Wedding Day Disasters

I’d thought along these lines myself, comparing wedding day disasters to birth trauma, intending at some point to write a post on it. But, this woman has already done so: part one and part two.

I have seen many, many talk shows or TV court shows where a woman is very distraught –often brought to tears–when she talks about her wedding that “went wrong”. How she had planned this day for so long, it was HER MOMENT, she will NEVER get it back. Even how traumatizing it was for her.

It dawned on me–women are given more sympathy (and more air time) for their wedding day disasters, than women who a bad birth experience!

You can plan weddings, and things can still go wrong. You can plan for how you would like your labor and birth to be — or, more to the point, you can plan who you would like to be there, and how you would like for them to treat you and the baby. Occasionally, things may arise that throw your plans out the window. [Click here to read Rixa’s post on the topic, plus many interesting comments following.] Borrowing from the wedding analogy — the caterer could be in a car wreck, smashing your cake; the photographer could fall in a lake, ruining not only his camera but the pictures as well; your future father-in-law could have a heart attack on the eve of the wedding; your flower girl could pull up her dress to show her pretty panties; the ring bearer could pick his nose (and eat it) during the most solemn part of the ceremony — there are numerous things, large and small, that could happen to disrupt your plans. Some, you can laugh off (at least, with the passage of time); others, not so much. Anyone can see that if the bride is disappointed on her wedding day, that something has gone wrong (or else she has her expectations too high, possibly). We go out of our way to ensure that women have happy weddings — that everything is “just so” or “just the way she wants it,” just the same as we would try to make sure that people have happy birthdays (anybody ever get a free dessert at a restaurant on your birthday?). Common courtesy demands at least that we treat people special on their special day. A woman giving birth should be treated with even greater respect, not just because it is most certainly a special day in her life, but because of the intensely personal nature of birth. Whatever happens in birth happens to her; something bad happening during a wedding usually does not (unless her hair catches on fire from the candles or something).

What is it about this culture?? We value the woman’s right to be a “princess” for a day, “The Dress”, pictures, cake and champagne more than the woman’s right to informed consent, to be treated with dignity and respect, free of coercion and harmful, unnecessary intervention.

And that, I think, is a great deal of the problem — when women feel mistreated, disrespected, coerced, and undergoing unnecessary interventions, they have a right to complain. If the intervention is necessary, then it can be explained in a respectful, dignified way. Common courtesy.

If the wedding was a disaster, be it a torn dress or a medical emergency, does everyone tell the newlywed to just be thankful they are married? After all, even though they planned the wedding for months, invested lots of time and money into it and were anticipating it, they got the end result they wished to achieve – marriage. There should be no reason to dwell on any upsetting or traumatic events. After all, it’s just a means to an end.  The moment they got married would  – and should – erase any prior upsetting events. Right?  I doubt it.  So why are women who share with others their feelings about disappointing or traumatic births told they should just “be thankful”? Why are they told that the process of birth doesn’t matter, it’s just a means to an end?

Click over to read the rest of the posts.

A public relations professional, mother, and “birth nut” had an insightful article about this topic called “Hitting the Right Notes.” She notes that often when people like us have conversations like this (where we, *gasp*, note the importance of being respected in birth, or talk about birth as being an empowering experience; or on the flip side, the trauma that can come from an upsetting birth experience), that people in the mainstream don’t get it. They think that we are setting up a choice between “a mountain-top experience” and “the safety of the baby,” and that’s false. Because they are not (usually) mutually exclusive. She writes,

A reporter once asked what was so bad about my cesarean. I could have talked about the painful recovery, the nearly failed breastfeeding relationship with my son, or the limits it placed on my future birthing choices. Instead, I botched my answer by talking about how emotionally disappointing it was.

None of these messages is wrong. In truth, the emotional aspect of birth is undervalued…

Talking about natural birth as a life-affirming amazing high fails to impress. Even if, on some level, women want that positive birthing experience, they don’t give themselves permission to pursue it. Too selfish. It has to be about the safety and well-being of their babies.

She then goes on to write that, rather than being opposing forces, a “one or the other” choice, a good birth experience has a great deal to do with good outcomes for mothers and babies.

By choosing our messages with care, we have the power to elevate natural birth from being a slightly hippie subculture to the safe and healthy standard that every health-care provider is obligated to uphold, and that every mother should demand.

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But it was just…

NavelGazing Midwife has written a thought-provoking post on birth trauma and birth rape.

One thing that stood out to me (probably because of the recent posts “At least you have a healthy baby” and “You should be grateful“) was the discussion of trauma in the setting of societal norms. In part,

Is Postpartum Post-Traumatic Stress Disorder (PPPTSD) an illness of luxury? If we were huddled in a migrant camp, would we really be concerned that the doctor pushed our legs apart to do a vaginal exam? Or would the multi-rape experiences overshadow the minimal intrusion the roaming doctor or midwife does.

Is PPPTSD judged by societal norms?

When I was in sexual assault self-help groups (almost always led by therapists), there was a tendency among the women to rate the abuse, almost always minimizing their own. “Well, I was just sexually abused at twelve from the guy next door. She was six and it was her brother. She had it much worse than I did.” Over and over, we had to remind each other (and be reminded) that rating the abuse discounted our own.

This is one of the angles I was searching for — maybe I hit on it well, maybe not — in those posts. If we compare outcomes, results, feelings, failings, etc., we will probably find that we are both better off and worse off than others — comparatively speaking. But should we compare ourselves with ourselves? That’s not wise. If we compare ourselves and our situations with how good they could be, we can always find something lacking. If we compare ourselves and our situations with how bad they could be, we can always see that it could be worse. But does the fact that we are not the lowest of the low mitigate the fact that we are in some way suffering and/or in pain? Why should we compare the level of violation we feel to what someone else “must feel” from having been violated in a different way? Is that helpful? If it is, then perhaps we should; but I don’t think that it really is helpful.

In one way, it is this “comparative way of thinking” that may embolden some people to continue acting in a hurtful way. “Well, sure, I did X, but at least it wasn’t as bad as what this guy over here did!” Using that criteria and logic (or illogic), a mass murderer could justify himself by saying, “At least I didn’t murder millions of people, like Hitler and Stalin did — I only raped and murdered 50 women!” ?!?!?!? “Well I may have raped 10 women, but at least I didn’t molest any children!” ?!?!?!? Are comparisons really even valid, when you’re comparing a rotten apple to a rotten orange? They’re both rotten fruit! — why try to make it sound like either one is acceptable?!

One of the first comments on NGM’s post was from Rixa:

Pain (or suffering) is like a gas: it fills the available space, no matter how small or big.

At least you have a healthy baby…

healthy baby apple

Many women, on telling stories of how they felt abused or traumatized during birth — or some other negative feeling, like having failed as a woman after having a C-section, or something — have their feelings dismissed with, “at least you have a healthy baby.” While there is certainly a place for looking for the “silver lining” in the midst of any cloud, no matter how dark, there is also a place for just putting your arm around somebody’s shoulders and “weep with those that weep, and mourn with those that mourn.” Dismissing a woman’s feelings does not help her — if anything, it only makes her feel worse, because then she has the added guilt of not being able to “just be happy” that her baby is healthy. Certainly she is happy that her baby is healthy… but can she not also be sad that it came at the cost of severe bodily trauma? — Especially if she is fairly certain that the C-section or whatever else that she endured during birth, was in fact not necessary for her baby to have been born healthy and well.

The above image came from this story on the Birth Love website, and was the woman’s way of expressing how she felt after her C-section. Even though I’ve not had a C-section, it certainly speaks to me; I can only imagine how women who have endured birth trauma would react to that — probably, “YES! This is how I feel!” Also, read Gretchen Humphries’ post on the topic.

Certainly, not every woman who had a C-section is going to feel this way — and I’m glad of that, otherwise there would be at least 31.7% of women last year who were as traumatized in body and spirit as this apple was brutalized, which would be unconscionable. It’s horrific enough that even one woman feels this way, much less every woman. This can be a point of contention among post-C-section women — some women can’t understand why others feel victimized by the same surgery that they had no problems with, or were even grateful for. Perhaps this image will help everyone who does not have negative feelings about C-sections (or other birth trauma) understand those who do.

So, the next time you hear someone process her negative birth experience, and you’re tempted to say, “At least you have a healthy baby,” remember the picture of the mutilated apple, bite your tongue, and if you can’t think of anything else, just say, “I’m so sorry.”

h/t to The Unnecessarean for the original post

In Search Of…

…stories from women who were traumatized during labor or birth, whether the form of trauma or mistreatment took the place of retribution (mom refuses Pitocin so she’s given an episiotomy without anesthetic and while she’s not pushing so that it will be as painful as possible; mom refuses an episiotomy so the doctor unnecessarily puts the baby into the NICU for 3 days and she’s not allowed to see the baby), coercion (rough vaginal exam after mom declines to have her water broken until she gives in and “allows” it), abuse (verbal [being screamed at], physical [being forced into an uncomfortable position against her will], or mental [“Well, if you don’t mind a dead baby, I guess you can refuse it…” or “If you don’t dilate faster, I’ll give you a C-section”]), or rape (putting any object, including a person’s hands, forceps, scissors, amnihook, etc., into a woman’s vagina against her consent).

I sent an email on one of my VBAC email lists after a woman had mentioned retribution a friend of hers had received after refusing a C-section, and the subsequent aftermath this woman endured:

I know this is getting into off-topic waters, but I think it’s important that patient abuse not be allowed to go unnoticed, even if it remains unpunished. Think of what the doctors and nurses in the 50s were allowed to get away with — mandatory and (near) universal… episiotomies, forceps, general anesthesia, bed labor, no husbands or other attendants, scheduled visits only for the mom/newborn, pubic shaves, enemas, and even physical restraints on the labor beds (this last one was a holdover from “Twilight Sleep” which made women animalistic in their actions). Only when women began speaking up and saying NO MORE and going public with it, did this treatment change — and a large part of the change was probably due to the reemergence of natural childbirth and home birth, which actually gave women the options and/or power to step outside of the system if the system refused to change. It wasn’t lawsuits, as far as I know, that changed matters; but public opinion in national women’s magazines and such that put pressure on hospitals to change. While I wouldn’t turn down a nice article in Women’s Day, Ladies Home Journal, or Good Housekeeping or any other magazine, we’ve got the internet at our disposal, which can be beneficial.

I think it’s time for women to say NO MORE to these kinds of retribution, coercion, abuse, rape, trauma — whatever name best describes how they were and ARE treated.

I recently heard of a nurse who is being sued because she “accidentally on purpose” pulled out a woman’s IUD because she was pro-life and didn’t like the abortifacient aspects of the IUD (it prevents a fertilized egg from implanting in the uterus). She is suing at least in part because the nurse performed a medical procedure on her without her consent. And a woman named Catherine Skol from Chicago is suing the doctor who attended her birth for mistreatment during labor and birth, including suturing minor perineal tears with a needle so large it was usually used for spinal taps and wasn’t even stocked on the L&D floor but had to be fetched from another wing of the hospital. (Her sin was that she didn’t call HIM before going to the hospital, although her regular doctor who was on vacation that weekend had told her to go to the hospital if she went into labor.)

These lawsuits may not garner multi-million dollar awards, and I don’t even think they need to. But publicity so that other women are aware of their options and rights is good; and bad publicity on the part of these @*!%$ doctors and nurses so that they are shamed and change their behavior (or their jobs) is also good imo. The settlements may be very small, as far as medical malpractice goes, because there are no dead or damaged babies, but if you get enough bad press and enough other women chiming in saying, “That happened to me, too!” then I think you’ll see things change, just like they did 30 years ago.

But if women keep silent out of shame, or fear of being not believed, or trying to blow it off as if it isn’t that big of a deal when it really is, nothing’s going to change except the perpetrators will continue their actions without fear of reprisal.

It’s gotta stop!

Sorry about the OT nature of this, but mistreatment of women — whether because they refuse a primary C-section or a repeat C-section or just don’t want to spread their legs to every Tom, Dick, and Nancy for unnecessary vaginal exams or whatever else the customer wants or refuses — needs to stop; and if women try to break VBAC bans by refusing unnecessary surgery only to end up feeling as if they’d been raped, and nothing is done about it, I don’t know that we’ve gained a real victory.

In response to that, a woman answered with her own email, which she allowed me to use:

I don’t think it’s off topic…  With my first I ended up with an “emergency” c-section… I put the word in quotation marks because it was Friday afternoon when they discovered my baby was breech.  (I wasn’t in labor yet, although I was one week overdue.)  After telling me the baby would DIE if I didn’t have a c-section immediately, they offered me the option of waiting until Monday to have the csection.  By then I was too terrified to wait and convinced that by Monday they’d be sectioning out a dead baby.  So I went ahead and had the c-section Friday night.  Anyway, two years later I was pregnant with baby #2.  Five weeks into the pregnancy I went back to the same OB/GYN who said, “Oh yes, we encourage VBAC” but it was obvious that you have to have a textbook-perfect labor to accomplish VBAC.  They specifically mentioned that I would have to dilate at 1 cm per hour — otherwise I’d have a mandatory second c-section.  Even my husband could see that there was no way with that doctor….  I asked about homebirth and she told me that if I tried a homebirth I’d end up with an emergency hysterectomy.  I decided to try a homebirth anyway.  At 41 weeks pregnancy the baby was transverse and even my midwife said I would need another cesarean.  (She had really tried for me!)  I asked if we could find a female OBG/YN instead of her usual backup male OB/GYN.  She called around and happened upon the same doctor’s office that delivered baby #1.  They agreed to do the cesarean… until they heard my name.  Then they told the midwife that if she brought me in to the hospital in labor, I’d be getting a hysterectomy.  (This is after NO physical examination… It was just retribution for not being more thoroughly grateful for the first c-section.) At that point my midwife called me with the option…. Did I want to use her male back up surgeon and keep my uterus or use the female doctor and lose my uterus.  I chose to keep my uterus.  🙂  Anyway, it turned out well for me.  One hour before my appointment with the surgeon the baby put his head down in my pelvis (for the first time in 41 weeks!) I went into labor a week later and had a head down, VBAC, waterbirth baby at home.  Oh, and I got to keep my uterus.  (Which is lucky… Because now I’m pregnant with Baby #3).

Things like this have got to stop. Spreading the word will help. Educating women so that they know it’s possible will help. I don’t want to spread fear unnecessarily — after all, the rate of abuse that women suffer at the hands of “care” providers is less than the rate of unwanted and unnecessary interventions in the 50s and 60s — but it still happens too often. How can you be sure it won’t happen to you? It’s something to be aware of, even if you’re pretty sure it won’t happen to you. If you’ve given birth in the past 3 years, fill out The Birth Survey — whether your birth was good or bad. If you’re in the New York City area, you can also use The Birth Survey to find out more information, directly from past clients of your doctor or midwife. Soon, nationwide information will be released. It shouldn’t take too long for abusive doctors and nurses and hospitals to get such bad publicity that they will have to change either their bedside manner or their jobs.

For those doctors, midwives, nurses, and hospitals who are true care providers, I salute you and hope that you are in the overwhelming majority! As for the others, I can only say, I hope you leave L&D as quickly as possible because you have no place in it.

You can leave a comment after this post (and you can make up a pseudonym, if you don’t want to give your real one), or you can email me at kathy_petersen_283 at yahoo dot com. Because it’s got to stop. It’s just gotta stop.

Birth Rape

Continuing in Dr. Rixa Freeze’s Born Free doctoral dissertation, starting on pg 118 of the pdf (pg. 104 of the dissertation), Rixa begins a discussion on “Birth-rape,” which is of course, highly troubling. Some women will choose to use the word “trauma” instead of “rape,” but the idea is definitely conveyed — outsiders doing things to a woman (specifically her genitals) against her wishes, and sometimes even against her explicit objections. The discussion goes on for several pages, and I think everyone involved in birth needs to read this, so that they can be more attuned to the concept — that some women feel traumatized by past births, or can become traumatized by future ones; that sometimes doctors and nurses can cause or contribute to those feelings; and that these things are real. Several women that were interviewed for this paper described previous birth experiences as either traumatic or “rape” — and this wasn’t restricted to hospital births attended by male doctors, but included births attended by female doctors and midwives in the hospital, as well as home births attended by a midwife. These experiences were so bad for these women, that the only way they could feel safe in birth was to go unassisted, since they could no longer trust medical personnel not to abuse their power as “professionals” or their office of trust.

One midwife who later came to believe that she had participated in “birth rape” said:

As I learned to be a midwife, I did horrible things to women in the name of education. I have held women’s legs open (“to get the baby out”). I have pulled placentas out (“to learn how to get one out that needs help or if the mom is bleeding”)….I have done vaginal exams on women who were screaming NO! I have coerced women to allow me into their vaginas for exams….I have manually dilated a cervix on a woman having a waterbirth (and I wasn’t wearing gloves) and got her cervical flesh under my fingernails.

As a doula and student, I stood by and watched as women screamed to be left alone. I watched midwives with 3 inch fingernails shove cervices from 3 to 10 [centimeters] in a few minutes. I watched as women had Cytotec inserted into their vaginas secretly….I have seen and heard women be screamed at to shut up, grow up, that she asked for it by opening her legs 9 months ago, that she gets what she deserves. I have seen a woman slapped by a midwife.

Rixa goes on to say, “Because such practices have become routine, few maternity care givers consider them abusive or inherently inappropriate.”

This is unfortunately all too true. You don’t have to look very far to find stories of women who were yelled at, sneered at, made to feel bad somehow (even stupid), forced to lie in bed, physically moved from a comfortable position into an uncomfortable one simply for doctor convenience, given unnecessary vaginal exams, given rough vaginal exams, cut unnecessarily, sutured unnecessarily, not given anesthesia for the suturing, etc. And this can happen even with “nice” midwives and “nice” nurses and “nice” doctors, which is the most troubling fact.

And this is why some women leave medical care and go unassisted — because they don’t like the way they were treated. After all, if you got raped when you went to a bar, would you go back to that bar again? I wouldn’t. And maybe not just that bar, but any bar, because that’s (obviously) where the rapists hang out, since one was hanging out there and raped you.

Average care in the early part of this century is better than average care in the 50s — there is more patient autonomy (no mandatory general anesthesia, major episiotomies, forceps births, etc.); but just because it’s better than it was doesn’t mean it’s as good as it can ever be, nor as good as it should be. Just as hospitals looked closely at their policies in the 70s with the advent of the “natural birth” movement and reemergence of midwifery, in order to keep women satisfied with giving birth there (not requiring general anesthesia any more, allowing husbands to be there when giving birth, making hospital rooms more “homey”), even so hospitals ought to look at their policies of today and address areas of discontent that many women have — including the area of loss of autonomy which the woman may process like rape.

Pro-life nurse sued for removing IUD without patient’s consent

Here is the court document, which is pretty short and to the point: a woman went into a facility to have an adjustment made to her IUD, and the nurse practitioner “accidentally” pulled out the IUD.

As that happened, Defendant Olona stated “Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.” She then explained, “I cut the string than went back and gently pulled and out it came. It must have not been in properly.” Olona then stated, “having the IUD come out was a good thing.” She asked Ms. Van Patten if she wanted to hear her “take” on the situation. Without receiving a response, Defendant Olona stated, “I personally do not like IUDs. I feel they are a type of abortion. I don’t know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.” Defendant Olona stated, “Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it’s not true, they accidentally come out when I tug.”

As much as I agree with the NP’s beliefs — that IUDs are abortifacient and that Mirena (the IUD in question, which has a hormone to prevent ovulation) may not always prevent ovulation, so may also be abortifacient — I cannot agree with what she did.

Assuming that what is in the court document is true, if this NP always “accidentally” pulls out IUDs when she tugs, then she needs at the minimum better training in how to properly place or maintain them. If she is against IUDs, she needs to be in another branch of the profession so she won’t have to deal with them, or have other measures in place to assure that she won’t be called on to violate her conscience by properly maintaining an abortive device. If she thought the woman was ignorant of the possible abortifacient qualities of Mirena, then she can educate her with the IUD intact, and then remove it if the woman wants it. And if the woman doesn’t want it removed, then the NP can remove herself from the room and get someone else to serve the woman.

Now, onto what I think is even more important, and that is the Civil Battery charge against the NP:

27. Defendant Olona intentionally removed the IUD without Ms. Van Patten’s consent to do so.
28. Defendant Olona’s conduct fell below the standard of care in the medical industry, which requires consent by the patient prior to conducting any procedures.
29. Defendant Olona’s conduct and actions constituted a civil battery upon Ms. Van Patten.
30. The intentional removal of the IUD proximately caused Ms. Van Patten damages and injuries.
31. Defendant Olona’s actions arose out of the negligence in the performance of medical treatment.
32. Defendant Olona’s actions were intentional, malicious, willful, and wanton.
WHEREFORE, Plaintiff requests compensatory damages against Defendant, including loss of consortium for her and her husband, Peter Van Patten, together with all costs and attorneys’ fees.

I would like to see something of this sort brought against every birth attendant who performs “any procedure” without “consent by the patient” — especially ones that cause unnecessary pain, bleeding, or “loss of consortium” (the woman can’t or won’t have sex). If removal of an IUD (which causes a little bleeding and menstrual-like cramps; and led this couple to abstain from sex for fear of pregnancy) without a woman’s consent constitutes battery worthy of a lawsuit that will compensate for the pain and loss of sex, how much more justified is a lawsuit because a woman’s vagina is cut against her will (episiotomy), or she is coerced or threatened into or given a C-section against her will? I’ve never had any of these — IUD removal, episiotomy, or a C-section — but I daresay the pain and loss of consortium caused by intentional cutting into a woman’s vagina or abdomen is a great deal more than that which is caused by the unwanted removal of an IUD.

This is not to minimize what this woman went through. Just to say that the comparatively small amount of pain and bleeding and lack of sex (either two weeks until the DepoProvera shot became effective, or 4 weeks until she got another IUD implanted — the court document says both, but only one can be true) is nothing compared to the amount of pain and loss of sex caused by an unnecessary episiotomy or C-section. When 73% of women whose vaginas were cut during birth were not given a choice about it (Listening to Mothers Survey – II, p. 19), then something needs to change. If enough lawsuits are filed on behalf of these women and their husbands and their babies due to the unnecessary and possibly “intentional, malicious, willful and wanton” use and overuse of unwanted interventions, then birth as we know it may change.

Court Document, Skol v. Pierce

Somebody dug around and found a PDF of the actual court document in that lawsuit I blogged about recently. Seeing as how it’s 31 pages, I haven’t yet read the whole thing, but thought some of you may be interested in the full document alleging the gross violation of trust and maltreatment from this doctor, because the woman did not call HIM before going to the hospital.