Abuse, coercion & violence. 3 Things that have no place in the labor room.

Violence, abuse & coercion in the birthplace

As a mother who has given birth four times and a doula who has attended dozens of births, I have seen and experienced my fair share of violence, abuse and coercion in the birth room. This is not a blog to make you fear your care providers or the hospital system, we are fortunate to have many wonderful providers and hospital staff in our area. But rather to raise awareness of the things that can and do happen, so you can prepare yourself and find ways to reduce your chance of these things happening to you. To give you warning signs that your provider may not be on board with your plans, to help you ask the right questions and find your voice.

The birth of your baby is a once in a lifetime event. It is something that you will remember for the rest of your life, and a story you will share many times over. When care providers, nurses and other hospital staff do and say things that are seen as traumatic or just down right wrong, it can ruin what should be a happy and joyous time. You deserve to birth your baby with confidence, respect and support. Noting less than those things are acceptable. While this is their normal day in and day out and routine, that doesn’t excuse their actions or words for your once in a life time experience. My hope is that you will arm yourself with knowledge and find the right care provider and birthing place for you. Names of women, care providers, hospitals, staff and locations have been omitted.

 

 These are my personal birth stories.

With my first child I was very young. I went to a care provider that my parents found for me based off of other’s suggestions. I truly believed that I had no say so in anything. My pregnancy was uneventful and most of my appointments were by the book. At my 40-week appointment I was prepped for another cervical exam to see if labor was near (which I now know that your cervix is not a crystal ball, and no one can tell you when labor will start by checking it, it’s just an educated GUESS. Nothing more). During the exam I realized this was taking much longer than previous exams did and then I felt a swirling motion of my care providers hand inside of me. It took everything I had not to jump off the exam table and I let out a whimper. My doctor said “there, now if labor doesn’t start over the weekend you will come in Monday morning at 5am for an induction.” And then left the room. No discussion about what he had just done to me or why he thought labor would start over the weekend. Definitely no discussion about the induction. He just told me what was going to happen. I didn’t know to ask any questions either. I later realized this man had given me a membrane sweep without my consent or knowledge of this mechanical induction technique. I went in Monday to be induced which started with AROM, or breaking of my waters, and instructed to not get out of bed at all. This was when Friedman’s curve was still in place, so dilation was expected to be 1cm every hour. I “stalled” at 5cm for 2 hours so Pitocin was started without any discussion of other options (walking, changing positions, nipple stimulation, etc.) This of course led to my request of an epidural.  It worked way too well. Pushing took 2.5 hours and resulted in vacuum extraction and 2^nd degree tears to my perineum. My doctor stitched me up and decided I needed an extra stitch, also known as the husband stitch. Again, there was no discussion of any of this. Later on, the nurse insisted I get out of bed to use the restroom. Even though it had been over 6 hours since my epidural had been shut off and removed I still was extremely numb and explained that I could not feel my legs, there was no way I could get out of bed yet. The nurse demanded I try anyways, she sat me on the edge of the bed and lifted me up. I immediately fell into the floor and she could not help me up, it took a second person to get me out of the floor only hours after giving birth. I’ll let you imagine the kind of bloody mess that made.

With my second child I endured a cesarean section because of her footling breech presentation. That was an experience I wish on no one. I had never felt so alone and scared. The anesthesiologist was not thrilled that I came in so late in the day in labor and required a surgical birth. He was brash and cold to me. He was sitting near my head, so I tried to ask questions about what was going on and he ignored me. After my daughter was delivered and taken to the nursery I began to shake uncontrollably, and I simply asked if this amount of shaking was normal. He responded with “Here is something to help” and injected a mystery drug into my IV line. Within minutes they were cleaning me up and taking the drapes off when a nurse screamed “OH MY GOD”. Because that’s what you want your medical team to shout when you are still on the OR table. I was allergic to this mystery drug and had broken out in hives from my neck to my feet. I began to hyperventilate from the fear that something was really wrong with me, finding comfort in looking at the machine by my head that showed my vitals. I wasn’t crashing so I was going to be ok right? Luckily that was the end of my allergic reaction but for many people their reactions are more severe. This mystery drug is no where in my medical records, even nurses couldn’t find out after the fact what he had given me, so we simply guess at what my drug allergy is. There is also NO information or notation of my allergic reaction in my medical history or the surgical report that I later recovered from the hospital.

With my third child I was planning a vbac and at 38 weeks she flipped frank breech and after an ultrasound confirming this my husband and I met with one of the doctors in the practice to discuss options. The u/s tech told me there must be something wrong with my anatomy to make my babies be breech (but my first was vertex, so…. what!?) and the doctor agreed. I begged for the chance to give birth vaginally and he reluctantly agreed to schedule a version the following week in attempts to turn her vertex and then left the room. I was already in tears and felt completely defeated and broken with no hope from this physician. As we left the room I saw him talking to a nurse telling her to schedule a version and book the OR at the same time because it was going to just end up in a repeat cesarean section anyways. I cried even more. How could he be so cold and just not care about me or my birth? I was enraged as well. I did my own research and thanks to spinningbabies.com and my recliner, my 8lb; 38 weeker flipped vertex and within 48 hours of that appointment I had gone into labor and birthed her VAGINALLY despite being told that I wouldn’t.

With my fourth child I planned another vbac. I was even more confident in my body by this point and had started to find my voice more and more. The only issue I had with a provider was around 32 weeks when a doctor I hadn’t seen before tried to tell me a RCS would be safer than a second vbac (wtf?!). I immediately stood up to him and let it be known that I was not planning a RCS unless it was very medically indicated and that I had done my research and knew I could vbac AGAIN. And I did. I never saw that Dr again either.

As a doula I’ve attended dozens of births. Most of them are beautiful and empowering and everyone involved is great and supportive of the mother’s wishes. But not always, sometimes care providers or nurses are just not on board for whatever reason.

I’ve witnessed care providers force cervical exams on women who do not want them, the women even yell “stop” during the exam but the provider continues with the exam. Telling the woman to “hush” and “it’s not that bad”.  Nurses that lie to women and tell them they are extremely high risk because of their choice of vbac (this alone is not a reason to be considered high risk). Anesthesiologists who berate women who choose to vbac, telling them that their “placenta will explode” (this one I’m sure he meant uterus would explode but he was so red eyed and acting odd it doesn’t surprise me he couldn’t articulate well). Or blaming a woman’s prior history of substance abuse for why her epidural wasn’t working and that the pain she felt down her legs was all her fault and nothing he did could hurt her. Women who are told that CPS will be called and probably cause them a bunch of trouble for not giving their baby the vitamin K shot or eye ointment despite having NO LAW that says to do this. Hospital policy is not law. (IL actually just made it so that DCFS will do NOTHING because it is a parent’s right to refuse things for their child. If you are in IL and would like more information about this, please contact us). Women that go to their midwife/doctor appointments and are forced to see someone besides their primary care provider and are bullied, belittled and made to feel like they are nothing more than an incubator for their child. Women being told that they have no say so when it comes to testing, induction, pain medication during labor or having an episiotomy or cesarean section for no other reason than the DOCTOR SAID SO. A lot of women tell me how when they questioned their care provider about something (let’s say mom is looking at a medically needed induction but wants to do a less risky method like a Foley balloon instead of Cytotec) and is met with hostility and told that their choices WILL lead to the death of their baby. So, they better just listen to the care provider. If a care provider says things have to be done “their way”; RUN. This is not how care providers are taught to treat women. Fear mongering and coercion by care providers is NOT supported by ACOG, yet a lot do it anyways for a multitude of reasons.

Wouldn’t you think calm conversation about risks and benefits would yield better results? And leave moms more satisfied with their care provider and overall experience?

Other doulas on our team have witnessed abuse as well. Even mothers who have been abused and coerced have asked to share their stories in hopes of shining a light on this sensitive topic. Following are their stories…

One doula has witnessed a care provider who poured a bottle of baby shampoo INTO a woman’s vagina before baby was even crowning because the doctor “likes to wash baby’s hair before they come out”. The baby was born with soap suds on it’s face. This mother went on to have 5 UTIs and yeast infections in the immediate postpartum time.

Another doula had the horror of witnessing a forced episiotomy. “Mom was a primip (first time mom), with a perfectly textbook labor. He started fussing about a c-section early on. The nurse- saint. Kept him at bay and pulled me out in the hall to pep talk and make a game plan together. Anyway, time to push. She said repeatedly no episiotomy. But that doctor jacked the bed up so high we couldn’t see what he was doing. He ninja-ed an episiotomy. I knew what happened when I saw the bloody scissors go by. She had an otherwise great birth. I could have said nothing, but I couldn’t. I felt she needed to know. She was mentioning pain after and I had to explain why. Because he had cut her with her explicit refusal.”

Stories poured in when I asked for some for this blog. If I shared each of them in full length we would be here for quite a while. This blog would never end honestly. Many women get bullied into cesareans because doctors suspect (because ultrasound is very inaccurate for weights the further along you get, it’s an estimated guess at best) a “BIG” baby. Or women are bullied into MULTIPLE cesareans because they had one in the first place. Doctors are quick to tell you the *small* risks of a VBAC but do not talk about the not so small risks with repeated surgery on the same organ. Women who are not informed of episiotomies until after it has happened, or pitocin and other drugs given without true informed consent. Doctors are not required to keep up with the latest research and trends for evidence-based care, and new information is coming out EVERYDAY. It takes almost 20 years for new information to become the norm, so by time it is the norm – it’s well out of date again. If you find a care provider who does research and stays up to date on the latest evidence-based care suggestions and guidelines – keep a hold of them! They are GOLD!

One mom writes, “Sadly, the memories that I have of my daughter’s birth are mostly negative. I struggle to think of anything positive from that week in my life. Despite taking childbirth and breastfeeding classes in preparation for her birth and making a birth plan, nothing went the way that I thought it would. Looking back now, I can say that I didn’t prepare myself for all of the possible outcomes, because why would I want to think that anything wouldn’t go according to plan? At my 38-week checkup, I was told that my blood pressure was elevated, and I was being referred to the hospital for induction. As a first-time mother, this alone made me nervous. I arrived there at approximate 2pm and was admitted. That evening, staff debated at whether I could eat an evening meal or not and they finally decided that I could. At 10pm that evening, they began my induction with a dose of cervadil. The following morning there was still no dilation, but rather new swelling and pain in my cervix, so it was discontinued, and Pitocin was begun. The Pitocin started out well. I felt contractions begin and I finally began to dilate. I was no longer allowed to eat and was told to remain in bed unless I needed to use the restroom. Throughout the day, the contractions increased in strength and turned into incredibly painful back labor. Even though I had no intention of getting an epidural when I had made my birth plan, I finally decided that I couldn’t bear the pain any longer and requested an epidural. I began to feel relief, but before I was halfway through the dose of epidural medication, I began to feel the intense back labor begin again. I requested a second dose and like the first dose, it took the edge off, but stopped working about a quarter of the way through the dose this time. With the incredible pain returning, I requested something stronger and after what seemed like forever, I was finally given another medication which once again took the edge off momentarily. During this entire ordeal, I never lost feeling or muscle tone in the lower half of my body. At this point, I’ve been catheterized and not allowed to leave my bed for many hours and I haven’t eaten and barely slept in well over 24 hours. The doctor decides that I’m not dilating quickly enough and asked to break my waters. I consent, because I’m absolutely exhausted and just wanting to get things over with. Within an hour or so, I’m finally dilated to 9cm and things are finally looking up. Upon my next check, I’m back down to 8cm, so it’s decided that I’m failing to progress, and preparations are made for a cesarean. Things started out ok during the cesarean. I didn’t really feel them prepping my stomach for surgery. I remember being most embarrassed about my lack of grooming due to the late stages of pregnancy. I didn’t feel the initial incisions and felt “pressure” as they were moving things around. By the time that they pulled my daughter out of me, that “pressure” was becoming much more noticeable. During the examination of my uterus and removal of the placenta, that “pressure” turned into pain. I began to grimace, cry, and verbally acknowledge my pain. As they began to suture my incisions, I was requesting additional pain medication. At one point I remember the obs (I had two of them in there) ask me to lay still so that it could be over faster. I was begging the anesthesiologist and to knock me out she told my husband that I’d want to remember this since it was my first child. All I could do was force myself to try to remain still, cry, and pray that it would all be over quickly. I refused to look over at my daughter. My husband had to force my head to look at her. I drew blood from my nails digging into his skin while I was holding his hand. I have no idea if anyone did skin to skin with her. I don’t think anyone did. I don’t even remember if she was in my room when I was transferred to a mother/baby room. They finally gave me morphine and between that and sheer exhaustion due to lack of sleep and food, I remember little of that day. I couldn’t hold a conversation without falling asleep. I don’t remember eating that day, but I’m sure that I did. I had nurses in and out of my room multiple times that day to check me and make me feed her. The only memory that I can vividly remember is crying that night because the nurse insisted that I hold and feed my baby, but this time I was all alone. My family had all gone and I insisted that my husband go home and rest since he’d spent three days in the hospital with me already. I begged the nurse to take her from me and I was told no, because I needed to do this on my own because no one would be there to help me once I went home. And she left. I spent the next couple of hours crying and trying desperately to force myself to stay awake. I felt too weak to place her back in her bassinet that was pushed out of my reach and I was terrified that I’d fall asleep and I’d suffocate or drop her. Needless to say, my next experience will be different. I’ve already learned SO much since then: about the medications, about my body, about hospital policies, about interventions, and about recommended practices. My greatest word of advice to any new mother is to do your own research. Don’t rely on the sugar-coated information that the doctors and hospitals give you. Fact check. Yes, there are some very scary possibilities out there, but if you are informed of them, then you can be better prepared to handle even small things that don’t go according to your birth plan.”

Another shares her story, “With my first child I begged for an epidural. I was told I could have one the moment I walked onto the floor if I wanted. I was induced, and my platelet levels were actually in a healthy range. That was the only concern they had, but the numbers were on my side. 30 minutes go by and the nurse tells me “you’re not ready for an epidural” and chases the anesthesiologist out of the room. 15 minutes later I beg again, the pit is really kicking up the contractions. Again, she tells me it is too early and I have to wait. Another 15 minutes go by and my water breaks on its own. I go into a panic and that same nurse grabs my face, makes me look at her, and yells at me to calm down and get back into bed. Scared and panicking internally now, I get back into bed and instantly my body goes into full blown labor. I ask if I can finally have the epidural and I am told it is too late. I’m angry, scared, and in absolutely pain giving birth to my first born. I make it through giving birth to a 8lb 6oz baby. At the end a young nurse asked me if I would like any pain meds. I laughed a little and said the hard part was over, no thank you. Moments later that same nurse that grabbed my face came into the room. I wasn’t really paying attention to her, I was holding my baby for the first time. Next thing I know I am fighting sleep with all my strength. She comes over and takes my son and says, “I gave you some meds so you can rest.” Before I could say anything, I was gone. Looking back, I should have called this nurse out the moment she chased the anesthesiologist out of the room. But I was young, alone, and already terrified. This experience did set a different tone for my second birth. It just amazed me that such a hateful woman would be working in labor and delivery.”

A fourth time mom writes, “My last child I had….I unfortunately delivered her at [omitted]….it was not a good experience at all. I had been laboring for about two days and felt like something wasn’t right, so I had my husband drive me to the hospital. We get there, and the emergency OB comes in and checks me, I’m only dilated to 5 so she gives the option of being induced or going home. I did not want to be induced so I went home. Once I got there I was passing a lot of green/brown discharge and knew she was coming soon so we head back to the hospital. Same emergency OB comes in says I am now dilated to 10, she calls my doctor, he comes in and breaks my water…. which I expressed I DID NOT WANT, and then Dr. realizes I am only dilated to a 7 1/2. He’s pissed, I’m pissed and now they are telling me I can’t push. In the process of all of this they tell me I have group B strep. My doctor never told me that, so they are hooking me up to an IV for antibiotics and the nurse put the IV in my hand. I told her it wasn’t in right and it eventually slipped out, she huffed and puffed about it and then put it in my left arm at the elbow, she never took the tourniquet on my arm off. But as I’m in labor I don’t notice this, but my husband did an hour later. The awful nurse also snuck freaking Pitocin into the IV she had me hooked up to! I was furious! The emergency team had to be there to clean out my baby’s lungs as she had already passed meconium in the womb. Thank God my mother was there because not a single nurse or doctor knew how to help me not push. That’s an urge that just happens and it’s hard to not push when your body wants to, so my mother told me every time the urge came to act like I was blowing a candle out real fast, just little puff puff puff over and over. I did demand that the nurse be removed from the room and I called her a wretched [expletive], she kept telling me really stupid things and being extremely rude and she was of no help what so ever and my mom was doing an amazing job helping me. She was removed finally. The emergency team made sure of that. Needless to say, my baby came out fine and my doctor apologized to me a million times and the emergency OB did get in trouble, and I didn’t have to stay the entire 48 hours they ‘require’. I told them that was impossible, as I have three other children to get home to and this isn’t my first rodeo with a baby so send me home!!! The hospital wasn’t happy about that, but I was gone in 24 hours.”

So what are some things you can do to prevent yourself from having a similar story?

*Interview MULTIPLE care providers, starting with home and hospital midwives. Research each provider, look up their cesarean rates, ask women for their experiences (but take these with a grain of salt as everyone has different expectations and philosophies about their own births and one woman’s philosophy may be completely opposite from yours).

*Research everything, question everything.

*Ask your provider questions about any concerns or scenarios you may encounter.

*Know that YOU have bodily autonomy. NO ONE can make healthcare decisions for you unless you give them legal power of attorney over you. You have the legal right to refuse anything and everything and to ask for alternatives or more information.

*If you feel bullied, pressured or uncomfortable with the choices that you are being forced to make, don’t make them. Take the time to research and think about it. It’s never too late to switch providers either. You owe your care provider nothing. If you like them personally, then take them out for coffee instead!

*If you’ve been wronged by a care provider. Make a formal complaint with the office/hospital. It is NOT ok for women to be treated in such manners.

*Take childbirth education classes, preferably independent ones. Hospital classes are controlled by hospital policies and there are many things they must tell you and must not tell you. Independent classes can tell you all the things that you really do need to know.

*Ignore anyone who is not supportive of your birth plan (lots of moms opt to not discuss things with people who are unsupportive). Friends and family may mean well, but this is YOUR BODY, YOUR BABY, YOUR BIRTH. NOT THEIRS.

*Finally, HIRE A DOULA. A doula will support you always and help you learn about your options, provide education and help you advocate for yourself. Most doulas can help you find the right care provider since having worked with most of them in your area. A doula can help you accomplish all of these tips listed.

*all names of women, hospitals, care providers, staff and locations have been omitted to protect privacy