No, “birth rape” is not for real

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I’ve been writing about this issue for years, but it has finally made it in to the mainstream. In a piece on Time.com, Bonnie Rochman asks Is “Birth Rape” for Real? The answer is a resounding NO!

What is “birth rape” supposed to mean? It doesn’t mean rape during birth, although that is indeed possible, and no doubt has actually occurred.

As Rochman tells us:

In a post on Salon.com by Tracy Clark-Flory, Reed explains the phenomenon: “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.”

According to Amity Reed, the Al Sharpton of birth activists, birth rape is:

an instance during labor “when an instrument or hand is inserted into a woman’s vagina without permission, after which the woman feels violated.

Like Sharpton who cries “racism” regardless of the circumstances, Reed cries rape regardless of the circumstances. But the circumstances matter.

We have a word for medical care without permission and the word is “assault.” But childbirth activists abuse the word “rape,” and demean the experience of victims of actual rape, because they are desperate for attention. The promiscuous use of language, as when people abuse the term “lynching” or “racism” any other shocking term, is a sure-fire attention getter.

They’ve figured out that “I didn’t like the way the obstetrician treated me when he was trying to save my baby’s life” is not particularly compelling, since anyone who has ever suffered a serious medical problem knows that doctors give priority to saving lives in life threatening situations, rather than respecting emotional sensitivities. Let me be very clear about this point: I’m NOT saying that doctors are always right. Often more compassion could be shown without compromising life saving efforts in the least. But lack of compassion is not rape, either.

What is the actual definition of rape?

the unlawful compelling of a woman through physical force or duress to have sexual intercourse.

The legal definition has been expanded to include other forms of sexual touching that do not involve intercourse. And while it is true that we have come to understand that rape is often more about power than sex, we limit the meaning of rape to sexual contact. We have a different word for non-sexual harm; that word is assault. This is a critical point. We don’t discount any form of abuse or harm, but we do insist on precision in describing and punishing it.

And we do not determine whether a crime has occurred by referencing the feelings of the victim. The feelings of the victim matter not at all; what matters are the “feelings” of the perpetrator. We a name for the perpetrator’s feelings: intent.

All crimes require more than a physical act. They require intent, legally known as mens rea or the guilty mind. Consider the crime of murder. A person run down by a driver who was texting is every bit as dead as a person run down by a professional hit man intending to cause the death. But only the latter case is murder, while the former is manslaughter at most. Intent is absolutely critical to determining whether a crime has been committed and what type of crime has been committed.

It does not matter how the victim feels about the crime (or in the case of murder, how the victim theoretically would feel about the crime). It does not matter that the relatives of the victim run down by a texting driver “feel like” the victim has been murdered, and that’s not because we discount their feelings. We are actually quite sympathetic to the anger and sense of loss of the victim’s relatives.

Let’s look again at “birth rape.” Rape requires sexual touching. A man can punch a woman and it is not rape. It might be assault, but it is not rape. Why? Because it is not sexual touching.

And it’s not merely a matter of the identity of the body part that has been touched. A woman can kick a man in the crotch, but that is not rape either. It might be assault, but it is not rape. Why? Because intent matters.

The victim’s feelings about the matter are irrelevant. The woman who was punched can “feel” like she was being raped, but that doesn’t make it so. A man who was kicked in the crotch might “feel” like he was being raped, but that doesn’t make it so.

And, as I mentioned above, a woman in labor can actually be raped. Do childbirth activists actually expect us to believe that a vaginal exam without consent is the equivalent of forced sexual intercourse during labor? I can’t imagine they do. And if they can tell the difference between the two scenarios, then they are aware that they are misusing the term rape.

“Birth rape” does not exist. It is a promiscuous abuse of the term rape for the sole purpose of garnering attention. The term is legally meaningless and ethically suspect. It is morally wrong to insist that a rape has occurred when nothing of the kind happened. It is ethically unjustified to misuse the term rape regardless of how worthy the motivation. And it is insupportable to base the accusation of a crime on how the victim “feels” about it.

  • sadlady

    Be careful what you call rape. You wouldn’t want an ob who had no intent in the realm of sexuality while doing what they thought was a routine cervical check, but got soon be reason it shipped their mind to ask permission. It would be awful for an other wise squeaky clean lady to pop up on a sex offender list in the neighborhood! The neighbors would think omg what did she do?! Did she molest a little boy? No she got overtired on the job and forgot to be nice during delivery. The sex criminal list doesn’t specify and that is not fair. Prosecute the abuse but please don’t use that word! Call it something else!

    • sadlady

      Riddled with typos die to predictive text… I meant slipped their mind….etc

    • Lioness

      you are mistaken. that is legally classified as an assault, not mere rudeness. it is illegal to touch a patient without their consent, and being tired is never excuse for assault.
      however, classifying it as a sexual assault is a grey and murky question, because it is most probably not a sexualized act for the perpetrator, although it feels very much like a sexual violation to the patient. I would therefore avoid the term rape because rape and sexual assault are legal terms with specific legal connotations.

      • Sadlady

        Um yeah I was agreeing with you. Don’t call it rape. Prosecute but call it something else. I don’t want to see these people on sex offender lists with child molesters is all I’m saying. You can get tired to the point of misbehaving I bet, but I doubt rape. I just mentioned that for their bad motivation. I meant whoever was like *yawn*rape. No that’s premeditated. But I can see how someone could be haphazard and forget to ask and then get all mad when the.woman acts.surprised. It’s still assault but it starts from a different aggravation than rape.

        • Lioness

          on the other hand, i believe when people describe their experience as rape, they are referring to there emotional experience of the event. I relate, because I too feel raped by what occured during my birth experience. Most of them i believe, don’t mean it in a legal sense. Thus, denying their experience because it wasns’t legally rape, is dismissive and retraumatizing. And also irrelevant, if the point is to deny hospital abuses. While i would still advise caution regarding the use of the word because of its legal connotations, if the person is clear regarding not intending it legally, then yes, the term may be very appropriate.

  • Suzywriter

    So when three junior doctors (the short coats) came in to my delivery and a fourth threw back the flimsy drape, pushed my legs apart and spread open my vulva even though I tried to squirm away and asked him what he was doing and why he was touching me, then shoved his fingers into my vagina without even asking for my consent, it wasn’t rape? My baby’s life was not in danger. He was demonstrating his humiliating techniques to his minions. The minions then took turns shoving their fingers into my displayed genitals, feeling my vagina and cervix while I repeatedly told them to stop, screamed even. The nurse glanced over and said ‘They’ll be done in a minute. They’re just feeling your cervix.” JUST feeling my cervix? For what benefit to me?

    It was all about them. They wanted to feel my vagina for their own satisfaction. I don’t care what they wanted to practice or learn, they ignored my protests and took what they wanted from my body in the form of exposing my private parts and penetrating me as they chose. That’s rape, lady.

    • Anonymous

      Why didn’t you file charges?

    • Lioness

      see my response above. it was clearly an assault but whether or not it was a sexual assault is a rather murky question. Although to me, thats really a secondary question- ANY assault is horrendous and should be treated as such.

    • guest

      No, it was not for their satisfaction. No, you were not raped.

    • ?

      If you’re so certain this constitutes rape, why have you not pressed charges?

  • teegsmarre

    Rape doesn’t just have to mean sexual intercourse, the dictionary meaning of rape includes: an act of plunder, violent seizure, or abuse; despoliation; violation, which I believe describes the situations perfectly. So birth rape is a perfectly correct term to descripe what happens to adused women in labour.

  • Milla
  • Azayki

    You are completely ignoring the fact that in “birth rape” the place where a woman is assaulted is her vagina and other sexual organs. So yes, a man can punch someone and it is assault. But if a man touches a woman’s vagina without her permission, it is SEXUAL assault. These women are being sexually assaulted.

    • Stupid people everywhere

      So if I kick a guy in the balls is it sexual assault?

  • Aaron Little

    Your definition of rape is wrong. It does not require the word “woman” in there. Women are not the only people who can be raped.

  • Rhea S

    I loved the examples about rape vs. assault– really helps drive the point home. Another great post, Dr. Amy!

  • FF4life

    Obs try to deliver babies with as little damage to mother and child as possible. If people took a second to realize that these doctors are minimizing complications as much as possible they wouldn’t feel so offended that the doctor didn’t ask before performing a life saving or damage minimizing action. It’s like asking a person having a heart attack if it’s ok to perform CPR.

    Birth can be traumatic. It’s not all roses and confetti. Before modern interventions women and children dying during labor was a common occurrence.

    People also like to focus on the fact that csections are pushed when there is even slight distress. Well duh. If you had to choose between having a csection or risking the possibility of causing brain damage because your oversized baby may get stuck and be deprived of oxygen you are going to choose the route hat has the least risks every time.

    Sorry but people need to stop seeing childbirth as this magical thing where nothing can go wrong and look at the realities.

    • Anonymoose

      Legally, you’re required to ask someone before you perform CPR. I worked at the red cross and we had a case where one of our students was being sued for performing CPR without asking permission first. She saved the guys life and he sued her. We then had to fix all our courses to include an extra step asking permission.
      I totally agree with your comment though.

      • anonymous

        In the US it’s assumed that if the person is unconscious there;s something along the lines of “default consent” to perform CPR. Not sure about other places.

      • Sara

        Isn’t consciousness an obvious sign that CPR isn’t necessary? When I got certified it was pretty clear that you don’t perform CPR on someone who is responsive.

  • yentavegan

    Remember the scene from the movie “The Colour Purple” when the main character gives birth to the child conceived from an incestuous rape? Remember how she is left alone to writhe in pain and then her newborn is taken away from her still dripping wet and even before the placenta had been delivered…. remember her pain and sadness from being powerless? That is birth-rape.

    • Anonymous

      Who raped her then?

      • Kumquatwriter

        Her stepfather. Both in the conception and yentavegan’s birth rape example.

  • Laura K

    you’re a horrible person who has no consideration for others.

    • moto_librarian

      Gee, thanks for the insightful comment.

  • moto_librarian

    I hate the term “birth rape.” It has been chosen because it is deliberately provocative. Now before I proceed any further with my comment, let me say this unequivocally: I absolutely believe that medical assault happens, and there are few instances when a woman feels more vulnerable than when she is giving birth. I fully believe that medical assault should be reported and punished. It is completely unacceptable.

    That being said, I often note that events suddenly become characterized as birth rape after conversations with NCB advocates. I firmly believe that HCPs should be getting informed consent, but there truly are times when an emergency is occurring that precludes it. When I started to hemorrhage after the birth of my first child, my CNM told one of the L&D nurses to give me a shot of pitocin, and she inserted cytotec rectally. She told me that she was going to examine my uterus for clots; she did not ask. Given that I had no pain medication for delivery, this was a horrific experience for me, but it absolutely had to be done. She talked me through what she was doing up to the point where I was in and out of consciousness from blood loss and pain. My husband had to sign the consent form for me to be taken back to surgery, and he consented to a hysterectomy on my behalf should it be necessary. Fortunately, it was not needed, but I had no say in the matter because I was incapable of making an informed decision at that point.

    This experience was traumatic for me, and I know that some people would equate it to birth rape. It was not, nor was it assault. It was a true emergency that required swift action to save my life. When someone says they are going to check you for clots, it is difficult to envision what that really means. In my case, it meant my midwife was inside me up to her elbows. Of course that was incredibly invasive, but again, it was done to save my life. Given the NCB habit of dismissing real complications as “unnecessary interventions,” I wonder how often this attitude causes women to rewrite their experiences as birth rapes.

    • AllieFoyle

      It’s interesting what becomes traumatic for one person versus another. I’ve read your story a number of times and think that it must have been a living nightmare to experience, but that you are a strong and resilient person to be able to work it through and come to terms with it as you have.

      Experiences in L&D can be undeniably intense and distressing, as well as hauntingly persistent for some time afterward. I read your account and think how great it is that you’ve been able to process it as well as you have. I also think that some other woman could have a similar experience, but for various reasons (personality characteristics, relationship with the provider, perceived support, history of previous trauma, etc.) come out of it feeling much less ok than you have.

      I think there has to be some kind of understanding of and language around these kinds of outcomes so that women have some context for working through their experiences besides the cult of NCB, and so that providers can be aware of the potential for problems and avoid or minimize them when possible and also identify when a woman has been traumatized and offer her the appropriate treatments and support.

      • moto_librarian

        I am not naturally strong or resilient emotionally. I credit staying on my antidepressants throughout pregnancy as the one thing that helped me to keep myself together after this happened. I replayed the event obsessively for a good month postpartum, and really didn’t think that I wanted to have any more children. I do think that doctors and midwives should have conversations about how the birth went at the postpartum checkup. It would probably help a lot of women to get the facts about what was going on, and if necessary, referral for counseling.

        I will also say that when we made the decision to have a second child, I talked at length with my CNMs about how awful that first birth was. Notations were made on the front page of my chart about my complications, and as soon as the on-call midwife determined that I was in active labor, she ordered my epidural. That support really did make a difference for me.

    • Young CC Prof

      You know, your story makes me realize a key problem with the whole birth-rape narrative.

      After a scary birthing experience like yours, woman immersed in reality might say things like, “Wow, I had a scary time during birth, I almost died, it hurt so much more than I expected, I need to take some time to deal with this, not sure I want to have more children,” and so on.

      The natural-childbirth cultist who was primed to view all interventions negatively and expected birth to be safe, fun and beautiful says, “The reason I feel traumatized was that the medical professionals were mean to me.”

    • Ob in OZ

      Excellent post. Wish it didn’t happen to you, but glad your alive to write about it, with a bonus of having the option of more children. A different person who initially would have refused some of these interventions (hopefully once unconscious their partner would have stopped her chewing on the palcenta and consented to everything), most likely ending up witha worse outcome and then blaming the staff for the worse outcome.
      In this kind of emergency we “walk and talk” by doing what we have to do and explaining along the way. Wouldn’t expect you or your partner would remember anything that is said, but at the time at the least we are hopefully getting a nod that it’s ok to proceed. Once surgery is warranted then someone will have to sign a consent form. Immediately after we talk to the patient (if concious) and the partner, and go through it again the next day. If the patient still has questions while in the hospital and we are not seeing her daily, especially if the word debrief isn’t actually written in the chart, we go back and go through it again. Finally most patients are offered a 6 week appt with us instead of midwife or GP if needed. You would expect this to be enough, but after all of that I had someone complain about 4 months postpartum, after never saying a word about any issues through these other visits. Bottom line, I think between postpartum depression (which it sounds like you were pro-active in avoiding?) and unexpected complications without an effective way in dealing with them becomes the same with the woo available (internet,ruined her birth plan, affected bonding after,etc) it is now rape/post-traumatic stress disorder . poorly written as I’m rushed but wanted to be supportive and rant at the same time.

    • Ob in OZ

      should have just read the other posts and agreed

    • Nmtupperlady

      The difference to me, is your provider told you what they were doing. Mine (in a nonemergent situation) did no, despite being point blank asked and agreeing less than a minute before. When I questioned him about it, his response was “you have an epidural I didn’t think you’d be able to feel it.” Meaning he thought he could do whatever he wanted to my body, as long as he didn’t think I’d be able to object. Simiar to saying “well I thought she as to drunk to notice.” That is why it was birth rape.

      • Kumquatwriter

        That doesn’t make it “rape”

      • moto_librarian

        What your doctor did was wrong. I am not disputing that. I still believe it was medical assault, not rape. There is no sexual component to what you are describing.

        • AllieFoyle

          Well, there may be a sexual component to her, so even if it doesn’t satisfy the legal criteria for sexual assault and very few people would consider it appropriate to prosecute in that case, it may have had a psychological effect on the patient very similar to what would be evoked by what most would consider a more straightforward type of sexual assault.

          It’s falling out of fashion, but it bears saying that that episiotomy without explicit consent (or even warning!) was pretty commonplace not long ago. I don’t particularly blame individual doctors–by and large, their intent was to help and they were doing as they’d been trained–but it should be acknowledged that this practice was upsetting for many women even though it was considered perfectly acceptable medical practice.

  • emkay

    on the topic of unwanted and innaproporate sexual touching, Ina May is probably responsible for actual rape during birth.

    • Lioness

      instead of throwing out haphazard allegations, kindly specify what you are talking about and include some evidence please
      ? As long as you are accusing a specific person it is your responsibility to back up what you are talking about.

      • sameguest

        Have you not read the “button” comments on this site?

  • Ob in OZ

    Excellent topic and discussion. There are a few words that generate a lot of passion that we all know regarding black Americans, jewish people, other ethnic groups and minorities, and I believe this is one of them. Which is why I don’t think that a group of rape victims saying it is OK to use the term birth rape means that this is an exceptable lay-term, just like some black people might say some white people can use the N word. Words matter, and words hurt. Imagine being accused of birth rape by a patient for doing your job (everyone present including her doula felt the doctor was completely appropriate. review of notes in chart showed excellent and legible documentation for once). Then the patient who can remain anonymous plasters the doctor’s name on the internet which means that when a new patient wants to look them up they now see these posts about raping a patient. The reality of the patient’s 5 page birth planned was ruined because she couldn’t push the baby out and the doctor who put up with you all day finally says if you can’t push the baby out (now 3+ hours without an epidural) then a vacuum is recommended or otherwise you’ll need a c-s, then delivers the baby with one pull and hands you a beautiful child but all you want to remember is that they stuck a vacuum on the baby’s head which felt like the doctor raped you…. So let’s just say I think people should ALWAYS choose their words carefully, and should not use certain words ever, and other words only in the context that they were meant to be used. I am not saying rape can only be uttered by those who use it in a legal sense, but like calling someone an N word or nazi (the other n word in my mind) or a few others, and I AM going to feel much less sympathy for the “victim” 99% of the time because that his how often it is the patient that is upset that others took the welfare of their as yet unborn child as more important than a f@#&ing birth plan!

    • Young CC Prof

      Well put. Yes, there are people who have been sexually abused by health care providers, it totally happens, although it’s probably pretty uncommon. A doctor in my town was arrested for it a few years back.

      However, someone speaking rudely to you during labor is not rape, even if this person was examining you at the time. Failure to follow your birth plan because the doctor recognized that the birth plan was no longer medically feasible isn’t rape. And furthermore, encouraging women to view rudeness from care providers as a major emotional trauma isn’t necessarily helpful in terms of recovery, and it may increase friction in future encounters with the medical profession.

      Assuming that your baby was born successfully with no major damage to either party, if you found your caregivers rude, inappropriate, unresponsive, or anything else, write a detailed and specific letter of complaint, and send it to the hospital authorities and the medical board. (Do not use the word “rape” unless the legal definition applies, in which case you should also consider a police report.) Even if the authorities don’t act immediately, they’ll file the complaint, and they will act if a pattern of similar complaints from different patients appears.

  • Kusman

    Does the “Rape” and “Assault” have difference law rule?
    So that will be a confuse on court to decide the condemn…

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    “But childbirth activists abuse the word “rape,” and demean the experience of victims of actual rape,”

    No, it doesn’t. It does not demean me as a victim of rape. At all. The women at The Curvature (an anti-rape website, ran by rape victims) wrote a piece recently that was supportive of the term birth rape.

    If you are more worried about what word someone chooses to describe an experience in their life instead of the actual impact the behavior has on victims then your priorities are totally wrong. I can tell you now that the impact on my life from medical battery during childbirth is hauntingly similar to the impact rape made on my life. It feels exactly the same. You are invaded. You are ignored. You never feel safe again.

    When you are raped everyone bends over backwards to explain to you why it wasn’t rape, why it doesn’t count, etc. Some people even jump in to tell you that you are using the wrong word and blah blah blah, like that is helpful. That is what I read in this article. Perhaps you should try some empathy.

    How dare you tell women how to name their own experiences. You’re an OB, what the hell makes you qualified to tell women if their experience counts or not? Rape activists and mental health professionals do not have a problem with victims naming their experiences however they feel like- its encouraged. Maybe you should wise up to how shitty it is for you to continue to whine about women using words you don’t like to describe things that THEY EXPERIENCED and YOU DID NOT.

    • Lisa the Raptor

      I might buy this if using the term rape did not imply that there was a rapist. It’s not just about how you feel, but about the fact that you are making an accusation that someone is a rapist. That could potentially get you sued were your allegations to cause someone to lose their job or to lose patients. It’s not just about our feelings. Rape is a crime, not a feeling. Violated is a feeling.

    • Algernon

      “You’re an OB, what the hell makes you qualified to tell women if their experience counts or not?”

      And you’re a fucking idiot. You can’t call something rape if it isn’t actually rape. Call it for what it is, “birth rape” is nothing more than standard medical malpractice. It sucks that it happened during child birth, but that doesn’t make it rape, unless the medical staff forced you into sexual activities without your consent. It’s highly unlikely that a doctor id going to take the time, mid delivery, to force him/herself on the mother.

      This whole ‘birth rape’ shit stinks of an attention seeking, self pitying, way to play the victim card to make a situation sound like something that it is not, was not, and never will be. The word rape refers to sexually based crimes, meaning all other crimes of a non sexual nature are not rape. I’m sorry medical malpractice cater to the special snowflake mentality people seem to have about things.

  • http://drakonofthemists.tumblr.com/ Dyke by choice

    I wish natural birth people who stop abusing social justice language and scaring the crap out of me until I realize what kind of site it is as with this site: http://mumanu.wordpress.com/2013/02/14/violence-against-pregnant-and-labouring-women/

  • Busbus

    I agree with Dr. Amy that “birth rape” is not the appropriate term. However, I do think that the special position of a woman in labor – vulnerable, in pain and often not in control of her body, circumstances or rational mind – needs to be taken into account (possibly as an aggravating factor?) when judging such issues.

    I wanted to see what is usually meant when people refer to “birth rape”, and came across this story on theunnecesarean.com: http://www.theunnecesarean.com/blog/2008/12/17/more-than-just-rude-behavior-the-rest-of-catherine-skols-all.html#sthash.9GzZbtGc.dpbs

    Now, if we take this story at face value – which given that I know nothing else about the case I will – this is certainly an egregious violation. I still think “birth rape” is not the right term, but I do think that providers who do things like that need to be sanctioned and possibly even criminally prosecuted. (Under assault laws, I guess? But I’m not a lawyer.) I am sure there are people who throw accusations of “birth rape” around quite liberally, and that is obnoxious (and makes light of actual rape). But I wouldn’t dismiss a woman’s accusation just because she or others frame it under the title of “birth rape”, even if I don’t agree with using that term.

    • Expat

      The story sounds like an encounter with a jerk with poor bedside manner, but why didn’t the plaintiff get the epidural when it was recommended at 6 cm? The central theme in the complaints is being denied pain relief at 8 cm and the doctor worrying out loud about hemorrhage and ordering blood as a precaution due to the prolonged pushing and the fact that it was her fifth baby. He took a cell phone call related to another patient and then he didn’t do a great job with anesthetic for the stitching. That happened to me, but I didn’t take it as a personal attack. The complaint about the gauge of needle used to inject the anasthetic doesn’t sound based on any expert knowledge and the dialogue she claims sounds partly outlandish and imagined. Plus, prolonged pushing is not a low risk situation as the plaintiff seems to believe. She wanted a more relaxed and la die da atmosphere, but it probably wasn’t warranted. The story just has too many NCB tropes for it to be believable for me. The doctor is painted as a sadistic lunatic while the resident and nurse just idly stand by. If he was really such a monster, someone would’ve stopped him. I ‘m sure he was a jerk, but the exaggeration just makes it sound like it is half made up. The patient sounds – well, it takes two to tango. Her final complaint is that the demon on-call doc filling in for her regular ob didn’t visit her post partum. Gimme a break princess.

      • Busbus

        I hear you. I don’t know what really went on in that case, and I agree that some of the complaints sound a little over the top. I would also assume that if she is right, that there would be more complaints about this doctor, that other staff would be aware of the issue and that she would have good chances in a complaint to patient advocate or whatever other regular avenues exist for such cases (especially if he really stitched her up with the wrong needle – for which there should be witnesses and maybe even a record). But in the end I have too little insight into hospital procedures etc. to be able to make a guess on how much of this story is believable or not. And I do think that even just “bullying” or scaring someone in labor is even worse than being a jerk to someone who comes in for another procedure where they are not naked and in pain while they talk to the doctor. I still hear your point. And in any case, it’s not “rape”.

        • Busbus

          I went back now and read almost all the comments on this post up to now. I am trying to get to the bottom of why I don’t feel quite happy with some of the things I read. Below, some of the commenters pointed out that some people are just weird, and that their negative birth experience may be due to their weirdness and not to something bad the provider did. I am sure that happens sometimes, as some people *are* just weird. I also assume that – mostly due to NCB propaganda – there must be a sizable group of people who come into the hospital ready to “fight the doctors for their NCB” which I am sure doesn’t set up a good relationship to begin with. However, I think it shouldn’t be our first conclusion when we read an account like this that there must have been something wrong with the person making the complaint, or that it takes “two to tango” etc. (Expat, this is not in response to your post but rather to some things I read further down in the comments.) Somehow, that gets awfully close to “blaming the victim” as we know it from sexual assault cases.

          Just like I am sure there are weird people out there who construe ultimately benign events into something malicious, I am also sure there are bad OBs and doctors and other HCPs out there – just like there are bad apples in every profession. Plus, just because someone is not the epitome of reason and believability doesn’t mean that something bad may not have in fact still happened to them. Furthermore, I would venture that abusive HCPs (and I use the word abusive in its broadest sense here) would be more likely to act inappropriately towards patients who they view as being “beneath them” or who they believe will not speak up or will not be believed if they do – ie, poor people, immigrants or people of color, people with bad social skills (ie, “weird” people) etc.

          Before I came to the US, I had an OB in Europe in whose office I overheard her interaction with another patient who (presumably) was there for a pelvic exam while I was in the other exam room next door waiting to be examined myself. The patient, who based on her voice and accent must have been a young Turkish immigrant, suddenly shrieked at the OB to stop the exam. She then started to cry and, after being admonished by the OB to “speak up” finally said, sobbing, that she couldn’t do it. What shocked me, though, was my OBs reaction – she was so cold and harsh, raised her voice and practically scolded the girl that she needs to put her hand in there now to do her work, and that the patient needs to get it together now. She practically snarled something along the lines of “now open your legs – I can’t wait all day!” and then abruptly ended the exam and left the girl, who was still sobbing. I immediately thought of a sexual assault in the past of that patient (who wouldn’t, right!?) and couldn’t believe how my OB had talked to her. That same OB had said some rude things to me, as well (and I believe she was known for that), but she had never addressed me – a white, well educated woman – in that harsh and belittling tone she used with the young girl in the room next to me. I switched to a different OB very soon after that day (and in the middle of my pregnancy), in part due to that occurrence.

          I am relating this story because it is my personal anecdote of a doctor treating a patient horribly, but I don’t think it needs anecdotes to “prove” that this happens sometimes. Of course it does. Bad things
          happen in all professions. In addition, while bad things do of course happen to men and women, there is a history in medicine – as in many other areas – to be particularly dismissive of women’s symptoms and experiences. Several other posters further down in this thread have related their own negative experiences with HCPs.

          So, given that these things happen – and I don’t think this is really in question – I don’t want to be automatically dismissive towards any one account of abusive treatment (again, in the broadest sense of the word) by a HCP. No matter what words the person making the complaint uses or how (un)sympathetic she seems. And even if some of the complaints are maybe not so bad in and of themselves (like in the story I linked above), it serves to paint a picture that should be investigated (by the patient advocate/hospital/medical board or whatever) to find out how much of it can be objectively verified, and to decide if any professional action should be taken.

          All of this, by the way, does not conflict with anything Dr. Amy wrote in her post above. I agree that using this kind of inflammatory language is obnoxious and incorrect.

          • Expat

            I agree that just because the account isn’t 100% believable that something bad didn’t happen and that the doc wasn’t unnecessarily unsympathetic. I’m also sure that cases of disrespect of poor or immigrant people are unfortunately as common in medicine as they are in the society at large, but it shouldn’t be mixed into the general issue of abuse during childbirth which has become the cause of the ncb movement. Should the on call doc have the right to get annoyed when a mom refuses an IV and then proceeds to bleed out? Or when she refuses an epidural and proceeds to scream for 3 hours of pushing, later blaming the ob for the pain? Or when she refuses a csection for a macrosomic vbac baby and acts smug when the baby makes it out alive? (I got that one from the comments). It troubled me that 98% of the comments were in support of the plaintiff’s claims that the treatment by the doc was horrific or “someone should’ve called the police”. To me it sounded like, gee, prolonged pushing with a badly positioned baby, no epidural and a bad tear. That must’ve sucked, and the doc sounded like an unsympathetic jerk, but what he did was not malpractice or abuse (except for the stitching without decent numbing, but maybe it was a tough spot to numb up, who knows?). The on call doc was also dealing with another patient who needed an abortion, so he was likely dealing with a bad case where the baby wouldn’t survive past birth and when one deals with sad cases, feeling sympathetic for less tragic situations might become difficult. (If that part of the story was true). I got the sense that part of the plaintiff’s complaint was the horror of being delivered by someone who performed abortions. That’s rough if that is how the dice fall and that is how one feels about such things, but it is in no way the doc’s fault. He did ‘t want to be called in any more than she wanted him to do the job.

          • Expat

            Insert the words “doesn’t mean that” into the first sentence, and then it makes sense. Is there a name (aside from stupid) for frequently saying/writing the opposite of what one means? Some sort of logical dyslexia? I couldn’t sense the difference between right and left until I was 13.

      • OBNurse

        As a nurse, I can tell you that I have stood idly by while the physician acted like a jerk towards a patient, because I myself have been bullied by the same doctors for years. We have a few of them on staff. We have complained, written formal complaints, to our managers, the chief of staff, you name it. I was once yelled at so badly for phoning the physician on call, when he just didn’t want to come in to deliver a baby at 3am, that I was shaking in my seat, as he was lunging over the desk with eyes bulging, finger in my face, accusing me of being a racist, because I didn’t call the white doctor. When I complained and had a meeting with the chief of obstetrics, I was told that this person had never had a complaint against him, and that I must have done something to set him off. It was all about blaming the victim and protecting the old boys club. I later found out that human resources has a file as thick as a phone book, full of complaints about this particular doctor. He then proceeded to stalk me for months at work, and eventually moved on to another victim. I have seen many patients treated badly by physicians, despite the fact that we, the nurses, try to protect them. For example one our anesthesiologists usually leaves patients in tears after seeing them, he is a horrible excuse for a human being, so I usually warn the patients. I say to them, he’s an a**hole, don’t take it personally. Just be quiet and hold still. He’ll probably tell you that you are too fat for an epidural or yell at you for moving/moaning during a contraction. At least if they are prepared they can minimize the amount of time that we have to put up with him. The patient wants the epidural, he is the only one who can provide it, so we are at his mercy and he knows it. I have seen more than my share of incompetent physicians ( and nurses too, to be fair) and have tried to protect them over the years, but as a lowly peon nurse, I really truly don’t have any power. If a doctor wants to give an epis, or slap on a vacuum when it isn’t indicated, or manually remove a placenta, without anesthesia, I have very little say in the matter. I may have over a decade of L&D experience but I am not an MD. So, back to this woman’s story. It might all be true and it might not be. But the part about the nurses and resident sitting by and not saying anything, well, I can believe that. I’ve been that nurse in the room and I’ve consoled and debriefed with the residents afterwards. Confronting the jerks usually only escalates the problem,( nor will we be supported in the aftermath by management), their behaviour does not change, the are never disciplined, and so it becomes a matter of picking your battles and saving your own skin in your place of employment. Thank goodness we have terrific physicians and OB’s who are great to work with a treat patients with respect, and thank goodness the bad experiences are far and few between. But they do happen.

        • Lioness

          Why I chose not to be a nurse. My limited exposure showed it to be one of the most disempowering fields around. Probably because it is so predominantly female. My advise to you is to get yourself another career and when you know your leaving, file complaints with the Department of Health.

          • Lioness

            Addendum: There are far too many institutions in which a nurse has to choose between being ethical and keeping her job, she can’t do both.

          • Amy Tuteur, MD

            How would you know? Wait, wait, don’t tell me: you are gullible enough to believe whatever crap other lay homebirth advocates fabricate.

    • Expat

      She also complained that the doc wouldn’t turn the ECM trace so that she could see it (I assume he was looking at it) and she was sure that because the resident had measured 8 cm, that she didn’t need to be pushing as the doctor was directing. She is so sure that she knows better and websites like the unneccesarian just reinforce those erroneous beliefs. A jerk and malpractice and assault and rape should not be conflated.

    • Lisa the Raptor

      How about “violated”? That’s a nice moody word that fits.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        I’m sure glad that you’re around to pick the correct word for other women to use to describe their feelings about their own lives.

        • Lisa the Raptor

          Sure , fine, be “birth sauteed” if you want to, no matter how little it make engrish language work pretty. Meaning cupcake.

          • S

            Wow. I’m not picking a side, but way to indiscriminately punch other people in the face to make your point.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      You can’t get ANYTHING done about it. Believe me, I tried. No one cares about medical battery unless you are rich and know an attorney who is willing to spend time on battery only. The medical boards typically don’t care, even though its a major ethics violation.

      When you are a pregnant woman you are treated like a baby vessel instead of a human being.

  • nohika

    This is really a semantics issue, and rather off-topic, but I do take issue with your definition of rape as cited in this article. It perpetuates the stereotype, for example, that men can’t be raped, and leaves out those that don’t identify among the gender binary. I know it’s not relevant to the discussion at hand, but. Using ‘person’ just tends to be much more inclusive.

    • http://drakonofthemists.tumblr.com/ Dyke by choice

      It is well known that rape is often male violence against women. “Gender binary” means nothing. It is females that are targeted class. This not something that should be downplayed and erased.

      • nohika

        Yeah, that’s true. But that doesn’t mean that there aren’t men raped by women, or men raped by other men. Defining “the definition of rape” as women being victims continues to make it difficult for male victims of rape or domestic violence to step forward because socially they should not exist. That shouldn’t be erased, either.

  • PJ

    I’m not sure the issues are so cut and dried. Using legal definitions of rape to define it as an act is problematic. Spousal rape was not a crime in most developed countries until quite recently, and continues not to be outlawed in many countries. Clearly a husband can rape a wife. Likewise, I can think of at least one country where legally women cannot rape men; I bet similar legislation exists elsewhere too. The law does not necessarily keep up with, or define, what we consider to be rape.

    • Sue

      There is a big difference between actions done in the practice of health care, vs those done purely in a sexual context, no?

      • PJ

        Yes, there absolutely is. I agree that many (or maybe even most) of those exclaiming about birth rape are doing so erroneously, offensively (both to rape victims and to medical practitioners) and with an utter misunderstanding of the nature of consent during the course of medical treatment. I still can’t agree with Dr Amy’s assessment of the subject here.

        What counts as a “sexual context” in terms of rape is pretty problematic too. One of the other things that bothered me about this piece was what seems to be an implicit belief that rape is inherently sexual in nature, but that is far from being a given.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        Rape isn’t about sex. Its about control and violence. So is forcing instruments inside people who make it clear that they do not want them there.

    • Lisa the Raptor

      Still requires mens rea, and a sexual act, no matter who does it.

  • Jen

    I am curious. I have never read any accounts or Doctors or hospitals doing anything that could remotely qualify as rape. I have read many stories from women giving birth at home that claim to have felt that way about their homebirth midwives. Stories about being held down by the midwife and doula while the midwife stripped the woman’s membranes without telling her and telling her to shut up when she screamed for her to stop in pain. I wonder about intent in this circumstance because so many homebirth midwives do homebirth because they get some sort of weird enjoyment out of the birth process. Especially with people like Inna May Gaskin thinking it’s ok to push a woman’s “button” during birth. Would these types of situations qualify as birth rape?

    • anion

      Having somebody massage my “button” during labor, without permission, sounds a heck of a lot more like rape to me than a doctor or nurse checking my cervix for dilation.

      I never really minded my doctor’s fingers up there, because that’s where they were supposed to be. They were NOT supposed to be tiddling with my “button” for any reason. Geez, there’s always a female nurse in the room at my gyn appointments specifically to prevent that sort of thing.

      • anion

        Eep, I just realized I made it sound like the female in the room is the only thing that keeps my doctor from interfering with me. I meant, they’re there to A) observe in case of some sort of accusation, and B) to make patients feel safer.

        My OB was a wonderful man. He never would have considered doing such a thing! (Sorry, Dr. Bob!)

      • Jen

        Yeah, that was kind of what I was referring to in my comment. Hospital staff are trained to get consent and are there because they care about patients. Homebirth midwives are obsessed with birth and female body parts and have no training on gaining consent. To me this makes it seem likely that birth rape could be very real. It just doesn’t happen in the hospital, it happens in the homebirth setting with midwives that are actually fetishists.

        • anion

          Oh, I know; I was agreeing with you. :-)

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          Hospital staff are trained to get consent but there is very little chance that anything will happen to them if they don’t. I’ve seen some really horrifying stuff before in a non l&d setting, like a physician trying 5+ times to place an art line in a patient who had no idea what the doctor was doing. This sort of thing is absolutely routine in health care, patients do not know they have the right to refuse treatment. If they do and their right is violated then they find a pretty horrible reality waiting for them when they try to get justice for it. No one cares. Really.

    • Lisa the Raptor

      Nope that’s simply sexual assault or rape. The location and other things going on at the time do not get to play a part in the act. We don’t have “House murder” and “hotel murder”.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        Yeah its not like there is ‘domestic violence’ or ‘intimate partner violence’ or ‘corrective rape’ or ‘hate crimes’ or anything. whoops! actually there is, because context matters.

        • Lisa the Raptor

          Huh?

    • guest

      Yes, unfortunately. I recently discovered that my reproductive endocrinologist pled guilty to over a dozen counts of felony sexual assault for telling women that his extensive sexual fondling after procedures was a treatment used to increase pregnancy rates. To my horror, the medical board just put him on probation, and now he’s practicing under his middle name with very few restrictions and no required disclosure to patients. (I was unharmed, as far as I know. But I was unconscious for part of my treatment, so there will always be a little question in my mind.)

      Evil people do go into medicine. But there’s a difference between this man and a doctor who has a legitimate medical purpose but has not obtained appropriate consent. To pretend that the second is the same as the first is absurd.

      You can imagine that the Ina May Gaskin quotes about clitoral massage really, really, REALLY disturbed me.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      there are predators in every profession. Do you really think that people who wanted to violate women repeatedly would avoid becoming doctors or something? It gives them a very easy way to go about doing these things.It gives them credibility over their victims.

      And yeah, it happened to me. Had a pressure catheter shoved up inside me and when I said “what is that????” she just kept going. I’ve become furious after reading the risks of that procedure and the ACOG recommendations about the use of the catheters. She knew I didn’t want that there and that permission to touch/do anything to my body was very important to me, and she did that anyway. It was horrifying because I was a birth center transfer and she was the OB on call and I had no one else to turn to, and I was afraid of her after that. What else was she willing to do to me without asking? Why didn’t my words mean anything to her?

      • Susan

        I just checked on the site and read your posts. I think it should be clear that I know I know there are going to be predators in our profession and every profession. I have been a victim on a predator ( not health care related ) myself and I know the pain of not being believed. It’s more than pouring salt on the wound. I find most of the posters here to be very aware of patient’s rights issues. I know that I am always willing, no matter how uncomfortable, to speak up if I feel a patient’s rights are being violated or they are being treating disrespectfully. I still agree with Dr. Amy that the term Birthrape is used inappropriately. At least where I have worked, doctors and nurses would stop if a patient did not consent to something. What you describe is a little more tricky, as it sounds like she was midway through putting in the IUPC when you asked that. It certainly would have been smarter, indeed what EVERY patient deserves, for her to explain it first especially since you were a birth center transfer and were likely to feel distrust of “interventions”. So with just those facts it sounds disrespectful, and wrong, on the doctor’s part. An IUPC isn’t an emergency procedure but it certainly can be helpful in giving a safe dose of pitocin or deciding if augmentation will help or not. You deserved an explanation first and an opportunity to consent, or not. I am so sorry that happened to you.

  • Kerlyssa

    Makes me wonder what they think of checking rectal tone after a suspected spinal injury.

    • Gene

      I do rectal exams regularly in the ED. It is just another part of the body to me. But I’ve seen quite a few (always) men pitch an almighty fit when they learn a rectal exam is part of the work up. One man (I was not involved in his care) unsuccessfully sued a hospital for a rectal exam after a trauma. I also once had a relative make an aside comment about being assaulted after a toddler had a rectal temp. I read him the riot act. Most rectal exam craziness is associated with homophobia (IME).

  • auntbea

    I don’t know. I think if people are describing how they feel, “birth rape” is not necessarily ludicrous. People use “rape” metaphorically to mean a violation, sexual or not with some frequency (e.g. raping the earth. emotional rape.) And perhaps some women DO feel sufficiently violated and traumatized by something that happened during a birth that their experience is on par with legal rape. And, in rape cases, the victim’s feelings certainly DO count: if she feels okay with it, it’s not rape.

    Accusing someone of committing rape, on the other, does raise some questions of the meaning, since rape is a seriously criminal charge that has a limited definition for a reason. Stating that someone raped you — as opposed to saying you feel raped — does call for being more careful with words.

    • thepragmatist

      Ah, but a victims feelings as to whether or not something is rape don’t matter a whit either, in the case of sexual assault being identified as a crime or as “rape” under the law (and the law is specific). No, the only thing that matters is whether there is clear evidence– of the physical kind– that a rape occurred. Right or wrong, this is my experience of trying to prosecute a sexual abuser. And as for being raped, and I was raped, there is NO WAY for me to have my experience legitimized as a crime because there is no evidence. My feelings absolutely DO NOT MATTER A WHIT in the eyes of the law, and the best I can hope for is to get those who caused me harm in a civil court. There is a reason such a small number of rapes ever are prosecuted: rape is a private crime so there is often no evidence other than the victims “feelings” and because we do not accept a victims word at face value (a rapist is given the benefit of the doubt, not the victim, ever– the victim is run through the ringer), it is rare that rape is ever, ever prosecute. The worry always is that a bunch of women would run ripshod, crying rape left and right, when really I believe it’s a throwback to a time when a woman’s word was worth far less than a man’s. I am involved in a case with multiple victims and it reminds me of how, under components of Sharia law, there needs to be four female witnesses for every one male witness. Well, in this case there were a number of female victims with exactly the same story, but the criminal was not prosecuted. Indeed, it was even found that a crime was indeed committed, but could not be prosecuted. I have a friend who was date-raped by drugging, and it took (hold your breath!) 26 f-ing victims before that man was finally convicted of rape. So 26 women “feeling” raped before someone would stop him.

      I see parallels in medicine. In fact, one of my abusers was a medical provider. But I’ve also been victim of medical malpractice by someone well known in the community to be unethical and to act far outside scope of practice. This person managed to make a career of it, and although well known to attorneys and to various women organizations and physicians, it went on and on, because how many women must have “feelings” of medical malpractice before it actually stops. I don’t even have an answer, but I can say it felt a lot like rape. I won’t call it rape though. It’s just medical malpractice: unethical, violating, humiliating… not rape.

      But TBH after that experience, I said to my beloved doctor, who was probably more irate than me (because I already knew it was happening so I was just relieved there was PROOF finally) that I finally realized how a woman could come away from a hospital setting *feeling* raped. It still doesn’t matter, since rape didn’t occur. Hell, it would be hard to prove medmal occurred. Again, a civil court is probably the best place to get any sort of recompense, as depressing as that is.

      But there is an issue here. The law and medicine both can be very cold, absolute places where there is no room for feeling, yet some crimes are mostly crimes of feeling. A dead person with a knife through their chest is very much dead with a knife through the chest. But a woman who has been assaulted during labour by an uncaring, discompassionate doctor who insults her, calls her names, and then goes against informed consent… that’s a crime of “feeling”. There’s no real physical proof anything happened there. That doctor can walk away and people will say he or she had a bad bedside manner, colleagues may excuse that doctor for having a bad day, but the patient my deal with the emotional fall-out, much the same way as a rape, for years, developing PTSD, fear of physicians and hospitals, etc. There is no recourse, it appears, for women who experience this specific kind of trauma, and there is generally no or little recourse for a woman who was raped to find justice. The harm done is often emotional and not even quantifiable. As a criminal injury lawyer once yelled at me, while pounding his desk, “Tell me how much your hurt feelings are worth! 200 grand! 500 grand! A million dollars!? WHICH? WE NEED TO PROVE REAL HARM!!!” I get it, but it illuminates the issue when we are trying to prove that a rape or medical battery constitutes a “real” injury. I do think this is buried in layers and layers of sexism and power.

      I am not sure this was very eloquent as it is hard for me to put words to this in a clear way so don’t all jump over me. LOL!

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        I want to thank you for your words here. The barriers to justice are huge – and it stinks to high heaven. It may not be economic to pursue these cases, but I absolutely believe they should be pursued whenever possible, and that making it more possible needs to be a priority. The damage is immense.

      • auntbea

        I only meant that the law cares about feelings to the extent that the same act — sex — is rape or not rape based on how the woman feels about it. Feeling violated is necessary for a legal case of rape (assuming we are not talking about minors here), but, as you have pointed out, really not sufficient.
        The fact that feeling raped and having been legally raped are not the same thing is why I am willing to give people who claim “birth rape” the benefit of the doubt, that they know something I don’t.

  • Cold Steel

    New commenter here– I’m a resident physician in surgery. Not an obstetrician (except in circumstances most don’t want to contemplate). However, I am finding it extremely difficult to appreciate that this happens with any degree of regularity. I have never, never, never– no matter how high-stakes the situation– done anything on a conscious patient without at least giving them a verbal heads-up. I’ve never seen anyone do anything on a conscious patient [non-belligerent, non-intoxicated] without explaining it beforehand. And in ob/gyn, where this need is magnified times a thousand, I find it nearly unfathomable that strangers are rushing in performing vaginal exams or operative vaginal deliveries or whatnot without introduction, explanation, and consent.

    I guess I’m extremely skeptical of these patient accounts. Can any of the OBs or CNMs around here comment?

    • theadequatemother

      I don’t know either…not an OB or RM but I didn’t see it in LDR during my training either outside of true emergencies and even then someone is usually explaining what is happening while it is happening or briefly just before. I started off wondering if maybe there is an altered sensorium that accompanies the pain of labour that means a lot of verbal communication is missed…but we have data from anesthesia where they have looked at patient’s recollections of the information given to them when consenting to epidurals and they really do remember it very very well even when significantly distressed…so that can’t be it.

      I have seen it during burn baths (as per a comment below). We are called to sedate burn patients for baths and I see them being treated objectively quite frequently. Same with ICU patients which is difficult as most of our nurses were socialized to provide ICU care during the era of much deeper sedation…now with daily wake ups and lower overall sedation doses we aren’t being nearly as mindful as we should be about treating patients less objectively.

    • guest

      Also not an OB or CNM but I’ve heard enough stories from various sane and level-headed friends to make me think at least some of these things do occur. Mostly mentioned in passing, not as a huge grievance, but as negative interactions nonetheless. Certainly at least the more minor things like stripping membranes without giving a heads up, stitching perineal tears without informing, etc. And perhaps for many women those things would be no big deal, while for other women they would be.

      • Sue

        Performing procedures without consent in a non-life-threatening situation is generally wrong, and might constitute assault, but not ”rape”.

        It’s hard to imagine that adult women having babies do not have any concept that their genital tract will be involved.

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          you know what? screw you. I expect to be able to control who touches me and when. Being pregnant doesn’t mean people can do things to my vagina without asking me first.

    • guest

      I’m an OB and also find most of these stories rather difficult to believe. However, I think some of the discrepancy may be generational. I’m 5 years out of residency, received lots of “sensitivity training”, etc. I always ask my patients if they want me to strip their membranes prior to vaginal exam but often hear from my patients that my older partners (20+ years out of training) just do it without consent. They also tend to choose induction dates for them rather than letting the patient and her family choose a date if an induction is necessary. I tend to give them a few days to choose from if we get to that point.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        I am kind of floored at everyone who is saying that these things do not happen because you haven’t witnessed them. Abusive people do these things deliberately and can choose to do them when certain other people are around (or not). Its like thinking domestic violence isn’t real because you never saw someone beat their wife before. Its ridiculous. Why would anyone ever think that a certain profession is exempt from sociopathic behavior? I mean doctors have murdered, raped, etc but they would *never* force exams or treatments?

    • Lisa the Raptor

      As a patient of three vaginal births with CNMs, and various other things with OB or GYNs I have never had anything like that happen. And I’ve had a lot of different doctors up in there (ER docs, CNMs, PAs, FNPs, MDs, Ph.Ds–ahem–)….but I’m also not shy. I’ll let the whole class of interns have a gander at my hind quarters. Maybe I’m not noticing it.

    • Mishimoo

      Not a CNM or OB, but have had 3 vaginal deliveries and 1 first trimester miscarriage + an investigation into why my menstrual cycle is weird. The only times I’ve had problems with lack of consent were during my miscarriage (which I personally class as assault and improper handling of biohazards) and a student CNM during a check-up with the latest bub.

      With the student CNM, she was a bit frazzled and was put on the spot by a superior so I wasn’t offended. She apologised profusely when her preceptor pointed out that she’d forgotten to introduce herself properly, didn’t explain what she was doing or ask for consent. Poor dear got cocky after picking a breech position, so the head midwife asked me if the student could come in and try to figure out foetal position because my babies always lie funny.

      Other than that, I’ve had to request vaginal exams and amniotomy. It wasn’t ever forced on me and neither was anything else – CFM, saline, pitocin – everything was discussed and requested by me. I like the staff at my hospital, I find that they’re really easy to work with. (It has a reputation for pushy/bitchy staff)

    • fiftyfifty1

      Yeah, I think the majority (not all, but the majority) of this is due to patient weirdness factors rather than docs doing something wrong.
      I think of an example from my own practice. A patient came to me for a second (third?) opinion on her urinary control issues. She expressed a large amount of indignation about her previous treatment recommendation which she told me was totally inappropriate and “borderline sick”. She described being sent to someone who “stuck fingers up there and humiliated me” and “told me to squeeze using my vagina”. Turns out she had been referred to pelvic floor PT. I looked to see whom she had seen and it was the same woman whom I had seen for my own pelvic floor PT therapy. This therapist had been, in my opinion, absolutely excellent and 100% professional. She explained what she was doing and why both ahead of time and during. Her warm, encouraging bedside manner is something I credit with helping me start to heal from the mental shock of all the damage I had sustained during my childbirth injury. I got to know the patient better as time went on and, well, she was a weirdo. Her stories were always just “off”.
      A certain percentage of patients are just weird. Again and again they just seem to run into sadistic docs or dismissive docs or incompetent docs. It defies belief that anyone could have that much bad luck. It reminds me of those certain men who complain that they are ready to give up on women altogether because again and again all the women they date turn out to be “crazy bitches”…. Sure, buddy, sure….

      • Dr Kitty

        If you meet one asshole today, you met an asshole.
        If you met two assholes today, you’re unlucky.
        If everyone you met today is an asshole…maybe you’re the asshole.

        There is, sadly, a reason why “heartsink patient” has entered the medical lexicon.

        • CanDoc

          Dr. Kitty, you took the words right out of my mouth. A new patient badmouths one of my colleagues, and I figure they just were a bad match or an off day (for doc OR patient). Once I hear about 5 of my colleagues who are all duds, incompetent, and inappropriate, I know that it’s not my colleagues who are the duds in this picture.

          • Dr Kitty

            I can think of patients who have sought third and fourth and fifth opinions because the Drs they saw “must” be incompetent if they say that the particular condition is not fixable.
            I get that it can be very distressing and upsetting to be told that your illness isn’t curable with the current knowledge and techniques, but it isn’t a reflection of the Drs’ incompetence if they decline to give you treatments they know will not help.

            I do know that vulnerable people can be repeatedly exploited and abused, BUT that isn’t the narrative with most of the patients who make complaints.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        You know what a common factor is for experiencing sexual abuse? Having been abused before. People who are abusive often pick up on it and know they have an easy target. It really isn’t hard to believe that someone who is vulnerable will be hurt repeatedly.

        • fiftyfifty1

          We aren’t talking about women who repeatedly find themselves with abusive boyfriends, we are talking about patients who claim they repeatedly find themselves with abusive medical providers. It really defies belief that there are a group of predatory medical providers out there who are picking up on signs of past abuse in people they meet on the street and then somehow convincing these people that they need to see a doctor and that moreover the doctor they need to see is themselves, and then when they arrive for the appointment they treat them badly. Or maybe there is an abuse ring of predatory doctors? They abuse one patient and then refer them to other abusive doctors within their secret ring of medical abuse (but sometimes it’s not an abuse ring, it’s just a rudeness ring or a dismissive ring. Whatever the docs are into)?
          Nope, I think the correct model is more like what Dr. Kitty proposes.

          • Anka

            It’s not just in the context of romantic relationships; I was abused by my parents, and–especially when I was a young adult–it was incredibly obvious to anyone who was looking for someone to bully that I would be a prime target because I had no clue how to defend myself. I think I got my first two jobs, which were terrible and skewed my view of the working world for a number of years, because my supervisors (both widely acknowledged by others in those two places to be toxic) could tell from the interviews alone that I was pretty vulnerable and would put up with anything. And this can definitely happen in a medical context as well (and did happen to me during my pregnancy). I don’t think anyone with a balanced view of the medical profession is suggesting that there’s a ring of predatory doctors–it’s never that organized. The simple combination of rude/nasty doctor on a power trip (and sure, there are some–there are some people like that in every profession) and a patient who, thanks to background, might have trouble defending herself and wants to be a “good” patient and not make trouble, is a recipe for abuse.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      I am not an OB or a CNM, but I have worked in patient care for many years at various hospitals. I can assure you that surprise/forced treatment is common place. It mostly depends on if someone feels like doing it to you or not.

      You may want to consider the possibility that your colleagues act differently around you because you are a doctor.

  • anh

    Kind of OT, but, food for thought.
    I live in VA and our state government supports a mandatory ultrasound for any woman seeking an abortion, which, if it is sought early enough, is frequently a transvaginal ultrasound. People referred to it as “state-sanctioned rape”, and while many objected, I think there was some utility in calling it that.
    It is still classified legally as rape when someone is raped with an objected. Forcible penetration doesn’t have to penile.
    Rape is defined as being forced through “force or coercion”, and I think denying someone an abortion unless they submit could be classed as abortion.
    I in no way believe the ultrasound tech giving the ultrasound is guilty of rape. But ostensibly a sociopath could force one individual to rape another, and thus they are the guilty culprit.

    thoughts?

    • Antigonos CNM

      No, it is state-sanctioned assault.

    • Sue

      Nobody should be forced to have TV ultrasound against their will.

      Having said that, no clinician should be forced to perform termination of pregnancy without being fully satisfied that there is a single intrauterine gestation.

      Easy, then, to wait until gestation is reliably visualised trans-abdominally. Then nobody forced to do anything.

      (Or have I missed something here?)

      • Dr Kitty

        It is only acceptable to wait IF that is what the woman prefers.
        It is perfectly possible to visualise a IUP trans abdominally from 6 weeks post LMP in a thin woman.
        In a woman with a high BMI by the time you were satisfied about the view you got on an abdominal US, you could be approaching the end of the window for medical termination.

        Mandating TVUSS when adequate views on abdominal scanning have been obtained serves no purpose other than to punish women.

        A significant proportion of medical terminations happen sub 6 weeks from LMP, when even with TVUSS you might not see much.

        Also it doesn’t matter if the pregnancy is single or multiple,if it isn’t going to continue, especially for medical TOP.

      • Anne

        It isn’t a requirement of medication termination to have ultrasound dating- just that gestational age doesn’t exceed the limit for the particular method (9 weeks in most countries) by clinical assessment.
        Any sonographer who is trained to do transvaginal scanning should rarely need to resort to this route to EXCLUDE a post 9 week gestation.
        Sure, they may not see a fetal pole/gestation sac transabdominally, but as long as there is no clinical suspicion by the doctor that there is a ectopic pregnancy, that is entirely immaterial.
        Is the pregnancy sonographically less than 9 weeks? If the answer is yes from the transabdominal scan (which should always be done prior to transvaginal scan), then no further assessment is clinically required.
        The few cases in which the question cannot be answered can be managed with alternative dating methods which the doctor can discuss with the patient- one of which is transvaginal ultrasound.
        I agree with Antigonas- state sanctioned assault dressed up as good medical practice.

      • Ainsley Nicholson

        Why should a woman have to wait until later in the pregnancy to have an abortion if that is what she is certain she wants, simply in order to avoid a state-mandated medically unnecessary TV ultrasound?

  • ngozi

    I’d just like to let you all know that a good number of African Americans find Al Sharpton to be an embarrassment. Personally, I take Al Sharpton about as seriously as I take Bill O’Reiley.
    Just making a side point…

  • Amy Tuteur, MD

    OT: The pressure is mounting. Cheyney feels compelled to spew more BS instead of revealing death rates.

    http://mana.org/understanding-mana-stats

    • attitude devant

      Classic Missy Cheyney—”I would just LOVE to release annual data” but first I need more midwives…..to get meaningful numbers? What the heck? Just cough up what you are sitting on, lady.

      • Squillo

        They don’t just need more midwives, they apparently need a feasibility study. As in, how feasible would it be to find excuses for our crappy stats every years?

        • Sue

          Yep – a FUNDED feasibility study – for the feasibility of releasing their data…

    • Young CC Prof

      17,000 isn’t enough? I sincerely hope it isn’t enough to provide statistically significant numbers of maternal deaths (of previously healthy women during labor) but it ought to be enough to provide statistically significant numbers of intrapartum fetal deaths or neonatal deaths.

      If your expected value is greater than five, you can do statistics without looking dumb, though you might need to use nonparametric methods. Other studies show about 3 deaths per 1,000 homebirths, so there ought to be about 50 dead babies in that data set.

      Now, she may have a point about the rarity making them potentially identifiable, but in that case, release national numbers only. The fact of a death, the year, and maybe separate out mandatory-reporting or non-mandatory-reporting states.

      Numbers! Numbers! Numbers!

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    The set of things being described needs its own language, the acts often described as “birth rape” are offensive in their own right. Awareness about the issue and sensitivity to it (and in some cases access to justice and accountability) is not facilitated by co-opting the language of rape (all be it victims in the absence of a vocabulary to describe what they have experienced, should be forgiven for its use and given an appropriate term to use instead). Obstetric violence – includes medical battery, medical assault, and medical neglect during pregnancy and childbirth. Those who experience it deserve to be heard, it is real.

    • AllieFoyle

      Exactly. It’s a terrible term, polarizing and offensive to some, but there isn’t much else on offer. Create some other context for understanding and addressing obstetrical psychological trauma so that this is not the only resource suffering women have available.

    • thepragmatist

      I think birth trauma is close. But not good enough. And it’s foolishness to think that trauma involving one’s sexual self– intimate parts– is NOT different than say, the jerk doctor who made me walk on a badly torn ankle, resulting in neuropathic damage. Yeah, I hate that guy, and my GP at the time was aghast when I came in and he realized it hadn’t even been compressed, but you know what, WAY DIFFERENT than if it had happened to my vagina and had lasting consequences. I have an injury from pregnancy I am still recovering from (pelvic recti and a torn disc) and I am pretty bitter about the fact it took two years to properly diagnose and get me into the physio that would’ve maybe saved me a torn disc had I ANY IDEA my pelvis was so out of whack in the post-partum. No one explained this to me sufficiently and my pain was disregarded as psychological in nature. The only reason it was ever diagnosed properly was because an OB/GYN just wouldn’t give up trying to figure out why I was in so much pain and believed me even when I started to doubt my own sanity. Now I am still in pain but at the least I don’t feel crazy! But it was definitely neglectful of my midwife to keep referring me to a chiropractor when I was literally screaming in pain every single appointment from 7 months onward. I mean, that was the worst pain I’ve endured in my life, and it just went on and on, and it changed me as a human being. It seems stupid to say, but it really did. It left me vulnerable, confused, and anxious. It left me feeling inadequate and out of control. I count myself lucky that I finally got pain management, but I have to fight for it still. Just recently my GP asked me if I was selling my pain medication and then confronted me and said, “Well, it’s not like your disc is herniated or something.” I said, “Uh, yes it is.” Rather smugly he said, “Well, let’s look at your MRI…” I sat there while he read out that indeed it’s herniated, torn, and deteriorating. He looked embarrassed. I started crying. I am well used to this kind of treatment.

      So, then it makes me anxious and paranoid about being left in pain again, like I was, and then they say I have an anxiety disorder and the pain is psychogenic. Meanwhile, once I almost got kicked out of a sports med appointment for challenging the doctor to consider how I would be treated if I was a MAN who had torn and herniated a disc at work. I know how I would be, because big burly loggers end up on bed rest with physio and pain management and sometimes, it ends their careers and they go on compensation. Meanwhile, this thing happened to me while pregnant, and there’s no medical leave, compensation, state-paid physio, nor am I treated as if I am entitled to the same level of care. I’m called crazy and anxious and my pain minimized. Same GP once asked me why I “cling so tightly to my pain medications”… uh, because without them I can’t move? Because I do not believe for one second my pain is psychogenic, since I know people with far less disc injuries who are in far more pain and do far less than I do (I am raising a toddler alone… chew on that!) And I am STILL waiting for someone to do something about it. It’s so frustrating. It’s destroyed so much of my life. I do think it’s sexist, so shoot me. I think it was sexism that stopped me from being adequately assessed in the first place. It was not OB/GYNs responsibility either, it was the GP. I went to him, sobbing in pain, begging for help, and was told I was just anxious and anxiously relating to normal pain of pregnancy. Not so. Do they say the same thing to men? I doubt it.

      • anion

        Please accept a big internet hug. I am so sorry you’re dealing with all of that.

        (And as an aside, and I won’t rant too much, but your treatment re pain medication infuriates me. You’re not the only person I know who’s dealt with or is dealing with constant pain who’s been bullied, berated, and/or denied pain meds because of the fear of addiction, because addiction is seen as always a negative. Quite frankly, who cares if you have a physical addiction to a needed medication if that medication helps you function? Once the source of pain has been dealt with the patient can be weaned off the meds. Is being unable to move without crying really better for your health and life and psyche than having a physical addiction?

        Antidepressants must be taken daily, affect moods, and can have some pretty gnarly withdrawal symptoms, but we don’t berate people for taking them and we don’t call them addicts.)

        • auntbea

          Actually, every time I switch doctors, they ask me if I want to stay on my antidepressants, or “see if can do without them now”. Um. No, no I don’t. Thanks.

          • anion

            That’s really not the same thing as flat-out refusing to give them to you, or berating you, or calling you a loser junkie weakling. It’s pretty standard for a new doctor to ask if the patient wants to continue taking meds prescribed by the old doctor; questions about meds/side effects/if you’re happy with them are part of routine care.

            Did your new doctors ask why you keep “clinging” to the antidepressants? Did they ask if you were selling them? Did they tell you to stop taking them because you just needed to look on the bright side and it was all in your head? If not, then it’s not comparable to thepragmatist’s experiences, or the experiences I was talking about.

            I have nothing against antidepressants or people who take them, at all. I have depressive issues myself, sometimes quite serious ones; I am a firm believer in people who need medication of any kind being given that medication, and it’s nobody else’s business. I used antidepressants simply as an example of a mood-altering medication for which the word “addiction” isn’t thrown around by society in general. You could substitute caffeine if you like, which studies have shown is more physically addictive than heroin (just with less intense withdrawals), but nobody treats you like dirt if you drink four cups a day because otherwise you’re a zombie.

          • auntbea

            Well, I wasn’t competing, but you can win anyway.

      • auntbea

        WTAF. Where are you? Can you get a new GP? Can you hit the one you have with a hot poker and then tell him to take an Advil?

      • Christina Maxwell

        What a horrendously awful time you have had, it almost goes without saying that this should not have happened but there is one thing I have to say. I’m sorry if it’s unhelpful. Your experience sounds very much like what my husband went through, obviously without the birth bit(!). He went through years, decades of pain and disability and we could not get one single doctor or physio to take it seriously. There was a lot of ‘man up’ attitude going on, an assumption that he was exaggerating etc. Eventually we found a Neurologist who listened and asked sensible questions. Wonder of wonders, he was interested in the answers! he referred my husband on to a neurosurgeon who agreed to an exploratory operation as the MRI was… unclear I suppose. The upshot was that the surgeon found 3 discs that had been herniated for so long that they had calcified, compressing the sciatic nerve irretrievably. He did what he could, a 45 minute op turned into 6 hours. My husband has never received so much as an apology from any of the other doctors and even now has to fight tooth and nail for any help at all from anybody. So yes, it does happen to men too. He went through all the feeling crazy stuff and so did I to a lesser extent.
        The good news is that with time and judicious use of powerful narcotics my husband has got his life back and even enjoys himself sometimes. Sorry to witter on for so long. I hope that you too find improvement over time.

        • Christina Maxwell

          Replying to myself to add that getting the powerful narcotics was a whole new fight, with all the usual addiction nonsense, suggestions that my husband is a junkie etc. He’s still a little scared, 10 years later, that one day somebody is going to refuse to renew his prescription. People should absolutely not be made to feel like that.

      • Nashira

        “I mean, that was the worst pain I’ve endured in my life, and it just
        went on and on, and it changed me as a human being. It seems stupid to
        say, but it really did. It left me vulnerable, confused, and anxious. It
        left me feeling inadequate and out of control.”

        Hey. It’s not stupid. You are not stupid. I have a severe form of neuropathy in my face: I AM NOT the same as I was before. Living with severe pain cannot help but change you, especially when the people you go to for help try and brush you off.

        Especially with the fucking anxiety shit… yes, I have panic attacks over the idea of not having my pain meds, because I really enjoy getting out of bed and doing stuff and not wanting to die so the pain stops. You and I, we are normal for having any anxiety about this, because /bad things happen when our pain isn’t controlled/. The best way to treat my anxiety disorder is to treat my pain.

        The worst part is, many of these folks have chronic pain so you’d think they’d get it, but… they don’t. Especially when you’re a woman and they’re a man who things sexism is the best ism. Men’s pain is real and women are crazy attention seekers.

  • Stacy Mintzer Herlihy

    My mom was forced against a wall by a family friend who shoved his penis in her vagina without her permission. That was rape. A doctor making reasonable decisions so you get through labor safely with a healthy baby is not. People who can’t tell the difference between the two are crazy and stupid.

  • Clarissa Darling

    My mom had a relative who was shot and killed by a man who was obsessed with her. ie: she died as a result of a murder. I’m sure her parents would take issue with characterizing someone who died as the result of being shot in a hunting accident as a murder victim. It’s not about denying the accident victim’s family the right to feel pain and It’s not about trying to determine who’s pain is worse. Bottom line–they are both dealing with the painful and senseless loss of family members but, as the result of very different circumstances and the difference between these circumstances is the intent. If one doesn’t acknowledge that intent has anything to do with it, why have any characterizations such as murder/homicide/rape/assault in the first place? Let’s just sentence anyone whose actions result in the death of another individual to jail for murder. Let’s just consider anyone who causes a woman to feel violated due to an interaction with her genitals a rapist. If the accident victim’s family insists on calling it “murder” and if women who are victims of other types of assault insist on calling it “rape” just because they “feel like” the experiences are equivalent this is naturally going to upset people who’ve been victimized in those very specific ways. If you can’t get your point across without using words that misappropriate another person’s experience, perhaps you’d better re consider how you want to make your point.

  • AlisonCummins

    I thought that legally the common-language “rape” had been replaced in most cases by “sexual assault,” which again has various degrees including “aggravated sexual assault.”

    If you place “medical assault” next to “sexual assault” it doesn’t sound so bizarre. In both cases there’s a power differential and in both cases bodily autonomy is not recognized.

    I understand that there’s more to the online cultural phenomenon of “birth rape,” I know very little about it beyond what I read here and I’m not defending it. I just like accuracy and dislike the practice of overstating a valid case.

    • thepragmatist

      You nailed this far more succinctly than my rambling post upthread. Thanks.

  • AL

    So offensive to true rape victims.

  • Amy M

    The author used the term “emasculating” to describe something being done to women.

    “Yeah, it’s wrong to make a woman feel emasculated on what should be one
    of the most empowering days of her life, but it’s not rape. ” That is a direct quote from the article. The quote seems to have been written by Rochman to describe another person’s (Clark-Flory) feelings.

    Someone correct me if I am wrong, but my impression was that women, by definition, cannot be emasculated, as they are not men (or masculine) to begin with. Sure a women being assaulted could feel violated, disempowered, and terrified, but emasculated seems as poor a choice of words as birth rape.

    • AlisonCummins

      You are not wrong. To “emasculate” is to castrate.

      • Amy M

        Yeah, that’s what I thought! No balls, no emasculation. Though of course it is often used in the figurative sense, when a woman does something that makes a man feel “un-manly” or takes a measure of his power away.

  • AllieFoyle

    I’m reluctant to wade into this one again, but before the negative responses pile up too high here, I feel compelled to point out that, whether or not the term is appropriate or offensive, some women do have labor experiences that leave them psychologically traumatized, with similarities to sexual assault. Whether those experiences are the result of egregious malpractice, an institutionalized insensitivity, or just the nature of an intense and difficult experience, such a woman currently has little recourse or support. Rather than focusing on whether or not such instances rise to some legal standard of assault, wouldn’t it be useful to explore why women are having these experiences so that such outcomes can be minimized in the future and appropriate support given to women who are already suffering?

    • attitude devant

      AllieFoyle, the whole point is that ‘assault’ is the correct term, not rape. And I’m happy to have the discussion. But the term ‘birth rape’ is inappropriate for all the reasons enumerated above.

      • attitude devant

        AND….I would disagree that there is little recourse. There is such a thing as filing a complaint with the Medical Board, or with the hospital. I assure you these things are taken VERY seriously by all concerned…..but not when someone is tossing around words that are ridiculously inappropriate.

        • AlisonCummins

          1) Does everyone have the appropriate words? If the only people who understand their feelings are calling it “birth rape,” then those are the words they know. Discounting someone’s complaint because they don’t share your specialized vocabulary is ridiculously inappropriate.
          2) If you have to assure people that complaints are taken very seriously, then you understand that this fact is invisible to most of us. If my complaint is that my nurse ignored me, in order to complain to her boss I have to a) understand that my nurse was not following the standard of care b) believe that my nurse’s boss doesn’t already know about the behaviour and c) believe that the boss is able and willing to do something about it. If someone doesn’t believe all three of those things, then no, for all practical purposes they don’t have recourse. (Especially if the only people who explain a) to them call it birth rape, and they are treated disrespectfully when they attempt to file a complaint using that phrase.)

          • attitude devant

            I sit on several committees at my hospital. In each one we are responding at various times to written complaints. Each complaint is evaluated and a written response prepared and sent. Action is taken when appropriate. And it is exactly my point that we should not throw around a phrase like ‘birth rape’ because it makes the complaint non-sensical.

          • AlisonCummins

            “We” meaning the committee? I agree. You would rephrase the patient’s words into your specialized terminology, which is appropriate.

            What you said was, “these things are taken VERY seriously by all concerned…..but not when someone is tossing around words that are ridiculously inappropriate.” In context it sounded like “someone” was the patient themselves, not the committee.

          • attitude devant

            No, sorry, I see your point. The ‘someone’ was all the idiot Janet Fraser types who promote this language and encourage people to frame there experience this way. Which is not helpful to addressing the concerns people have about their care, and erodes the confidence people have in their providers.

          • AlisonCummins

            So Janet Fraser promoting inappropriate vocabulary is a problem, but doesn’t result in committees’ taking patient complaints less seriously?

          • attitude devant

            I think it adds an extremely unhelpful layer to addressing the complaint. If you have a complaint to make, surely you want to make it as articulately as possible? Surely you don’t want to layer on inappropriately accusatory and inflammatory language? I assure you the ‘lack of consent’ issue is serious enough and has enough legal ramifications.

          • AlisonCummins

            And patients are presumed to be wilfully rejecting appropriate language? If someone complained about their care during a “hiterestomy” would you take them less seriously than if they knew that the correct word is “hysterectomy” and were able to spell it?

          • attitude devant

            I don’t care how it’s spelled or if it’s written in crayon on the back of her parole officer’s calling card. Complaints are taken seriously.

          • AlisonCummins

            Yes, that’s exactly what I would expect!

            Which is why I’m so puzzled that you keep dancing around the idea that if a complaining patient doesn’t have access to the vocabulary you do and expresses her experience as “birth rape,” that her complaint is taken less seriously. Sometimes you seem to say it isn’t and sometimes you seem to say it is.

            Maybe in an ideal world it wouldn’t be, but in reality it is?

          • attitude devant

            Yes, I worded that poorly above. But as someone who takes these things seriously, I find it frustrating when people are encouraged to use language as unhelpful as ‘birth rape.’ If I get a complaint that says “Dr. X birth raped me,” it’s hard to know whether or not to call the cops to report a crime. If I review a complaint about the same incident that says “Dr. X did not introduce himself or ask permission before cutting an episiotomy,” then I’m on solid ground and can then address the complaint.

          • guest

            and what would likely happen in your institution in a case like that? (the second, not the first)

          • AlisonCummins

            I guess I was assuming that people would most typically do both. “Dr X birth raped me by just walking in and cutting an episiotomy without talking to me.”

          • AllieFoyle

            So you… send a letter? What good does that do someone?

          • attitude devant

            And take action as appropriate, which can range from opening to a peer review complaint or sanctions or restriction of privilege. And mind you, I am only talking at the hospital level. If a complaint is made to the state Board of Medicine, there is hell to pay. In my state you have to hire a lawyer to represent you before the Board, and there is the very real possibility of having your practice restricted. I know of cases where people lost their licenses or had severe requirements placed on their practice.

          • AllieFoyle

            But that does nothing for the person who has been harmed. It doesn’t take away her nightmares, sense of shame, anger, depression, anxiety, fear of medical situations, altered sexuality and damaged relationships, etc. or make her whole again.

          • attitude devant

            What would you suggest? I am asking seriously.

          • AllieFoyle

            I’d suggest that:

            1.prenatal care include much more information and discussion of what will happen during labor. Childbirth prep has been farmed out to hippies with a ncb agenda. Hcps need to be sure their patients have a realistic sense of what the experience is likely to involve and an understanding of their choices and the various risks and benefits thereof. Respect for autonomy and privacy and excellent pain control should be paramount.

            2. attention should be paid to situations that are potentially traumatic, so that special care can be exercised to minimize the effect (or at least identify and treat trauma early). Instrumental deliveries, episiotomies, fetal distress, severe pain, fear, humiliation (hcps may not consider the situation humiliating though it may be to the patient), complications, invasive procedures (manual placenta removal, etc.), substantial pelvic trauma, history of sexual assault or abuse–> extra care to avoid or minimize effect.

            3. efforts to identify and treat patients who are suffering effects of trauma. You already screen for PPD, why not post traumatic stress? Have the discussion with the patient and have some referrals ready.

          • attitude devant

            All good suggestions. But they do not answer my question which was what you would have the hospital or Board responding to a complaint do, since you find what we do inadequate.

          • AllieFoyle

            I’m not suggesting that your actions are inadequate in any professional sense. They just don’t do anything to help the person who has been harmed.

            You’re focused on obtaining some kind of punitive justice, but I think that’s less important than creating a situation in which people are less likely to be traumatized and which has something helpful to offer them in the event that they are. As has already been pointed out here, no one even has to really be at fault for someone to be traumatized.

          • AlisonCummins

            AllieFoyle, I didn’t read AttitudeDevant as asking for your creative ideas for punishment. What is the “something helpful” to offer when patients are traumatized?

          • Busbus

            I agree that it’s good to put procedures into place that should help avoid traumatic experiences in the first place.

            However, in cases where a provider *did* act inappropriately, I think that professional sanctions (such as what could happen in response to a complaint to the hospital or medical board) would be a very appropriate response. I think that would be very useful and an important thing to do. Yes, it won’t help the patient heal, but no official procedure will and that’s not really the point. The point is to make sure this doesn’t happen again or with regularity, to raise awareness, and to weed out “bad apples” if they exist. If one person complains, and then another – that suddenly makes a very compelling case and alerts the hospital or board to the fact that something is amiss with this particular practitioner.

          • AllieFoyle

            I do agree with that. Giving feedback about your care can be very useful in changing the behaviors and culture that facilitate bad experiences, as well as holding people accountable when they’ve provided poor care.

        • http://Www.awaitingjuno.blogspot.com/ Mrs. W

          I’ve got an odd perspective on this issue. Recourse is largely limited – it IS part of the problem. What will a complaint do for the victim of such acts? Little.

          • attitude devant

            Mrs. W, you know that I admire and support you and you know very well that I DO provide ECMR, but I don’t think the lack of recourse in your situation is comparable to the recourse available to patients who experience assault. (Although, again, I grant you that I do agree that what happened to you was wrong)

          • thepragmatist

            Not true. But we are in Canada, where physicians are protected by one of the largest insurance lobbies in the country and are very, very unlikely to ever be found guilty in a civil suit. As much as it is a good thing that physicians are protected from frivolous lawsuits, it DOES lead to what appears to be a climate of absolutely no accountability. The Nurses Unions and Association also have a very large, powerful lobby, and so following through on complaints and having them actually go to a point where there is compensation is extraordinarily unlikely. I do think we have a sick culture in medicine up here, no offense to fellow posters who are doctors in Canada. I do like some of my physicians but for the most part I’ve found care to be substandard at best and I think part of this is the freedom from potential litigation. Doctors know it is unlikely they will ever be found in the wrong in a lawsuit and patients run out of money long before they even get to a courtroom because they just do not have the financial capacity to sue a physician who has a HUGE fund behind them to pay for litigation. Same goes for hospitals. Something has to change to level the playing field.

          • AlisonCummins

            Hail fellow Canadian, well-met!

            I’ve had a mix of good and bad care. My GP is wonderful, and so are the other docs I see at her clinic for walk-ins. She has always taken me completely seriously.

            My interpretation of the difference between the litigation cultures in the US and Canada is at least partly that in the US you need to sue someone for damages to get your medical bills paid. In Canada many of the expenses of a bad outcome are carried by our single-payer insurance system. We don’t need to prove that Dr X caused the damage and force her to pay for it.

          • theadequatemother

            I have a little different perspective, not bc I am a physician but because I have a family member who worked for the firm that has the CMPA account for western Canada.

            If expert witnesses cannot be found to support the doctor and substandard care has caused harm, they just settle. It’s part of a strategy to reduce costs. If expert witnesses can be found the main strategy is to get the plaintiff and their council to drop the case after discovery. Very few cases actually go to trial.

            The machinery in the provincial college and the pt affairs offices in the hospital are alternative ways patients can affect change. Closure is another matter. Sometimes things change without the original complaint ent being aware. And sometimes closure is seen by patients as requiring a successful suit. I’m not sure why but I do think there is a desire to punish.

            What do you think about places like NZ where there is universal indemnity and you can’t sue at all? Is there a correlation with increased or decreased medical error? Patient complaints? I dunno but I’m curious because one of te big theories in patient safety is that if ou move to no blame things actually get better.

          • CanDoc

            I’m sorry, you have no idea what you are talking about. As a physician in Canada, I can assure, legitimate lawsuits are lost or settled by the physician via the CMPA. Frivolous ones (ie where the physicians’ actions are defensible and appropriate and the the plaintiff’s complaint is not supportable) are not. Not in the same high-profile, billions-of-dollars way that is seen uniquely in the US, but physicians are just as accountable in Canada as in any other first-world country, and those who do not meet the standard of care are addressed – either through the legal system or by sanction from practice from official bodies. There are always lawyers willing to take on legitimate malpractice cases, because they are reasonably easy to win. If you think your care is “substandard at best”, please find a new country and get out of mine.

      • AllieFoyle

        I don’t believe that filing a complaint in a situation of this nature is likely to lead to a satisfying outcome. Do you? It becomes essentially a he-said, she-said situation, and there really is no win once a person has already been traumatized. Recognition of the potential for psychological trauma, concerted, systematic efforts to avoid it, and methods of recognizing and treating trauma compassionately when it does occur would be much more helpful.

        • thepragmatist

          Not only that, but unlike when you file a complaint of rape, there is no protection of the alleged victim (at least here, when you file a complaint of rape there is immediately a no contact order), so retaliation from the medical institution is a very real threat and issue that prevents many women from ever coming forward in places where there may only be one OB/GYN practice and one hospital. Fear of retaliatory action is a real problem and why a lot of women do not say anything or complain. Masking complaints would be a much better solution.

          • anion

            Why not first talk to the doctor or whomever in question? “You know, it was really upsetting to me that you did X without telling me/discussing it with me. I was emotional and scared and you made me feel less like a person. I understand you were doing your job, but just a few seconds of your time would have made a difference to me.”

            Isn’t that the best place to start? All the doctors I’ve ever known would have listened to and cared about such a comment.

            I’m not saying the situation may not need to be escalated, and I don’t mean to sound rude (and this isn’t directed at anyone personally), but seriously. Have an adult conversation.

    • anonymous

      Allie, as last time, please give us an example of one of these labor experiences. Here’s a few I’ve heard from the birth nutters:

      “I couldn’t play my Enya cd during labor! Birthrape!”
      “They washed my baby!”
      and of course
      “I didn’t want that procedure! Birthrape!”

      If a woman comes into the ER from a botched homebirth and the only way to save the child is a cesarean and mom doesn’t want it, we’re going to assume that she’s nuts. Why? Because she’s no longer the only patient. If it’s going to save the child’s life or from a lifetime of crippling injury it’s happening. Deal with the rest later. Notice that you don’t hear anyone except the birth nutters trumpeting this stuff. You don’t hear it from people brought in after a massive car wreck, fall, attack, etc.

      • Guest

        I had a doctor strip my membranes during a cervical check, without warning. It was shocking and it hurt and it very much violated my trust. His response to me when I said something was “Well you wanted to get this labor going that’s how you do that.” Blame-the-victim, anyone?

        Is this rape? No. But a problem, not an uncommon one. I love this post because Dr. Amy has spelled out clearly what language does not belong in this conversation. This post also dovetails nicely with her recent posts about patient autonomy and the fact of her being pregnant, or naked, or in labor, does not constitute a blanket consent for the doctor to do whatever he “knows” is right for her.

      • guest

        I’m a PTSD specialist and actually have had people seek treatment in cases in which part of the trauma is the EMT and medical care they received: one after being shot, several for burn care following burn injuries. I don’t think it’s nuts at all.

        • attitude devant

          I’m currently treating a mom with PTSD from the emergency c-section that saved her life and her baby’s life. No one did anything wrong and she did fully consent at the time, but it was traumatic. Everyone recognizes this. No one blames anyone, and no one was raped.

          • guest

            yes. agreed.

            in the cases I’m citing above, similarly no one did anything “wrong.” The gun shot situation was a life-threatening emergency. The burn care patients were also in life-threatening emergencies at the beginning. Unfortunately on the burn unit, as is sometimes the case with obstetrics, it seems that patients are often not treated as sensitively as i would wish. There is sometimes a disconnect between the staff and the patients about the experience, a lack of understanding of how frightening it is to be taken into a tank room by a bunch of masked strangers, stripped of your gown, and hosed down with high pressure water where you are freezing and in terrible pain. so in that case, not rape, but potentially violating, and certainly a seeming lack of understanding about the fact that the treatment, while necessary, needs to be delivered as sensitively and humanely as possible.

          • attitude devant

            It does not help that sometimes the patient is in an altered sensorium. We had a nice lady with an overwhelming chicken pox infection while pregnant. She survived and her baby survived, both of which are nearly miraculous, but she was really sick and her interpretation of what was happening (she saw the isolation gowns as nuns’ habits and thought she was being held prisoner in a convent) was terrifying to her.

          • guest

            ugh – that poor woman! so nothing to be done there, except to help her process the trauma afterward. similarly some of the burn patients are on ketamine during procedures. which is goooood, because less pain, but baaaad, because compounds how confusing and frightening the procedures can be.

          • Zornorph

            That sounds like a script for a horror movie or at least an episode of the Twilight Zone.

          • anion

            A week after I had my ulcer surgery I developed a massive hematoma in the incision, which required a second surgery. I’ve always tolerated anesthesia really well, but for some reason when I woke up in recovery I thought there was a big noisy party happening in the room. I mean, I saw balloons and streamers and heard people screaming with laughter and singing. I was really scared; I thought I was in an asylum or something for a minute.

            I fell back asleep (like a stone!), and when I woke up again, probably only a few minutes later, I mentioned to the nurse how the party had disturbed and upset me. Of course there had been no party. But I can still remember very clearly what I thought I heard and saw.

          • Mrs Dennis

            Eminently sensible approach, no need for a new word, just recognition of harm and suitable help given. My first labour was long, exhausting, frightening, horribly painful, with ‘pain relief’ that hurt more than it helped, and ended in a forceps delivery and extended epis. Hurts my perineum just thinking about it!

            After 20+ hours, two doctors came in, prepped the forceps while talking about fishing, applied the forceps, told me to pull myself together when I screamed in agony and panic, hoicked the baby out, sutured me while talking about football, and left.

            It took several years, four normal births, 3 years’ midwifery training and several years’ midwifery practice to help me truly come to terms with what happened. I now think, they were there to get my baby out, not to harm me. They should have been nicer, but fair enough, I was all over the place, barely rational. They didn’t intend to hurt me.

            I am now a health visitor, and I always talk to new mothers about their birth, and encourage them to attend debriefing sessions if they would find it helpful. It’s not about guilt or blame, but about understanding what happened, why it happened, and putting things in perspective. The very end of labour can feel scary, chaotic, confusing and unbelievably painful, even when women appear to be coping well. Did I nearly die? Did my baby nearly die? How much danger were we in? And was it REALLY the paediatrician who did that last VE?!

      • melindasue22

        I have read about a woman who declined a vaginal exam in labor and was picked up, put on the bed and given one. Another woman wanted to deliver on all fours and was physically turned over and held to deliver on her back because the obstetrician said “I’m not a veterinarian.” The manual removing of large clots from the uterus during hemmorhaging while medically indicated can be terrifying. I have read quite a few thing that amaze me and not all from home birth nutters. Just having pre-e and having mag sulfate can be scary, not rape if course, but I wonder how many docs/nurses sit down with someone after things and say “that was pretty intense and overwhelming. Why don’t we talk about what happened?” I know that many of the experiences women write about are through the eyes of a scared woman in labor but it just doesn’t seem fair to say they don’t happen.

        • Bombshellrisa

          I don’t know that most doctors or nurses have enough time to sit and listen to a patient talk about how they are feeling. I was so upset and triggered after giving birth that I couldn’t lay down on my back, I kept curling up into a fetal position (even two years later as I would try and sleep at night)-but talking with a nurse who came in to check on me or even my doctor about what had happened just didn’t happen.

    • thepragmatist

      This.

  • Mel

    On a related idea, how exactly would a medical professional get consent for every different technique required during labor and delivery?

    I’ve never given birth, but I’ve been through pelvic exams. For my first one, my GP explained to me what she was going to do before starting the exam. During the exam, my doctor gives me updates about what she’s doing – “Ok, I’m starting the pap smear. I’m gonna do a bimanual exam now.” I don’t want to have to give verbal consent for each of those….that’s just stupid.

    One time, I let an intern do my pap smear. She was a bit too vigorous with the brush and I started bleeding. (What I saw/heard/felt while staring at the ceiling and making my grocery list – Intern: Oops! Dr. A: Let me take a look…. string of doctor-ese with the word “os” every now and again…..Melinda, you are going to have some more spotting than usual after this exam. Me: *stifling a yawn* Gotcha.”

    Was my GP supposed to tell me exactly what had happened, what she was planning to do and ask consent again before she checked on the minor cervical bleeding? I hope not.

    • Zornorph

      I know it’s not really the same thing, but about 10 years ago, I had to have a hernia fixed. I wound up going to 3 different doctors (one in the town that I was vacationing when it happened, my regular doctor and then a specialist) and just got used to my balls being played with. So when they were prepping me for the operation the nurse started up with ‘May I shave you and…blah, blah, blah?” I was just like, ‘Do what you need to do, go to town on them, as long as I get happy balls at the end of the day, I don’t care what you do.’
      I would assume most women don’t mind some discomfort in that area as long as it’s in aid of a healthy baby. Not that this excuses medical staff who are needlessly rude and intrusive, but I just can’t see that most in that position would be deliberately trying to cause distress in their patient. Unless you were a sadist, what would be the point?

      • AllieFoyle

        I think though, that it’s often possible to cause distress without intending it or even comprehending that the thing you’re doing could be upsetting or traumatizing to the patient. Particularly if no attention has been given to that aspect of treatment in your training and your own experience has normalized it as just part of a process, you may not even have an awareness of the potential effect on the patient.

        • attitude devant

          “Particlularly is no attention has been given to that aspect of treatment in your training….”

          Sigh. How much DO you know about medical education? Now I happen to think my med school was particularly good, but one aspect of my training seems to have been shared by all my colleagues from other medical schools: we were all explicitly taught to remember the experience of the patient in our care. The topic was given much weight in nearly EVERY course we had, AND we were evaluated on our sensitivity in every rotation.

          • AllieFoyle

            I find your attitude insulting. I have been treated by many different doctors and hcps and, in general, I believe they were well-trained and considerate. The exception has been with obstetrical care, which I think is approached differently, perhaps because it is viewed as a “natural process”, perhaps because it only involves women… I don’t know. My opinion is that providers sometimes ignore the psychological and psychosexual aspects of the experience because they have been trained to view it as non-sexual, even though the patient may not experience it that way.

          • Dr Kitty

            My medical school did a whole 2hr session about consent, propriety, chaperones, boundaries etc at the start of the gynae rotation- which was before anyone was taught HOW to do a gynae exam, and when THAT happened everything was gone over again.

            The teaching about intimate examinations is actually very good. Most OB/Gyns are women. They get it.

            Personally, it makes my day if a patient says that the smear I’ve just done was the easiest ever, or less bad then they thought, or more gentle than they were expecting. Who doesn’t want to hear that kind of feedback?

            I’ve been in A LOT of delivery rooms and nobody ever just did a VE without asking if it was OK.
            In an emergency it was usually phrased “I need to examine you now, OK?” rather than “Is it ok if I examine you now?” but it was always done.

          • attitude devant

            I am amused that you wouldn’t think I would be insulted too. When your career is all about sex and reproduction and someone asserts you have no training in sensitivity to these issues? And that I was trained to see reproduction as non-sexual? The idea is ludicrous on its face.

          • AllieFoyle

            Stop making it personal. I’ve never referenced your care or training specifically; in fact, everything I’ve read that you’ve posted here speaks to the fact that you are most likely a kind and sensitive provider and have nothing but the best intentions for your patients.

            Upthread someone posted about friends’ experiences–not knowing what was being to their genitals, strangers walking in during sensitive moments–and her fear that a similar situation might be triggering for her. I am not suggesting that what hcps do is routinely or intentionally cruel or insensitive, only that it has the potential for psychological harm and that I think it is often not recognized or adequately addressed.

            Another example: was it you who posted recently about a brazilian patient who wanted a MRCS but you denied her one because TOL was standard protocol? That experience may have caused her legitimate psychological harm that you neither intended nor understood– you simply weren’t trained to consider or appreciate that aspect of her experience.

          • AlisonCummins

            AllieFoyle, I’d be careful about assuming the only reason things you disagree with happen is that people are “not trained.” If you are smart enough to know that something isn’t nice without having been specifically trained that it isn’t nice, then there is no reason to assume that someone with overall much more training than you have doesn’t know things because they haven’t been trained.
            It’s more helpful to speculate or ask questions about why things that aren’t nice happen, or why people who should know better (who do know better) do not-nice things, than to assume that you know the answer and that it’s “you were never trained to be nice.”

          • AllieFoyle

            But I don’t believe that it comes down to being nice, particularly. If your training has led you to view L&D as a mechanistic process without much emotional valence or potential for psychological harm, you could have all the respect in the world for your patient, but still cause her harm because you fail to appreciate her perspective.

          • Dr Kitty

            And the training specifically DOESN’T MAKE YOU VIEW IT THAT WAY is the point.

            The training, over and over is that this is a scary, intimate, painful, private experience. That it is important to be kind and respectful. That personal boundaries are being crossed. That previous bad experiences might be triggered. That you can cause trauma.

            That IS the training today. I’ve done it.

          • AllieFoyle

            That’s great. How recently were you trained?

          • Dr Kitty

            Hmmm…medical school OBGYN would have been 2004, so really, not that recent.

          • AllieFoyle

            It sounds like things are changing, which is good, though I’d consider med school in 2004 still pretty recent. I’m probably a few years older than you, and things like routine episiotomies and forceps/vacuum deliveries were pretty common not that long ago. The scenario described by a poster above–having some people walk in, cut you without asking or often even telling you, insert an instrument and then pull the baby out without any regard for your feelings of horror, fear, shame, or violation–was a common one until very recently. In fact, I’ve read plenty of contemporary accounts that make it sound as though there are still plenty of places where things are done this way. This may be an efficient way to deliver a baby; you may be able to excuse it as adequate medical care, but you will never convince me that it is a humane way to treat the woman, and that it doesn’t often have negative effects on her well-being and mental health.

          • attitude devant

            AllieFoyle, please revisit your posts above. You asserted there was no training in these issues. I replied that such training was universal. You then informed me that you were ‘insulted by my attitude.’ I then replied that I was amused by your response. Now you tell me I’m taking things personally.

            I think there are plenty of examples above that refute your assertion that such training DOES take place. So then let’s get to the heart of the matter: why do we have these stories? If we agree that such training does take place (because it most certainly does), then what is going on in these situations? Let’s have THAT conversation.

          • AllieFoyle

            Ok, let’s have it.

            You assert that training about the potential for psychological trauma during obstetrical care is universal. If that is the case, what are the universal care standards used in order to avoid it? Why are some women treated respectfully and informed and consented before every procedure/exam, while others are not? What is done to determine if a woman has suffered psychological trauma during L&D? What sort of treatment is offered if so?

            My feeling is that the potential for trauma is often simply not recognized, and this results in a situation in which a provider may believe he or she is treating the patient respectfully and following the standard of care when he or she may actually be causing psychological harm without intending or realizing it. As in the case of the brazilian woman requesting CS– her treatment may have been fine by the standards of care at the time, but it may also have caused her grave emotional harm.

          • attitude devant

            All good questions. Is this a perception issue rather than a reality issue?

            It’s interesting. I often review my patient’s experiences with them at follow-up visits. I ask what they remember and a lot of times they don’t remember a heck of a lot. Sometimes they ask me about things that happened during labor that they didn’t understand, and it’s not that these things weren’t explained and that they didn’t give consent, but that they were ?overwhelmed? or just were trusting me in the moment but are now trying to put pieces together? I think that, as in most things, there is a variety of experience.

          • AllieFoyle

            Of course. We can only get at reality through perception, and of course peoples’ will vary with their psychological makeup and backgrounds. My point here is not to prove that hcps are routinely treating women poorly. I think that anything in obstetrics approaching the sort of predatory, criminal act we associate with the word “rape” is vanishingly rare. My concern is that there is a general lack of appreciation for the psychological consequences of the childbirth experience and that more could be done to ensure fewer women have this type of experience as well as to help those that already have.

        • Young CC Prof

          No, doctors are definitely trained to be courteous to the patient if at all possible, and behave respectfully even towards unconscious people. Yes, if you’re bleeding out, they might have to manhandle you and cut your clothes off, but as far as possible, they tell you what’s going on and ask permission before touching.

          Of course, some people get upset by things that, well, wouldn’t upset most people. Doesn’t mean they’re crazy, just that you can’t please everyone. It’s impossible to speak without offending someone, it’s impossible to prepare a meal that no one will be allergic to, and it’s impossible to provide urgent medical care to intimate parts of the body without making at least some patients uncomfortable. In all three cases, you should listen to people to try to minimize the problem.

    • attitude devant

      It’s not so difficult: you just talk to her. You explain what you are recommending. You encourage her to tell you if it hurts, you apologize. It’s just basic human interaction.

    • guest

      well, as an actual rape survivor, I’m perhaps a bit more sensitive than most to these gyn things. Pap smears and pelvic exams, no big deal, but more invasive things do make me nervous. when I was pregnant i was quite fearful that a whole lot of things might go down in my genital area during my L&D without my consent (was especially afraid of an episiotomy without consent and bunches of different people’s hands inside my body, especially if it wasn’t my doctor whom i had a relationship with). what I wanted? just to have someone say what they were doing so that I wouldn’t feel violated (not birth raped – what insanity – but violated). so it wasn’t so much consent that I wanted to give as much as just wanting to not have a bunch of people doing things to me as though i wasn’t there.

      so i asked that if possible during delivery they take a moment to (1) get my attention (b/c I thought i might be a little preoccupied with the whole intensity of the situation) and just simply say, for example, “we’re cutting an episiotomy because…” or “now I’m going to reach my hand in to….” or “I’m injecting lidocaine,” “now I’ll stitch up your tear,” etc. if it was an out and out emergency, I knew all bets were off and that in that case, if I had trouble psychologically later, I could seek therapy to get over it, but barring an emergency was hoping for a little more info than I’ve been told that my friends were provided, and which they didn’t really feel ok with, although it didn’t bother them as much as I thought it might me, given my history.

      All of it, btw, ended up being for naught as I failed to progress after induction and ended up with a c-section.

      • FormerPhysicist

        This puzzles me so much. Not because of what you wanted, but, because, in seeing well over a dozen gyns during my lifetime, this sort of announcement has ALWAYS happened. I get those explanations during routine care, and also have during fairly urgent care during labor or miscarriage.

        I have never experienced a flat out dire emergency with scores of people running into the room to save me, but you explicitly exempted that situation.

        • guest

          I honestly didn’t know what to expect. And when I spoke to a couple of friends who delivered in the same hospital, they talked about doctors walking in and out while they were pushing without acknowledging them on entrance or exit and a complete bafflement as to what had happened genitally. Did they tear or have an episiotomy? they didn’t know – no one told them. also when they got stitches they were done without a word (probably in an attempt not to disrupt the first mommy and baby moments, but still, for me, i knew I wanted to be informed b/c I knew it would freak me out to just have things done to me in that way, even if with good intentions).

          i agree, in most of my gyn dealings, this has always happened. i’ve felt informed. but the sheer numbers of people involved in hospital birthing a baby made me nervous that if I didn’t make clear my vulnerabilities, I might end up triggered and have extra issues to deal with on a very important day.

          • FormerPhysicist

            If you need something, it’s good to state it. If it’s solidly part of standard of care, that just makes it easier for the doctors to provide.

          • Sue

            Agreed – and also to ask questions if you want to know something.

          • Nashira

            This is long because I am trying to phrase this delicately, and please understand that it’s rooted in my own experiences with being severely ill (and almost admitted to hospital last night, fml). I sometimes wonder how much people may not realize that what we remember of scary, painful, upsetting experiences, and what actually happened, are not the same thing. And that sometimes, you can get the best, most caring, most considerate providers in the world, and an experience will still be traumatic. There is no way they COULD know this, without prior experience with being sick, so please understand that I blame NO ONE for this: I empathize a very great deal, because I had one of those brilliant-care-but-traumatizing experiences after jaw surgery. I still get flashbacks and then nightmares when I hear heart monitors and smell ‘hospital smell’.

            Plus… I’ve been to the ER twice this month, thanks to tentatively diagnosed yesterday ulcerative colitis fml and extremely bloody stools and (in percocet-provided retrospect) holyshitpain. The only reason I know specifics of what occurred is because my husband was with me, and we made certain that every healthcare provider knew that I needed him to hear or be told everything important they told me, because I knew I wouldn’t remember. Not clearly. I was too busy being terrified, wrestling with my hospital phobia, in pain, very nauseated, dehydrated to the point of mental impairment, and then blessedly high as a still in pain kite on morphine and groggy from Zofran, and thirsty since NPO, no ice chips allowed, sucks even with a bag of saline. He was just terrified for me, so his brain worked better. I know they consented me before touching me, I know my nurse listened very closely when I explained the details of why I had the phobia, I know they actively avoided my biggest two triggers, I know they actively managed my fear regarding my current illness, and I know they patiently explained things two or three times when it was necessary, before the pain eased up and I could think more clearly. I know this because he told me, not because I remember. He knows to tell me because this isn’t our first rodeo.

            I am only able to be so calm about knowing I
            don’t remember because I’ve had years of severe pain from atypical trigeminal neuralgia, thanks to that jaw surgery, and occasional pea soup mental fog from the meds. It took me most of those to get to the point where being told that I most certainly WAS told something, and here’s proof, did not make me feel like I was losing my mind and going bad crazy. I have coping skills built up, with multiple fail safes, and
            taking my husband w/ me to doc appointments is a major one. If last night had happened several years ago, I would be having panic attacks today from not remembering and I would be convinced I was not treated well at the hospital, since I don’t remember most of the copious considerate interactions, I just remember being so thirsty and not allowed to drink or eat, and wanting to vomit from pain after every butterfly wing gentle exam of my abdomen.

            BTW if anyone is in the mid-Missouri area in the US, Capital Region is utterly and completely fabulous, with the best nurses and gentlest, kindest doctors I’ve seen in ANY of the six or so hospitals I or a loved one have been in, across two states and DC. Beats the pants off St. Mary’s, and not just because it’s NOT a Catholic hospital. I’m sending them a letter of thanks,
            copied to everyone important at the hospital, in addition to apparently having gushed to my nurse as she gently started a huge IV in my hand, where the good veins are. They are rockstars.

        • AlisonCummins

          FormerPhysicist, your experience is quite close to mine.
          I’m wondering: I used to read blogs by ER docs. There were a bunch of them venting their spleen because they provided charity care to people who behaved badly and weren’t grateful. Is it possible that in *some* county hospitals in the US, *some* medical professionals are frustrated with their poorly-educated, defensive patients who they consider to be receiving charity, *and* that this attitude is tolerated by their peers?

          • FormerPhysicist

            Perhaps. But I’ve seen well over a dozen gyns in 5 US states and this has been consistent.

          • An Actual Attorney

            Some people want more detail than others. At my nephew’s birth, my brother was a little frustrated that they kept getting told things were “medicine to help labor” or whatever – he wanted to know names of meds and specifics. My SIL, the actual patient, didn’t so much care. But bro is an engineer who is fascinated by medicine and SIL is a community organizer who focused on the damn labor.

          • FormerPhysicist

            :D

          • Young CC Prof

            Lots of people in many professions from medicine to retail remain polite and professional at work and then vent privately or anonymously later. Sure, some overworked hospital staff behave badly, but most do not.

          • Nashira

            I work at a work comp insurer, handling calls from treatment providers’ billing or collections folks wondering where their money is. Even in the face of abusive, screaming people, we are utterly polite and bend over backwards when working to resolve their problem. Then we hang up the phone, stand up, and go vent to a coworker using colorful language until we calm down. We aren’t trained in dealing with upset people while remaining calm, and were all left to figure it out on our own. We still manage to treat them as we would want to be treated and then go vent our own upset in a safe space, where the customer can’t hear.

            If we can do that in a call center, don’t you think that doctors, trained in providing care to terrified sick people, can’t do the same thing? Don’t judge the way someone is at work based off the way they vent to handle the stress.

      • Amy M

        This is what they did for me, and I didn’t even ask. It should be standard of care, though I could see how it could be overlooked in an emergency (or if the patient is not conscious.) But yeah, they always said “now we’re going to do xyz, ok?”

        • guest

          i was told by two friends that that did not happen when they gave birth in same hospital, with same OB practice. it frankly terrified me. so yeah, one would hope, but i didn’t want to assume when the emotional stakes felt high to me.

          • Amy M

            Oh I understand that it doesn’t happen everywhere, just saying it should.

          • guest

            agreed.

        • me

          That, unfortunately, did not happen with the delivery of my first child. An episiotomy was cut without warning or consent (I had an epidural, I was fairly calm, and there was no emergency… still not sure why he cut me). The cut extended and caused a pretty horrible, long recovery. Yes, I was angry, for a long time. We moved out of the state it happened in about 6 months later, so by the time I even reflected on it enough to realize there was a legitimate complaint to be made, it seemed like too much trouble, and besides, it is totally he-said, she-said. All he has to claim is that he thought it was “necessary” and point to standards of care or whathaveyou that leave that sort of thing up to the doc. As a layperson, what are you really going to do?

          It is ‘emasculating’ in the sense that you feel like a powerless child. His actions turned me towards the ‘woo’. Thankfully I opted for a hospital birth with my subsequent children, but I did have CNMs and insisted on no medications (the worst part was the feeling of powerlessness – even if I had known he was assaulting me, I wouldn’t have been able to get up and fight back). Things went beautifully the next two times. No episiotomies. But more importantly providers who didn’t do anything to me without my knowledge or consent.

          At any rate, I agree that ‘birth rape’ is the wrong term. But I also relate to the, for lack of a better word, *icky* feelings associated with knowing someone did something to your most private bodily parts without your knowledge or consent. Assault seems to benign a word for it.

          I wish there was a better word for it. Actually, I wish these things didn’t happen in the first place.

          • Karen in SC

            The doctor should have informed you about the episiotomy. Though I would like you to consider that your subsequent children could have also been “episiotomy-free” with an OB as that is the usual experience. I had an a cut with first child and didn’t like the pain, then the itching. With my second, I was able to push just twice with no episiotomy.

          • me

            The episiotomy extended to third degree. I should have been more clear on that. There was more than just ‘not liking’ a little pain and itching. There were longer lasting effects. But that’s neither here nor there. I could have accepted what happened, but the lack of consent, the total failure to tell me what he was wanting to do and the opportunity for me to accept or refuse it was more the issue here.

            No. What happened to me wasn’t “rape”. But “assault” (well, really battery, as assault is the threat, battery is the act) seems too benign a term. When you place yourself under the care of a medical professional, you are trusting them with your very life (and, in labor and delivery, the life of your child). I’ve been the victim of battery before (crazy, intoxicated acquaintance sucker punched me at a party – apparently I said/did something she didn’t like). It wasn’t nearly so personal and certainly didn’t traumatize me in any way. Then again, I didn’t place my trust in some crazy bitch at a party, you know? And I was no worse for the wear (a black eye for a few days, no long lasting damage).

            Maybe abuse is a better term. It’s certainly closer to the reality. A trusted person in a position of power causing harm to someone in a very vulnerable situation. Though, that obviously isn’t a crime by legal definition (it would be obstetric violence, akin to domestic violence). But it certainly seems to do a better job of getting the message across of how despicable these actions are.

            As far as whether I could have used a different OB with my subsequent children, without fear of being cut, well, I wasn’t willing to take that chance. With my second child I had seriously considered homebirth. Fortunately my husband was totally NOT onboard and I was aware enough to know that we were too far from a hospital for it to be anywhere remotely “safe” (not to mention insurance covered 100% of hospital delivery, HB would have been totally out of pocket). No, using a CNM over an OB was not a perfectly “rational” choice, but after what had happened I wasn’t feeling particularly rational. I just wanted to do whatever I could (even if only in my own mind) to prevent such an abuse from occurring again.

          • auntbea

            How did you find out about the epi? Did he tell you later? Did your husband see it? I believe you; it just seems so strange that a doctor would do that without even telling you. It’s not like telling you would have cost more than 5 seconds.

          • me

            My husband and my mother were there. The doctor only told me that I had “torn to the rectum” while he was doing the repair. It was a comment my husband made later (about watching the doc cut me being the hardest part for him to witness) that tipped me off that I hadn’t simply “torn”. I corroborated this with my mother (she’s a nurse, I knew she knows damn well what an episiotomy is and couldn’t have mistaken anything else for it).

            That’s when I started to get really upset about what had transpired. Of course, this was well after the fact, I’d even already had my 6 week check up :( I still can’t believe the doctor not only said nothing about it at the time, but then basically lied about what happened. Hence the lack of trust for OBs with my next pregnancy. And I had such a wonderful (complete 180) experience with my CNM that there was no question I would go with a CNM for my third child. I don’t plan anymore children, but I will strongly encourage my daughters to seek out CNMs if/when they have their babies!

    • AlisonCummins

      I think there are different ways to get consent, much of it implied. From the stories I’ve read one complaint seems to be “the nurse came into my room, stuck her hand into my vagina without looking at me, and left.” Just because in the same circumstances I might simply be upset because the nurse was being a dick, especially if I had someone with me, doesn’t mean that the strong feelings of violation another woman might experience — perhaps a woman from a very sexually restrictive culture labouring alone — are somehow invalid.

    • fiftyfifty1

      Bleeding is super common with pap smears and is not a sign that your intern was doing it wrong/too hard. How much a woman bleeds depends on her age and estrogen levels (young woman+ high estrogen level at the time=bleeding). I remember the first time I did a pap and a woman bled. I was a student. I did the same thing: slight moment of panic, and then had my supervising doc look at it.
      Thanks for being such a mellow patient. Patients like you were gold to me when I was a nervous trainee.

    • Sue

      Mel – in many other areas of health care – people entering hospital give a sort of overall consent for all the procedures that are required as standard management of that condition. There would be separate formal consent processes for invasive tests/procedures and things like blood transfusions.

      SO generally I agree with you – most people sign up for the standard package of ”whatever you think needs to be done in this situation.”

      That doesn’t mean that clinicians shouldn’t inform along the way, and confirm that the person still consents to care. But it;s also not a very constructive relationship for the person receiving health care to refuse necessary procedures – even routine procedures – just because they find them unpleasant.

      A woman with true PTSD or some other trauma related to sexual penetration really needs a good agreement with her health care team well in advance of labor.

      As in most circumstances, the key is good communication. But health care providers, being human, can occasionally come across as terse or uncaring. That doesn’t make them rapists.

  • Zornorph

    I suspect what those who push ‘birth rape’ don’t realize is that by using such a ridiculous term, they actually cause less people to take them seriously. It sounds like a joke.
    On the other hand, would Ina Mae be guilty of real birth rape, since she touches the private parts of women with genuine sexual intent during labor?

    • Mel

      Based on excerpts of Ina Mae’s book, I would have pressed charges against her if she fondled me during labor.

  • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

    THANK YOU.

  • attitude devant

    Thank you! This is wonderfully cogent and compelling.