When healthcare professionals cause birth trauma
Tomorrow marks the beginning of the 16 Days of Action Opposing Violence Against Women which is from 25th November- 10th December. I thought now would be a fitting time to share my experience with an often overlooked and normalised type of violence against women, obstetric violence.
What is Obstetric Violence?
Obstetric violence is abuse by a care provider that may leave a person feeling dehumanised, disrespected, physically or emotionally traumatised, violated or humiliated. It is often a cause of what many people refer to as "birth trauma." Obstetric violence may occur during pregnancy, childbirth or the postnatal period and can manifest in many ways, including:
Verbal humiliation
Disregarding a labouring person's needs and/or pain
Physical violence
Invasive practises
Forced or coerced medical interventions
Unnecessary use of medication
Denial of treatment
Other dehumanising or rude treatment
No Consent is Violation
My encounter with obstetric violence occurred during my second pregnancy. My consultant in hospital in the United States and I had discussed my birth preferences at an antenatal appointment and he signed off on them. He knew I wanted a low-intervention, vaginal birth. I asked that my membranes not be stripped, my waters not be artificially ruptured, no labour augmentation, etc. and we had discussed these things.
My last antenatal appointment was on a Friday, one day before my baby's "guess date." The nurse noticed that I was "due" the following day and asked if I would like to schedule an induction for Monday. I politely declined and awaited the arrival of the obstetrician. When my doctor entered the room, we went over how I felt physically and emotionally. I consented to a vaginal exam to check the state of my cervix- whether it was effaced (thinning) or if I was dilated at all.
I laid down on the exam table and my doctor began performing the vaginal exam. My husband sat in a chair in the exam room with me and I looked at him as the exam was performed. I'd had vaginal exams before, both during my first pregnancy and my current one. I remember there was suddenly a lot of pressure and discomfort during the exam that brought tears to my eyes. As my husband and I locked eyes, he saw and acknowledged the pain I was obviously in. When the exam was over, I sat up.
My doctor said "Here at the hospital we normally don't like women to go too far past their due date." To which I said, "I understand that. That's why next week I thought maybe if I felt comfortable, I might consider a membrane sweep." He looked at me and said as if it was nothing, "Well that's what I just did."
I was speechless. I consented to a standard vaginal exam for cervical dilation. I DID NOT CONSENT to a membrane sweep! For those who may not know, a membrane sweep is when a healthcare professional inserts one or two fingers into the vagina and up past the cervix. Just inside the cervix, they circle their finger around to separate the amniotic sac (which is holding the baby) from the base of the uterus. In doing so, it is believed there is an increase in the production of prostaglandins in the mother which may help the cervix thin and dilate. As with any type of intervention, there are risks to performing a membrane sweep- pain associated with the procedure (as I felt!), an increase in irregular contractions, bleeding, cramping, a healthcare professional may accidentally rupture the amniotic sac (this happens with approx 9% of people), it increases the risk of infection for mum and baby, etc.
This is an instance of obstetric violence because my consent was never given for the procedure. My doctor never explained the possible benefits, risks or alternatives. He never asked whether I consented to the membrane sweep and had he, I would have said NO. I had already written in my birth plan that I did not want a membrane sweep, so I will never understand why he thought it would be okay to perform one!
My doctor also had no clue that I am a survivor of sexual assault. Inserting his finger into my vagina, past my cervix and into the base of my UTERUS without my consent was assault. It brought back many of the feelings of violation I felt in the past after being sexually assaulted. I was too distraught to say anything at that appointment but I expressed my shock and horror to my doula at the time by contacting her before I even made it to my car. The stress that this situation created at the end of my pregnancy is hard to describe. I was grieving the loss of trust I had with my healthcare provider while also having detailed memories of my sexual assault. I was drowning in a cocktail of betrayal during the end of my pregnancy when I should have been relaxed and reassured while joyfully anticipating the birth of my child.
What happened to me is sadly, not uncommon. There are thousands of stories from women who have had their membranes swept by midwives and doctors without their consent. I encourage women to have a frank discussion with their medical providers about this issue. Mention it at every.single.antenatal.appointment, especially if you are having a vaginal exam. Alternatively, you have the right to refuse vaginal exams so there is zero chance of this happening.
I have shared my story at numerous gatherings surrounding pregnancy and birth. Many people find it hard to believe or gasp at the point where my OB said "Well, that's what I just did." Obstetric violence is real, it does happen and it creates trauma for expectant parents and their families. As with all violence against women, we need to raise awareness, we need to support one another and we need to take action.
To learn more about obstetric violence, please see here.
