Experiencing Obstetric Violence: My Story
WHEN HEALTHCARE PROFESSIONALS CAUSE BIRTH TRAUMA
My experience with obstetric violence occurred during my second pregnancy. My hospital-based obstetrician in the United States and I had discussed what was important to me during labor and birth and he had received a copy of my birth preferences aka birth plan. He read it in front of me during a prenatal appointment and we discussed it. He knew I wanted a low-intervention, vaginal birth. I asked that my membranes not be stripped, my waters not be artificially ruptured, no labor augmentation, etc.
My last prenatal appointment was on a Friday, one day before my baby's "estimated due 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 see what was going on with my cervix- whether it was effaced (thinning) or if I was dilated at all. In many ways these internal exams are viewed as routine by both healthcare professionals and expecting parents at the end of pregnancy. I knew at the time that I could have declined them— and I wish I would have.
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."
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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 mom and baby, and more. They may also simply not be effective. In fact, in most cases, they aren’t! Only 1 in 8 people will go into labor following a membrane sweep, if performed at forty weeks.
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! I was never given the opportunity to decline the sweep because he never discussed it with me that day.
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. This experience immediately 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 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.
It has been over eleven years since I experienced obstetric violence. There have been two occassions in the past when I started writing a formal complaint to submit to the hospital. In both instances, I stopped and never filed it. Writing the complaints stirred up many emotions I wanted to avoid. I’m now in a place where I have decided to contact the hospital and file the complaint— although I’m not sure it will do much of anything. I doubt this doctor remembers me or what he did to me. I was just another person he violated without thinking about it. Will he even admit to what happened? Doubtful. What I am going to do is ask for an apology and acknowledgement that I was violated.
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 postpartum 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
One part of my healing has been sharing my story. Birth Monopoly has a feature on their website where people have shared their stories of obstetric violence, which is where I shared mine if you take a look at Green Bay, Wisconsin on the map.
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 people to have a frank discussion with their medical providers about this issue. Mention it at every.single.prenatal.appointment, especially if you are having a vaginal exam. Alternatively, you have the right to refuse vaginal exams at the end of pregnancy 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 when I describe my OB saying "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 so these forms of violation are not permitted to continue.
To learn more about obstetric violence, please see here.
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