldn’t be. We need to listen, learn and become allies to mothers by not only centring your voices but using our own to advocate for mothers everywhere.

The previous two articles both discuss how stereotypical feminists (or rather the dominant cultural idea of feminism) doesn't understand the issues facing mothers in dealing with injustice in maternity care. It now appears that some "majority" feminists are becoming aware of what us feminists in the minority are facing. Like Courtroom Mama, my first run-in with patriarchy may very well have been in my first birth experience and it certainly played a large part in coming to self-identify as feminist. I too felt, before birth trauma, that feminist history afforded me a "post-feminist" spot in my world.

On cruelty:

Henci Goer: Still Cruel Maternity Wards

We have a culture of impunity in maternity wards. Once pregnant, a woman effectively cedes her right to autonomy and bodily integrity to obstetric staff who sometimes—on grounds of fetal welfare, self-protection from malpractice suits, or mere convenience—manipulate women into compliance in ways that would be considered fraud in any other venue. Without fear of being called to account for it, they can bully, coerce, humiliate, and threaten. And, yes, they can physically mistreat or even sexually assault them

It is this that needs to be exposed. In her article, Henci links to recent news stories that highlight some of these abuses. Its starting to be uncovered but it still seems to far-fetched so far from the norm, but then what is normal seems irrelevant because of its normalcy. It seems the media has not just captured the sameness of these outrageous cases with the outrageousness of the "normal" cases. The whole history of hospital birthing has been this way and its just sick.

The Unnecesarean: Women Have Right to Complain about Mistreatment During Birth

I really believe that someday, our daughters or granddaughters will be amazed that any woman was ever arrested for refusing a c/section, or operated on against her will, or prevented from moving or eating or making noise while she labored to birth her baby. They’ll regard much of what is still considered normal today as cruel, and uninformed, and backwards. And they’ll be right. But only if we keep refusing to be silenced.

It exactly this that I could not and would not believe before I contemplated becoming mother. It seemed so blatantly wrong that it seemed impossible that it could be indicative of systematic injustice. It really did feel like just being pregnant and giving birth that I was going into a dark and dirty underground system. ACOG has been labeled a cartel and for good reason.

Amy Romano @ Science and Sensibility: Patient safety, disciplinary action, and the marginalization of midwives

But whether disciplinary action is against midwives or physicians, is punishment the best way to deal with breaches in patient safety?

When this question is posed to someone who has experienced birth rape, the answer is: They have to held accountable somehow. If its not through a hefty check from their administrators, then it needs to be some censuring from their superiors. If not that, then it needs to be criminal charges. When a woman is feeling like her OB or midwife is entering her body with the same force and skillful manipulation of a rapist, yes, the provider must be held accountable. RH REality Check: The Cure for An Ailing Maternity Care System

The idea that maternity care should be evidence-based, safe, and efficient seems like a no-brainer but one key goal to note is how these imperatives lay the groundwork to minimize “overuse, underuse, and misuse of care practices and services.” We need to make sure we’re providing optimal care to all women by guaranteeing women are able to access the services they need if they need them. However (this is a big one), let’s also start from a place of understanding that pregnancy is a healthy state of being – not an inherently sick state – and so let’s also minimize the amount of unnecessary interventions that now drive up costs and place women and newborns at risk for poorer health outcomes.

It must be said: the "overuse, underuse and misuse of care practices and services" are causing trauma to new mothers, rendering it exponentially more difficult to care for their babies in their early years. Its not yet known what sort of long term effects can be had from a traumatized mother in early life, but there are studies that show that children of depressed mothers are more likely to experience depression, children whose parents experienced PTSD are more likely to experience PTSD after a potentially traumatic event. Are our children being hardwired to face life's challenges with disorder? Its not just about health care costs, its about a mother's sense of confidence in her ability to care for her children. Its about the baby's sense of being cared for and loved. Michel Odent equates these early unnecessary challenges to a threat to humankind. He even poses the question "Can humanity survive?"

Its starting to sound pretty melodramatic and that's exactly what I would have labelled it before my experience, and before I learned that I was not alone. I find its a coping mechanism to write in this manner and that I cannot be objective and unemotional when I read the stories of birth trauma at Solace for Mothers and the MDC birth trauma board. Some of it seems so fundamentally, viscerally wrong that I struggle to articulate how and why it is so wrong. So instead, I try, though my blog to illustrate, highlight and show case examples so it can become clear to others without my feeble attempts to spell it out.

What Trauma Looks Like

Warning: this post will be triggering for birth trauma survivors

Make an on-line slide show at www.OneTrueMedia.com

When watching this video, I was reminded of the pictures taken of me holding my babies for the first time after their births. They are starkly different. I've pondered over the differences before and now that I've seen this video, I feel like posting the photos to illustrate to others what trauma looks like.

After a traumatic birth, described as birth rape:





























The joy at meeting my baby comes through (and a sense of my victory over the system's efforts to control me), but look at that far away stare showing the disconnect between me and my baby. And do you see the timidity and the reservation with which I'm holding my baby boy? And how the smile doesn't make it to my eyes?

When my son looks at pictures from his birth, this is what he is going to see. I hope he never questions because of these pictures, "Why is my mama sad? Did she want me? Does she love me? Is she mad at me because of how I was born?"








And then compare, to this:









From this, and another example from a friend's blog, I see that birth experience matters. Not to the mom's hedonistic desire for self-satisfaction, but to the baby that the mother greets. I feel my babies deserve to be greeted by a mother who feels victorious, respected, capable and empowered; not one who has been victimized, disrespected, dehumanized and demeaned.

Not Letting it Happen to You Can Lead to PTSD

The blogger at Nursing Birth posted last year a series called "Don't Let This Happen to You: The Injustice in Maternity Care Series" and in one of the posts, she described a phenomenon that I had never heard about, but recognized it immediately as what was attempted on me when I was pregnant with Willem.

In my prequel, I described how at 37 weeks 6 days, contractions started at 11 pm. At 11 am the next day, I was 3 cm dilated having contractions every 6-15 minutes. The midwife at a prenatal appointment that day told me that I was in labor and should check in with Labor and Delivery to be admitted to the hospital. The midwife on call at Labor and Delivery called failed to progress and, after performing cervical exams every hour for 4 hours ,started advocating for pitocin/AROM augmentation as she called it. It was 9 pm, 3 to 3 1/2 centimeters dilated with contractions between 6-10 minutes apart.

In the prequel, I asked if this sounded like a phenomenon that you've heard of before. Do you know?

Nursing Birth taught me that this is called a backdoor induction and she defined it this way:

If a woman is 4cm dilated but is not having regular, noticeable, and painful contractions that are causing cervical change she is NOT in labor. If said woman is sent into the hospital and any interventions to stimulate contractions are started, then it is by definition considered an induction NOT an augmentation. And if said patient was not scheduled to be admitted on such day, then it is considered a backdoor induction. I knew it as soon as I read it. This is what happened to me. It is unethical and just as Nursing Birth calls it, an injustice perpetrated on a birthing woman.

Even at the time, I knew it was inappropriate for labor to be stimulated artificially and I refused. This is where my story and Nursing Birth's patient's story begins to differ. I did not go along with it with the recommendation for induction. If I had been more savvy to manipulative tactics such as this, I would have known to not trust the midwife who referred me to L&D. But then again, if I had been more savvy, I would have known that hospitals are not the appropriate place for low-risk mothers to give birth in the first place. Even then, we weren't understanding why the midwife would make the recommendation to check into the hospital obviously in early, non-progressing labor but in our excitement, we decided to trust her. To our detriment.

Because in my experience, I then learned what PTSD is like. I'm not faulting Nursing Birth for leaving the story off as she did, but I have something to add to it. If you fight the system, even if you win, which is not likely or common, you will still lose. You will lose a sense of being human, the feeling of being respected and treated like the person deserving of dignity that you are. Such dehumanization can have indelible impact on the psyche.

The converse is true, letting it happen to you, can lead to PTSD. But not knowing it is happening to you seems to be a protection. It appears to me that the mother, Jessica, in the story was unaware at the unsavory practice that she was being subjected to. So what is worse? Not knowing you've been victimized, or knowing the feeling of violation because you do know you've been victimized?


........

After I had begun to process my birth experience, I wrote an email to the referring midwife telling her the outcome from her recommendation. To my surprise, I received a conciliatory email in response.

After I learned the term backdoor induction, I was upset for a couple of days. I talked through it with my colleague from Solace for Mothers and felt better sharing the stress with someone else. Since, I've intended to blog about it, but I'm only finding myself able to do so after writing the prequel and being triggered by the previous article I wrote about.

Sharon with Solace for Mothers asked me the question, "What are you now going to do with that knowledge?" I answered that I would write a letter to the hospital saying I knew what they did and emphasize how distasteful and unethical the practice is. I have not done that yet, because I'm struggling to find the words to express how and why that is so wrong.

So, I'll ask my readers, after telling my story in a letter to the hospital and midwifery supervisor, how do I support my claim that practicing backdoor inductions is an unethical practice?

What Triggered the Prequel

My post from last night, The Prequel of my Traumatic Birth Experience, was prompted by a friend posting this article on facebook. Though it is reporting a study saying that that anxiety in pregnancy can predict developmental delays in the baby once born, my attention was drawn to this paragraph:

"Contrary to old beliefs, however, research shows that ordinary day-to-day job and home stress isn't likely to cause low birth weight or other problems for most women. Traffic delays, work deadlines and other everyday hassles aren't likely to pose a threat to unborn babies, researchers say, and pregnant women who feel they are coping well tend to do just fine."

I disagree with this statement based on my experience (copied from the prequel):

When I was in week 34 of my pregnancy, I was working part-time at a preschool (9am-1:00 pm each day). I had a commute and prep time before class started so I was waking up at 7 am. I'm not a morning person (if you ever notice when most of my blog entries are posted you'll know that I'm a night owl). I was constantly tired in my pregnancy. I'd get home from work and have to take a long nap each afternoon just so I could function the next day. One day, I had to rush away from work for a prenatal appointment, but that day had already been a struggle. I was fighting nausea the whole day (strange for the third trimester) and had thrown up 3 times, once as I was getting into the car to head to the appointment. Already feeling tired and sick, I encountered unexpected traffic which was making me late to the appointment. I generally get very stressed when I am late to something so the combination of being impatient, stressed sick and tired was not boding well for that appointment. I then parked rather far away from the clinic and had to walk (more like jog since I was worried about being so late).

I also remember there was a journal article that linked maternal employment in late pregnancy to increased blood pressure. The researchers of the study being discussed in The Wall Street Journal either were unaware of this study published in American Family Physician in 2001 (Increased Blood Pressure and Working in Late Pregnancy. American Family Physician Oct 2001), not considering increased blood pressure as a "problem" for women, or had reviewed the findings of that study and disagreed with its findings.

To me, my experience leads me to support the findings of the 2001 study. Even though, I was incorrectly diagnosed with pregnancy induced hypertension at that appointment, it is true that my blood pressure was elevated from my baseline (diastolic at 88 after that stressful day, but its 60 when not pregnant, and at 70 when pregnant).

Reading the Wall Street Journal report last night brought that all back. Even at the time, my husband and I ascribed my working, the stressful commute and the brisk walk to the increase in blood pressure. I still do not understand why the midwife was not willing to accept that as a possibility. We felt it was lunacy to then think that rechecking my blood pressure later in the appointment, AFTER diagnosing me with gestational diabetes, putting my on bed rest and leading me to believe I was experiencing PIH, was going to result in a lower blood pressure reading, because I had time to "relax" during the appointment!?!

That was precisely the time when I stopped feeling like I could enjoy my pregnancy. Up until that point, I had felt very excited and happy as the birth approached. After that appointment, that happiness was clouded by the specter of the dead baby and dead mother card, as well as an induction that I knew made a cesarean more likely, which increases the chances of complications and death. All of this then caused greater confusion in my mind because at the beginning of my pregnancy, I was given a priesthood blessing by my husband and adopted father in the gospel which told me that I would give birth and go through the pregnancy without complications. Given what my husband and I knew, we believed the blessing was still true because the midwife was mistaken in her diagnosis. But how to handle a situation with a maternity care provider where our version of reality didn't mesh with hers? It all added up to a great deal of stress in our minds and just paved the way for the trauma I experienced as a result.

I often think that if the birth experience had happened in isolation of the prior stress, I wouldn't have experienced PTSD to the degree that I had. As it is, I felt there was so much manipulation and lies that I knew I wasn't safe going into labor so my stress response to what was happening in the hospital was amplified.

If I could do it all over again Part 1: Preparing for Childbirth

I've learned so much from becoming a mother and my blog is somewhat of a catalog of that learning. Since I posted my review of Birth as an American Rite of Passage, I've been thinking about what I know now that I wish I had known before Willem was born. So much of it comes from what I wish I had read. I have often thought that if someone had told me that I could come away from giving birth traumatized by having to fight for an unmedicated birth, I wouldn't have believed them. I would have needed to read the right books to be fully convinced. I think I've now found a reading list that would have convinced me if I were to have read them while I was pregnant the first time.

Birth as an American Rite of Passage by Robbie Davis-Floyd

This has been a very influential book for me. Framing the obstetric culture in terms of technology over nature was a very helpful framework for me to see the potential battle that birth can be between a mother and hospital workers. If I had read the book while pregnant the first time, I would have know that I was in the wholistic camp, believing that a woman's body is capable of working properly to birth a baby. Viewing birth as a rite of passage also likely would have illuminated the spiritual aspect of birth in a way might have compelled me to view the upcoming event as a spiritual event as well. The women stories in the book also very clearly describe common hospital practices that upon reading, I would have known I wanted to avoid. Homebirth was clearly shown by the mothers stories to be one of the only viable ways of really avoiding those practices.

Rediscovering Birth by Sheila Kitzinger

The strength of this book comes from the cross-cultural descriptions of birth practices, as well as covering the history of childbirth. Kitzinger places the natural process of birth as the foundation of the book and so when describing the migration from homebirth to hospital, it becomes very clear to the reader how unnecessary a hospital birth is in the majority of births while respecting their usefulness is certain situations. As a first time mother, I had had no exposure to the cultural context of hospital birth. I believe, like circumcision, if I had known the history behind the practice, I would not have been accepting to engage in it. This book also highlights the spiritual and emotional aspects of birth, which as I've said, would be very helpful for me.

Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block

While Rediscovery Birth examines the history of the way childbirth has been handled across societies, Pushed examines the current issues confronting childbearing women in our society. Like Birth as an American Rite of Passage, I believe I would have clearly seen the incongruent care being given to childbearing women and how that can lead to avoidable harms. Block gives a sense of the whole picture that comprises all the parts of maternity care and how each part in interrelated from hospital administration to insurance companies, malpractice lawyers, midwives and law-makers. I feel that the book shows very convincing how women can be painted into a corner when it comes to making decisions for birth. As it was so extensively researched with up to date information, I believe I would have been very convinced by Block's reporting.

Gentle Birth, Gentle Mothering by Sarah J. Buckley

Buckley describes the biology of childbirth and describes very well the type of environment needed to allow the process to occur most successfully. I feel that her presentation of the physiology defines why privacy, familiarity and no intervention is so important in childbirth.

From this book, I also would have learned the whys of babywearing and been introduced to the concept of elimination communication, which I may have been intrigued enough to try it as soon as Willem was born.

Ina May's Guide to Childbirth by Ina May Gaskin

If I could have read one book on how to cope with and prepare for the physical sensations of childbirth, this would have been it. It would have been very helpful for me to know about "the sphincter rule," the value of cuddling and "smooching" during labor, "horse lips" and maintaining a relaxed mouth and throat. The Hypnobirthing preparation I did do during my first pregnancy was helpful in learning how to relax and breathe but I feel that Ina May's Guide covers that very well, with more applicable information for the continuous motion often helpful during labor.

Also the normalcy of home and out of hospital would have been reinforced and added to how convinced I would have been to avoid the hospital.

A Thinking Woman's Guide to a Better Birth by Henci Goer

Not only is this book convincing for why common obstetric practices should not be routinely employed, it also works to prepare a woman who may need to have a hospital birth for whatever reason. I think through reading this book in conjunction with the others, my confidence in my knowledge of what I want to avoid would have been bolstered and I also would have been prepared to deal with the hospital if I had needed to.

If I had read all of these books relating to childbirth during my pregnancy (or before), I still would have needed to convey the information to my husband. He is more difficult to convince than I am when it comes to information that it outside of cultural norms or claims to be scientific in anyway. Like I found between my pregnancies, he did learn a great deal from the times when I stopped reading and couldn't help but tell him about the frustrating, funny, interesting fact that I had just learned. That strategy went a long way, but it did come to a point where he told me to stop talking about birth (more because it reminded him of the trauma he experienced from Willem's birth). Because of his limited time as a graduate student, I would have needed to pick one source of information on childbirth to share with him.

The Business of Being Born produced by Rikki Lake and Abby Epstein

This documentary provides a DVD format and covers all of the main points of the books I've listed. Its animation of the "technocracy's cascade of interventions" is useful in the quick way it describes the drawbacks of hospital birth. The history of hospital birth provides enough information to see just how money driven, patriarchal and unjust hospital birth's origins are.

My husband has seen the documentary and though he was convinced by the information regarding what is wrong with the hospital based maternity care system, he still was not completely convinced about a homebirth. HIs preference would be to fix the hospital system so unmedicated birth is the norm, but I think even he realizes that is not going to happen in time for births in our family. He accepted the homebirth option because he didn't see a better way, in the moment, that I was comfortable with. I think this is what is called "opting-out." Even still, I'm not sure whether he would have been convinced regarding homebirth without first witnessing the down-right abuse I experienced in the hospital giving birth to our first child.


All of the books, and the DVD, I discussed in this post are available on the amazon associates store that I posted at the bottom on my blog. There's reading list widgets for blogs or there's shopping directly from a blog, I chose the latter--saves time for the reader. That's also my explanation for why I didn't link individually to each item or post pictures, its all there, just below the post.

Review of Birth as an American Rite of Passage

I just finished reading "Birth as an American Rite of Passage" and I found myself wishing that if I had read just one book to learn about what giving birth in an American hospital would be like, I wish this book written by medical anthropologist Robbie Davis-Floyd. Through the words of women in response to interview questions relating to their birth experience, readers get a very realistic view of what obstetric culture is like and the expected role of women birthing in hospitals. I often said that if someone had told me what giving birth in a hospital is like based on culture, medical ideology, current practices, etc., I would not have believed them because it all sounds so very irrational, paranoid, conspiracy-theorist and unethical. However, after reading "Birth as an American Rite of Passage" I think I would have been convinced through Davis-Floyd's analysis and the selected quotes from women's birth stories. She clearly describes the "technocratic model" that predominates our current culture and how it renders women as objects who malfunction who are not to be trusted and who threaten the very premise that our world can be saved by technology.

In the article I recently wrote for the Exponent, I quoted the author's definition of technocratic birthing rituals and I'll also include it here:

“The term technocracy implies use of an ideology of technological progress as a source of political power. It thus expresses not only the technological but also the hierarchical, bureaucratic and autocratic dimensions of this culturally dominant reality model—dimensions that are immediately visible in many realms of post-industrial American life.”

Davis-Floyd goes on to state:

“According to the technocratic model of birth, the human body is a machine. The medical system [which is inculcated by the technocratic culture] has done a thorough job of convincing women of their defectiveness and dangers in their specifically female functions”—pregnancy and childbirth foremost.

Through reading the book, I've also come to have a greater understanding of why women are so steeped in our culture and why non-technocratic birth is unlikely (as 98% of women in the US give birth to babies in the hospital, and only 1% birth at home). Indeed, when as I became a mother, I too felt the obligation to follow the dominant culture. If only I had know the historical underpinnings of hospital birth and read this book, I may have been able to be convinced that birthing in a hospital was not the way I wanted to welcome my child into my arms.

I was pleased to read that Davis-Floyd recognized and named trauma as a result of birth experiences; however, the symptoms of post-traumatic stress disorder were misidentified as mild postpartum depression. In my research on PTSD resulting from childbirth, the earliest citations I have found declaring the diagnosis of PTSD were from 1995--before the first edition of the book was published. However, I am disappointed that in the revising for the second edition, the author did not update sections on trauma to reflect the new diagnosis.

Also I felt a category of women's experiences was missing. Davis-Floyd stated that of the 100 women she interviewed for the book that women either fully accepted and embraced the technocratic model of childbirth, they rejected it entirely or they were somewhere in between. To give the benefit of the doubt, there is a chance that the reason why my missing category was not included was because none of the women in her sample would have matched it. The in-between categories included:

• Women who maintained conceptual distance from the technocratic model by achieving "natural" childbirth in the hospital (15%)
• Women who maintained conceptual distance from the technocratic model by placing technology at the service of the individual (10%)
• Women who found conceptual fusion with the technocratic model with cognitive ease (42%)
• Women who found conceptual fusion with the technocratic model during birth by experiencing cognitive distress, e.g. trauma (9%)

And now, because you are wondering what this missing category I am referring is: I feel she left out, or did not have a woman in her study matching the profile, of a women who maintained conceptual distance from the technocratic model by achieving "natural" childbirth in the hospital with cognitive distress.

For this was my experience, I was able to attain the ideal unmedicated, low-intervention birth in a hospital and the detriment of my mental health.

Perhaps it could be argued that my experience would fit into the last category of finding fusion with cognitive distress, but I did not find fusion. And if someone wants to state that I did, because I consented to AROM at 5 cm, I'm not listening...

An interesting correlation can be mentioned however, that the percentage from Davis-Floyd's study of women who experienced cognitive distress is the same commonly cited percentage rate of PTSD after childbirth--9%. Making her omission of PTSD as a sequelae of childbirth, even more disappointing.

So in conclusion, this book is a very persuasive case for birth as a initiation rite for women as they transition to motherhood and current obstetric practice as a vehicle for gaining compliance and reinforcing the dominant cultural view of technology reigns supreme. If I were to create a list of influential, informative books for future mothers, this would be near the top.

To end, a quote from the book that summarizes why birth is so exceptionally profound and important to me:

Her baby constitutes for her a powerful symbol of her motherhood, her individuality, her new family, the beauty and wonder of nature, and the perfection of her own body and her procreative powers.

Just responded to a CEO

Amy Romano at Science and Sensibility pointed me in the direction of a blog post written by the CEO of the hospital where a C-section was televised on the Today show, earlier this week.

Here's the clip of the video:

Visit msnbc.com for breaking news, world news, and news about the economy

Amy's response turned post and a link to CEO Paul Levy's blog

In response to Amy's post and others written by members of the birth community, Levy responded:

I understand many of the points that people have raised here regarding the rate of c-sections. That will be addressed over time.

But I have to admit to some concern that people here and at Amy's site are making judgments about this particular patient and her physician's advice. That, in my mind, is just not right. You cannot know all of the details involved in this case, and it is simply wrong to raise doubts like that about it.

Perhaps you think that the patient's decision to have the procedure on TV gives you the right to comment on her medical choices, but I would ask you to display some kindness and to consider the possible effects of your comments on the family.

My response:

At no point has a poster disparaged the mother who participated in the TV segment for her medical choices. The critiques have been directed to the woman's primary obstetrician and the one who performed the surgery (be they the same person or not). There was no indication in the segment that this was a maternal request c-section.

In all likelihood, the c-section that America saw was strongly recommended by the woman's OB who cited such misinformation like suspected macrosomia as an indication for cesarean, which it is not.

If one is to maintain that a woman's choices are being disparaged, then the only criticism that she can receive is that she trusted her doctor.

He still continues to maintain that posters comments and their "values and judgments about this topic could be interpreted as being critical of this specific doctor-patient decision."

On that he's right. I am critical of this specific doctor-patient decision, but not, like he is asserting, critical of the mother's decision. He seems to be equating the doctor patient relationship to the patient herself--like the patient assumes all responsibility for the unethical practices of her provider.

I think I feel a CODE MEC! coming on...

Where is this all coming from?

Many of my recent posts were prompted by a thought process that Rixa started me on when she posted a blog about doulas making a difference in the birth outcomes of women. She expressed her reservations that doulas may unintentionally support the status quo in our maternity care system.

This is my response to her post, and what started me on thinking about what an "organized effort" to promote change in the maternity care system would look like.

On August 20, at 9:58 pm I wrote:

In the last few months, I've been having a crisis of faith in doulas which has kept me away from going through the certification process.

From a first time mom who then came into the birth community, I learned that doulas tend to represent themselves as advocates and spokespeople for laboring women. But then the same doulas turn around and change the definition of advocate into something that doesn't mean what is being heard when a pregnant couple hears "advocate."

I also know that I am one of those mothers who found a doula as a no confidence vote in the hosptial. And while I avoided the cesarean, my plan backfired when I experienced PTSD after being forced repeatedly to find my voice in order to speak up for myself like Jen said. I did that and it was like trying to stave off a freight train that was trying to barrel down on me. And Jen is right, it is the responsibility of DOULAS (not mothers!) to correct the misconception that they aren't there to be advocates or spokespeople.

In addition to all of that, I do believe that doulas are contributing to the status quo of what is happening to women during birth. I see them spending more time trying to make women "more educated" when all that ends up happening is that those women go into the situation that is stacked against them. Doulas should be mounting organized efforts against hospitals and maternity care providers that change the face of birth in hospitals so in time it will become what we know is the true face of birth is supposed to be.

I see the efforts to make those changes being kept separate from the work of doula-ing. I've heard doulas say "when I'm older, I'll take on the system but now I'm going to focus on the individual family." While I understand where they are coming from, I strongly think that most doulas have the responsibility to do both: care for their individual familes and take on the system. As they do that work, women will join them.

This is also a time to say that when I do see doula efforts to take on the system, it is very disjointed and in little pockets. While that is the way grassroots changes come about, its important to connect those pockets and getting them to work together. It is that organized effort that is needed now.

To see the posts I've written aspects of what an organized effort would look like go to:
Birth "Think-Tank"
Legal Rights to Informed Consent in Birth
Framing Birth As Public Health, Reproductive Rights Social Issue
Speaking of Frames

Stay tune as my vision and ideas coalesce themselves, and how the organizations that I volunteer for (The Coalition for Improving Maternity Services and Solace for Mothers) fit into that vision.

Bound and Gagged

In a dark room with no windows,
a drug coursing through my veins
that left me bound and gagged.

I lost my mind and coudln't move.
I was no longer myself.
I was lower than dirt.
A wounded animal to be put to sleep.
I heard whispers of "just put her out of her misery."
"Get that thing out of my sight. I can't deal with her now."

Locked in a room.
I heard my screams in my head, but I couldn't get them out.
A terrible nightmare but with the crashing, debiltating knowledge that this was reality.

Powerless to stop the penetration.
Unable to resist orders.
Catatonic and numb.
Unable to move.
No where to run since my legs were tethered to their place.

The torture ensued.
My body defiled, and abused.

I lost all power.
All determination and will.
If coherent speech had been an option,
the thoughts were drowned out by the screams of my mind.

Then it was all over,
the drugs had worn off.
The figurative bounds released.
And I was torn and broken, discarded and pushed aside.

Down the hall, I hear a distant
"Next!"

I got my copies!

Today was an exciting day in my house, I got my copies of the Business of Being Born in the mail. I've already got a date to share it with a friend later this week. She's been excited to see it since we first spoke of it and she's glad I got my extra copy to share with her. Opportunist. and cheap skate. Ha. I'm glad to share it, after all that's why I bought two copies.

As I was picking up the package from the apartment office, an idea dawned. A movie night at the community center showing the documentary to the residents. As it is a student family community, childbearing is not only a prerequiste for living at the complex, its also a common reoccurence in families. So that will be a project I'll be working on. Coming soon to UW Family Housing!

A Mother's Birth Rape

Last week I wrote about recognizing birth rape and how it is an accurate way of describing some of the treatment that women experience when birthing babies in hospitals and with professional birth attendants.

This week, I was sickened when I read an account of one of the worst (or best, depending how you look at it) examples of birth rape. Warning: some graphic detail that left me feel utterly repulsed by this doctors actions.

The mom will remain anonymous for her privacy. During the homebirth of her child, she realized that she needed some extra support when she reached the pushing stage of labor. She decided to transfer to the hospital to find that support. Upon transferring, she encountered an agressive OB. Her story continues as follows:

This doctor yells for me to stop pushing and get on the bed. I tell her no, and she yells for the EMT guys who are still in the hallway to help get me on the bed. I give in rather than be manhandled. Another contraction hits and I push, and of course, baby’s crowning. She (doc) yells at me to stop, grabs that nasty betadine stuff and starts scrubbing me, then literally throws a cup of mineral oil over my crotch. My husband and kids walk in then, just as L’s head pops out. One more good push, and there’s her body. I start to say, “give her to me,” doc yells, “THICK MEC,” and cuts the cord before I can even finish saying it. They had her off, and I demand for her not to be suctioned. Believe it or not, they listened. However, at this point, doc grabs the cord and starts yanking, and says that the placenta is having a hard time detaching, and I need to push. I give a tiny test push, and know it’s not coming, so I tell her NO! STOP PULLING! STOP! STOP! STOP! I’m screaming by this point, because she’s pulling with all of her might. I grab my belly where I can still feel it attached and beg her to stop, telling her it’s attached, STOP STOP STOP! My husband is saying the same thing…then it comes out. She tries to pull it away, but I scream at her again. She then says “Your placenta looks odd. You may have had a collapsed fibroid come out with it.” At this point, I’m getting tunnel vision, and a ringing in my ears, and say that I’m gonna pass out. You guessed it, this bitch has pulled out my entire uterus.

Aside from gross medical negligence, this is the essence of birth rape--a woman who is not consenting, in fact yelling NO, STOP, exactly like a rape victim, when a doctor continues to perform an procedure or action that is inflicting more pain, above and beyond the pain experience during a nonmedicated birth.

The mother almost died from losing over 3 liters of blood, and was lucky that the doctors who performed emergency surgery were able to reinsert the mother's uterus. Hopefully, she will be able to have another child and she will heal physically.

Knowing my own experience of PTSD after chilbirth, I would be very surprised if this mother does not experience extreme PTSD symptoms and will face an emotional recovery very similar to that of a rape victim. I pray that she is able to emotionally cope with her experience and gets the support and love from people that she needs.

A sickening this about this story, is that this is an extreme example, but similar things--performing procedures without the consent, in fact inspite of their refusal-- are being done to women EVERYDAY by doctors and midwives, who then turn around and act like they saved the mother's life (paraphrased from mother's birth story).

The mother states that she intends to not let the OB get away with that treatment and intends to pursue legal action and file formal complaints against the OB.

Updates report that, "It turns out there were two things that occurred simultaneously when the doc put traction on the cord. 1) the uterus was inverted, which was not in itself life-threatening, 2) the placenta was yanked out, which caused significant bleeding. They took her to OR because the doctor who pulled the uterus out high-tailed it out of the room, and they took her to OR for general anesthesia. She was not, however, cut open (thank God). They just pushed her uterus back in there. She later received two units of blood to cover what was lost in the placenta removal. She's in some pain, but is moving around well, and there doesn't seem to be any major future implications re her uterus."

Advocate Healthy Birth with Healthy People 2020

Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease. Since 1979, Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity. Currently, Healthy People 2010 is leading the way to achieve increased quality and years of healthy life and the elimination of health disparities.

The website is accepting public comments on various health issues important to the American people. They welcome "suggestions as part of a collaborative process."

Now is the time for birth advocates to post what they know about healthy birth. Suggestions for change include using hospital based obstetrics only for childbirthing emergencies, moving low-risk pregnant women and birth out of hospital under the supervision of midwives. Cite the research of Michel Odent, MD; Sarah J Buckley, MD; Marsden Wagner, MD, Ina May Gaskin, Henci Goer and the other big names in birth.

Now is the time to talk about the need of changing the current system which puts financial gain before the well being of women and babies.

Damages Granted in PTSD after Childbirth Case

I have wondered if there is a legal precedent of a case where a woman successfully sued a doctor or hospital for malpractice and medical negiligance that caused Post Traumatic Stress Disorder in the patient. I would like to take my case to court in an effort to bring awareness to birth attendants, health care providers and the public that doctors are abusing laboring women in their care. Women's personal dignity and privacy is being impinged upon, as well as their patient's right to informed consent is being violated. Women are then suffering mental anguish, sometimes on top of a physically debilitating recovery. This is not an issue about alive and healthy mothers and babies, but its a human rights issue where women are being subjected to forms of torture and rape at the hands of their "care" providers.

In Meader vs. Stahler and Gheridian, $1.5 million was awarded to a family after a women suffered PTSD after an unneccessary C-section which she was coerced into by her doctors. Her lawyers argued that the doctors violated her right to informed consent and their negiligance in turn caused her months of agonizing physical and emotional recovery.

An article written about the case in Forensic Psychiatry and Medicine states:

Thus, it was not simply the physically disabling consequences of the surgery, but the loss of personal decision-making power concerning her body, her health, and the birth of her child, that caused Meador to suffer from Post-Traumatic Stress Disorder. Similarly, her husband's experience of loss of consortium was exacerbated by the physicians' failure to consult him to interpret his wife's wishes during labor. Instead of having participated in a true informed-consent process, he was left to feel powerless and helpless. In this way, forensic psychiatric testimony established a persuasive causal link between the lack of informed consent and the physical and emotional damages suffered by the patient and her family.

So there's my precedent! If a lawyer were to take on my case, he/she would be able to use Meaders case as evidence that others in our society and judicial system have viewed PTSD afterchild birth as a preventable condition and poor outcome caused by doctors who are not doing their jobs correctly. It was just that which lead to me experiencing PTSD after birthing in an abusive, manipulative hospital environment.

The above cited article goes on to discuss the relationship between informed consent and managed care (remember that labor care in hospitals is called aggressive management). It states that malpractice litigation based on violations of informed consent will become more frequent as medical care becomes more managed. The article mentions that "physicians may also be held liable for failing to inform patients about the conflict of interest they experience between their duties to patients and the dictates of managed care."

It was that conflict of interest that I encountered, where the manipulative and coercive treatment I received to convince me to either leave the hospital or consent to procedures against my wishes was done with the intent to clear the labor and delivery room faster so other patients (and their money) could come in, and in turn the hospital wouldn't be "wasting" money on me holding up their room.

A publication is currently being drafted by the American Medical Association that asserts that"physicians must serve their patients' best interests regardless of financial incentives." And if they do not, physicians can be held liable for damages.

Recognizing Birth Rape

As my readers know, I experienced PTSD (post traumatic stress disorder) after the birth of my first child. It was because the process of giving birth was particularly grueling or painful, but it stemmed from feeling like my bodily integrity and autonomy was taken away from my by hospital staff during the vulnerable time when I
was bring my child into the world.

Since his birth, I have learned alot about PTSD after childbirth and found something surprising: the treatment I received can be considered a form of rape. And my considering that term, I can say that exactly what it felt like to have strangers forcing me to do or submit to certain practices.

Amity Reed, blogger of TheFWord describes birth rape in these terms:

A woman who is raped while giving birth does not experience the assault in a way that fits neatly within the typical definitions we hold true in civilised society. A penis is usually nowhere to be found in the story and the perpetrator may not even possess one. But fingers, hands, suction cups, forceps, needles and scissors… these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her. Women are slapped, told to shut up, stop making noise and a nuisance of themselves, that they deserve this, that they shouldn’t have opened their legs nine months ago if they didn’t want to open them now. They are threatened, intimidated and bullied into submitting to procedures they do not need and interventions they do not want. Some are physically restrained from moving, their legs held open or their stomachs pushed on.

The writer goes on to describe that many women who experience birth rape also suffer from post traumatic stress disorder like I have and something called tokophobia or fear of childbirth. If, and they often do, women find themselves pregnant and facing the birth of another child, Reed states that their actions include:

Those who experienced trauma or rape in their first births are either electing for planned caesareans (which have their own, very real risks), terrified of going through the pain and degradation again, or forgoing hospitals altogether and birthing their babies at home, sometimes even unassisted by any professionals (called ‘unassisted childbirth’ or UC).

Those who are familiar with my plans for my next birth know that I refuse to experience that type of abuse and degradation again and instead am opting for a homebirth that may or may not be attended by a birth professional. I do not want to be exposed to another person trying to exert their will or exhibit control over my body when I'm working and allowing the process of birth to take place.

I wish that more birth professionals and hospital birth attends will learn that their actions have the same psychological effects as rape on the women they treat in that way. I would like to see trainings and seminars for obstetricians, midwives, nurses, family doctors and pernatoligists that discuss ways to prevent this result from happening to other women. As Danell Swim of TrueBirth states, "these Birth Rapes are perpetrated by an individual, or several individuals. It is not medically necessary, and yet the act is horrific, and leaves emotional and sometimes physical scars." Birth professionals need to be aware of this, in order to prevent it.

And wouldn't it be nice if the individuals who perpetrate these actions are held accountable? Reed states that attempts for complaint or criminal persecution are often "remote and insignificant." I hope that someday a birth rape case will be won on behalf of the victim and that the financial and liability wake-up call will be enough for birth professionals to change their ways.