April is Sexual Assault Awareness and Prevention Month and Cesarean Awareness Month.

Content warning: sexual assault, sexualization of children, birth assault, and traumatic birth

There are two traumas that happen when an assault occurs. The first is the event itself. The second is when people you trust don’t believe you about it.

When I was a young girl, a family friend sometimes babysat us and he sexualized me. All I remember is he made a couple of inappropriate comments that, at the time, my brain red-flagged as strange, but weren’t so overt that I understood what he was doing. It wasn’t until many years later that I grasped the implication of his words.

I have very few childhood memories, but these two are frozen in time for me. The only other thing I know is that I had a hatred for him by the time I was a teenager. I still don’t know why.

Years earlier as an adult, I had shared with my parents some of what he had said to me and they were disturbed by it. I’m not sure they processed it as much more than creepy, or knew what to do with it, though, and by that time their friendship with him had cooled for reasons that had nothing to do with me. I got the impression that addressing it with him was never an option.

Their flaccid response sent me a message: a little tinkly warning bell that they–still–couldn’t protect me. No one would stand by my side. It was still just me.

One day within the last year, I had drifted off during a body therapy session and was having those funny flashes of dreams you have when you’re in that half-asleep state. Suddenly that man’s name came at me out of the dark and I had this woosh of utter panic. It was uncontrollable, like a switch flipping on, almost like someone had pushed the plunger on a needle without warning me that my bloodstream was about to be invaded. I fought waves of panic and this sense of utter aloneness in the universe and a lack of control over anything–like an astronaut being set adrift from a space ship into the void.

Thank God I had enough experience working with traumatized people, I was able to find one tiny little toehold of sanity that let me talk myself through it: “I am safe, I am safe. These are just feelings. I already lived through the thing, it already happened, it’s not happening now. This will be over soon. I am safe.”

I recognized in that incident just what so many women have described to me of the aftermath of their traumatic births. The part where you’re pitched into outer space, the panic, the feelings that roll over you like you have no mass.

Just a few months ago, I walked into a family event and there he was: this man, sitting there, occupying a seat in the midst of my own family.

First was the shock of that surreal scene, like opening your sock drawer to see a hand grenade; then, a minute or two later, my legs started shaking and I felt sick to my stomach. I found I was scanning the room for emergency exits with a rising sense of panic. “If he comes this way, I’ll go down that hallway. If he comes that other way, I’ll go out this door.”

It occurred to me after an eternity of seconds that now, as a 30-something adult, I didn’t have to stay in the same building as him and I didn’t owe anyone an explanation about it. I said a cursory goodbye and walked out the front door.

I called my mother. I told her what had happened, that I didn’t understand why that man would be among my own family, and the weird physical reaction I’d had. We talked for a few minutes and she suggested that I tell my father the same thing. I said I wasn’t sure if I could, and when my mother asked why not, I answered, without even thinking: “Because if he doesn’t stand up for me, I WILL DIE.”

I really meant it. It felt like… If he said anything other than, “I will do anything to protect you; you will never see him again; he will never enter our family’s space again,” my heart would just stop. If he hesitated even a little, my soul would quietly detach itself from me to retire wherever souls go when they have no purpose in the world.

Based on my father’s reaction the first time I’d told them about this man’s behavior, it felt unsafe to confide. So, today, I still haven’t been able to talk to my father about it. I can’t afford for him to let me down. I do not want to die.

The severity, the gut feeling, of my response–that I would drop dead, that the negation of my experience was incompatible with my actual life–speaks volumes about what it means to be believed in your vulnerability. What it means to be believed.

This is just one reason we don’t shout from the rooftops when we have been intimately wronged. The possibility of death by disbelief is too real. The piece of us that is hurting is so extraordinarily fragile, sometimes a breath of the wrong words or a split second of silence in the wrong place can destroy us.

I heard the same things over and over again from women on the Exposing the Silence Project tour. When they finally got up the nerve to talk about their traumatic births to loved ones and were cut short, it sent them into a tailspin. Many called it “retraumatizing.” Some said it was that second event that actually triggered their PTSD.

So, the first traumatic event among virtual strangers was horrific, but the second–among the people closely linked to their security and identity–was just as traumatizing in another way.

Indeed, with stakes this high, not being validated at all can feel safer than the risk of being invalidated.

So why don’t we risk talking about what has happened to us, in birth and in sex? Quite rationally, we want to protect ourselves. We can’t afford to be disbelieved.

I believe myself.

It’s now April 2021, over two years since I wrote the first part of this article, and I did finally talk to my father about that man.

I described to him how that whole situation was connected to why I also didn’t tell my father about an attempted assault in high school, the night I ran through a strange house and slammed the bathroom door on the arm of the man chasing me, then fled outside to spend the night hiding in some bushes along the road.

This event was long over, but it lingered for me that I could never tell my own father about it. It took a long time to get to a place where I could take the risk of telling him.

I realized that the only way I could ever do it was if I believed myself about it. I needed to value my own perspective as much as I did his. After all, I was there. I know what happened and what led me to be there that night with those people. Whether or not he believes me does not change the facts.

“Do I believe myself?” I thought. “Yes. I believe myself.”

I practiced. I ran through my head, what happens if he says I am not remembering correctly or good girls don’t get themselves in those situations? I would be ready only when I could be sure that nothing he said could shake my confidence in what I myself had experienced and what blame or shame belonged to me for it. I kept asking myself, “Do I believe myself?”

I kept answering over and over, “Yes. I believe myself.”

Over time, I was able to develop the muscle that let me hear, respect, and not personalize his opinion. I could understand his perspective as a 70-something-year-old Italian-American man raised in a small town; I could still value his opinion and adore him; and I could choose not to let any of that change my story about myself.

It was months before my belief muscle felt strong enough, and then I sat him down and blurted out all of it.

It didn’t devastate me when he did, in fact, tell me I shouldn’t have been at that house in the first place, sneaking around or lying about whom I was with. I knew he would probably say that and that it wouldn’t be fair to expect more right then, hitting him with this story decades later without giving him a chance to process it. Later, I remembered that he also said a lot of supportive things, but I couldn’t remember any of them. The ones that stuck were the ones that felt like little darts and made my heart skip a beat. But then they died away. They didn’t shake my core.

By then I was sure that even rebellious teenagers don’t deserve to be raped.

I didn’t die.

I remembered that I believed myself.

Afterwards, I thought, I’ll always believe myself now.

The body remembers.

Last week, I happened to get chatting with someone I went to elementary school with for fifth grade and she reminded me that we had ridden the bus together–the wild bus, the one that was always getting in trouble. It was my first year in public school and, coming from religious schools in a tight Christian community, I was horrified by how those little heathens behaved.

I used to sit by myself in the front of the bus and keep my head down.

At some point, my friend mentioned the name of one boy who she said always bullied her and the memories hit me like a truck.

That kid used to sneak up behind me on the bus and lower his arm very slowly down behind me, between my back and the seat, and rub or stroke my back. I still remember the feeling of terror and revulsion.

Neither of us ever said a word. I just remember dreading his approach. We both knew I would pretend it wasn’t happening, every time. Shame, more than anything, would keep my mouth shut.

Over the years, though, those memories had faded and I wasn’t sure they were real. Was that even his name or did I invent it? Maybe I imagined that he touched me. Maybe it only happened once and it was an accident and I was dramatizing it–making it sexual when it wasn’t. Which, by the way, made me the pervert.

My friend said then, oh yeah, he was real, that was his name, and he was totally a gross little bully who picked on girls.

Maybe the most nauseating part was that he absolutely knew that touching me quietly would work with me. He loudly bullied my friend in because that was what worked with her. At ten years old, this is what we were all learning. How to manipulate, how to be manipulated.

In that conversation with my friend that day, I remembered the truth in my body. I had hated his touch and I was afraid of him. He made me feel disgusting and dirty.

Also, I would rather have died than told anyone what he was doing.

It may sound strange to say, but there was something reassuring about having these memories confirmed. I could deal with the truth that this boy had touched my back on the bus in a creepy way–deep down I always knew it anyway. The real horror would be to realize that I could not trust my own memories or perception. I always had a deep fear that maybe I had created it all myself because, I had heard, little girls like drama and attention.

Now, I felt relieved. I could believe myself as a little girl, too. I could always believe myself.

How do we keep ourselves safe when we report birth assault?

We have good reason to fear being disbelieved and invalidated when we speak up about gender-based mistreatment, and this carries through into maternity care. The very first “At least you have a healthy baby!” from a loved one makes it very clear how little we are valued as the person giving birth.

When we so desperately want to trust that our schools, hospitals, state boards, and courts will protect us, the reality can be excruciating: to discover that, even when you have finally found the strength to use your voice, you have not yet reached a safe place. How jarring to realize the burden of proof is on you, about an event for which no evidence is likely to exist beyond your own words, and you will be required to advocate for yourself yet again in the reporting process. Indeed, the accountability systems in place are neither very effective nor attuned to people carrying trauma.

But there’s good news, too. I’ve spent almost ten years now advocating for traumatized birthing people as they work through hospital, state, and legal processes for accountability. In the last year, I’ve been digging into medical boards around the country and gotten involved with a fantastic consumer watchdog group that monitors them independently.

During April at Birth Monopoly, will explore How to Report Mistreatment in Childbirth. Our resources include free information on filing complaints with hospitals and state boards and a state-by-state directory to the boards that regulate and discipline care providers; expert interviews; as well as the publication of our how-to manual and a checklist to make the process a little easier on you.

But before we get into the nuts and bolts, I want to share with you something I have learned to share right off the bat with the brilliant and strong survivors I work with individually:

Use the reporting and complaint processes in maternity care as a tool in your healing, and not the endpoint.

The expectation that your trauma will be cured by holding someone accountable for it is not realistic from a practical standpoint nor from a trauma standpoint.

Trauma cannot be reversed by meeting a goal; it can only be healed through a process.

Deprioritizing your healing may very well allow your trauma to creep back up as the very thing that prevents you from pursuing justice.

Trauma can be a powerful driver, but one that leaves you stranded on the side of the highway, exhausted and depressed, if you aren’t paying attention to it.

And, in turn, as you give loving attention to your healing, the more resilience you will have to pursue accountability from those who caused you harm.

You CANNOT rely on external validation in this process–there is much that is beyond your control–but you CAN use this process as one powerful part in your healing journey. It is a chance to reclaim your story at your own pace, take back your agency, and advocate for yourself from a stronger position than the last time.

As an individual, you can heal.  You are not alone.

As a group, we can challenge the system armed with knowledge about it.  We can strengthen our own community of advocates by supporting each other and ourselves in healing.

Be sure to sign up for our email list to get updates as we share with you resources and information on reporting mistreatment over the next weeks. In the meantime, please give some thought to what healing means to you and how you can use these upcoming resources to come out on the other side stronger and more whole.

Much love,
Cristen

P.S. This article was published with my parents’ consent, without edit.

Please feel free to comment below about what this brings up for you.  This is one way we can show others they are not alone and normalize talking about gender-based assault without shame.

The post Why Don’t We Report Assault in Sex and Birth? appeared first on Birth Monopoly.

I know I’ve said this before but… This community rocks.

Last week as we were rolling out the “How to File a Complaint” manual, the group Life After 4th Degree Tears (private Facebook support group is here; follow them on Instagram here) contacted us to ask if they could put some money towards manuals and consultations for other people. Of course I said, absolutely, and we didn’t even have a chance to announce it before those donations were snapped up.

Also, without even mentioning it to me ahead of time, several members of our Know Your Rights community (doulas and a nurse) went ahead and purchased manuals to be held for people who needed them but couldn’t access them for financial reasons. If that’s you: shoot us an email at birthmonopoly_at_gmail.com. We have limited stock right now!

These scholarships are in addition to the number we set aside in honor of the women I’ve known personally over the years who pushed forward to demand accountability after being harmed and traumatized in birth. As I was putting this together, I couldn’t stop thinking, “This one’s for Rachelle; this one’s for Ashlee; this one’s for Kimberly; this one’s for Christine; this one’s for Lisa…”

Reflecting back on those women’s situations, it gives me chills to think about how far this movement has come since the days when we had to protect their identities from the public because of the shaming and derision they would face for simply saying, “I matter, too.”  I’m not kidding.  Eight or nine years ago, for a birthing person to come forward to say, “I’m being forced into a C-section against my will,” was to invite trolling and threats against them for having any other attitude than, “Do what you want with my body; I don’t exist.”  Whew!!

Now, we are announcing that Birth Monopoly will match any donations made by this community for this community through May 5, 2021. Donate here at the “Pay It Forward” link in any quantity. Quantities of two or more will go towards private consultations with me as well as the manual for an individual.

Please email us at birthmonopoly_at_gmail.com to tell us WHY you decided to give, or WHO it is in honor of.

I continue to be amazed at the ways we support each other. This community has so much power. And I think we’ve barely even tapped into it. There’s lots more good stuff ahead.

Again:

If you would like to GIVE a scholarship, go here.

If you would like to RECEIVE a scholarship, email us at birthmonopoly_at_gmail.com.

Don’t forget to keep following and sharing our informative series on social media about filing complaints!

… More on Instagram and Facebook

The post How to File a Complaint for Mistreatment During Childbirth: *Scholarships Available* appeared first on Birth Monopoly.

As the world begins to find its way back to normalcy, it saddens me that the COVID-19 pandemic is still having devastating effects on the Black community.  But as a Black woman who is a victim of healthcare discrimination and mistreatment myself, I have to admit I am not surprised, either.

According to the Alabama COVID-19 Data and Surveillance Dashboard, about 43% percent of COVID-19 cases in Madison County have been Black people. This may not seem like an overwhelming rate, but we also know that black people only make up 24% percent of the population in that county.

Seeing these health inequities made me wonder about how differently this pandemic is impacting Black and brown people, and how the hidden factor of racism influences our health outcomes when we go to a hospital for a serious disease that requires medical treatment. 

Then, in the summer of 2020, cell phone video footage surfaced on YouTube showing a biracial couple being mistreated in the 24 hours after the birth of their child–at the same hospital where I had given birth twice and had more than one horrible experience with staff members.

Witnessing that family’s mistreatment on video made me dig deeper into my own birth stories and reflect back on how I was mistreated as a Black woman in the hospital during two of the most important events of my life.

IT’S STILL HAPPENING: THE WASHINGTON FAMILY IN 2020

The recording posted by the Washington family shows hospital workers directing attitudes of annoyance at the Black father just for asking questions about the care of his child and wife. Though the father speaks perfectly calmly throughout the conversations, a staff member states they feel “threatened” and the hospital then changes the requirements for the couple to be able to take their child home.

The staff repeatedly says they must follow guidelines and policies, but they have no reasonable explanation healthwise as to why the child cannot go home. Between the bewildered, frustrated parents and the irritated staff, this all culminates in a staff member actually calling the police, and a confrontation between a hostile police officer and the sobbing mother who has just given birth, as her husband tries to advocate for her with his mother on speaker phone giving them support.  Just one of the shocking moments in this exchange is the officer repeatedly asking the birthing mother for identification as she lies in her hospital bed cradling her new baby.

I encourage you to watch the entire video to witness their full story.

A 2019 study found that experiences of mistreatment during pregnancy and childbirth in the U.S. were consistently higher for Black parents. Having a Black partner increased reported mistreatment regardless of the birthing person’s race. The researchers reported “For some indicators of mistreatment (e.g., Health care providers ignored you, refused your request for help, or failed to respond to requests for help in a reasonable amount of time) White women with a Black partner were twice as likely to report mistreatment when compared to White women with a White partner.”

There are also documented racial disparities in Child Protective Services (CPS) reporting. In a 2012 study from California, Black newborns were four times more likely than white newborns to be reported to CPS at the time of birth. This was despite similar rates of alcohol and illicit drug use identified in Black and white pregnant people in prenatal care. So, failing to comply with medical recommendations carries more risk to Black parents. White parents can raise their voices and question authority figures with more liberty—without as great a fear of intervention by police or social services.

After watching the video and having a conversation with the family, I was disappointed to realize that it seemed like the hospital had not followed through on my own petitions to them to educate themselves about their misconduct.  After having two babies born at Huntsville Hospital for Women and Children, I pleaded with them on multiple occasions to implement more training and education, and I had hoped that real changes were made to better the care of patients.

In addition to giving birth there, I have also been hired by patients as a doula to attend births, and been employed at the parent company for the hospital–each time resulting in a negative experience. It seems to be more than a few rare incidents but a systemic pattern they choose not to change.

The Washington family did have a meeting with the hospital after the incident, but as of the publication date of this article, nothing had been achieved.  Mr. Washington said, “They told us they would be taking steps forward to improve and that we would be a part of the process. They never reached out and ignored several phone calls.”

THE EVIDENCE OF MY OWN EXPERIENCE WITH BABY #2

The World Health Organization states that “addressing inequalities that affect health outcomes, especially sexual and reproductive health and rights and gender, is fundamental to ensuring all women have access to respectful and high-quality maternity care.”  But respectful and high-quality are definitely not the words I would use to describe my births.

In 2015, I gave birth to my second child at Madison Hospital in Alabama. Both doctors and nursing staff treated me so negatively, I doubted my strength and ability to give birth. My pregnancy and birth were met with discrimination and racist remarks. I heard comments like “Do you have the same father for your kids?” and “Because of your weight you are not a good candidate for VBAC (vaginal birth after Cesarean).” I was never shown data, documents, or reports that supported the statements they made. During birthing transition–the hardest part of labor–I was told to “shush” and “calm down.”

Janice A. Sabin, Ph.D., MSW is one of the first researchers to apply the science of implicit bias to the health care system. In a January 2020 article, she discussed a 2016 study that found that “40 percent of first and second-year medical students endorsed the belief that black people’s skin is thicker than white people’s.”

For more on the story, visit my interview with Birth Monopoly founder Cristen Pascucci.

In the end, my doctor didn’t even want to enter my room. From my doorway, all he said was “I guess you were right,” about me successfully having a VBAC.

ALONE IN A BUILDING FULL OF PEOPLE WITH BABY #3

Two years later, I was pregnant with my third child. After how I was mistreated during my last birth, I delayed seeking obstetric care until well into the second trimester. I chose a new office with a new set of doctors after a referral from a close white friend. My friend had nothing but rave reviews and I was excited to have a new birthing experience I could be excited about. 

When I arrived, I was treated fairly well. But when I spoke very clearly to my doctor about the unsupportive care I received with my previous birth, she responded, “That was probably just a bad day.” Now, I understand not wanting to talk negatively about a colleague, but having my traumatic experience minimized by my care provider was not what I needed as a pregnant patient.

After that, my anxiety built and birth became something I dreaded. I wanted it over with as soon as possible. I couldn’t enjoy the precious moments of growing a child.

Ten weeks after that appointment, my water broke early at the estimated 35-week mark while my husband was away with my daughter as she had surgery. When I arrived at Huntsville Hospital alone, I was made to sit in a waiting room as amniotic fluid dripped down my leg. Once I was in triage, a nurse performed a vaginal exam on me, and when I asked her to stop, she proceeded to continue the exam while I backed further away from her in the hospital bed in pain. She just kept going.  Afterwards, she said, “If you[d] relaxed it would not have hurt.” I felt violated.

With my husband and daughter away, I had no one. A building full of people, and I was alone. In that moment, I decided to call another family member, who was two hours away on business, to make the trip and be my support person. In the back of my mind, I knew I needed someone there just in case something happened to me. Or in case something else was done to me.

The moment I was transferred to my room, I let my nurse know immediately about how I had been assaulted in triage. I do not believe she reported it to anyone.

But from there, after such a bad start, my son had a beautiful entrance into the world. I was honestly shocked. My doctor was extremely caring, the nurses were amazing, and I was on cloud nine after bringing my child earthside with no medication in three easy pushes.

WHEN CAN I FEED MY BABY???

That bliss quickly ended when I was told my son needed to be transferred to the Neonatal Intensive Care Unit (NICU) to “get warmed up” and help him regulate his temperature. I waited for hours with no status updates–I had not yet been able to breastfeed him, a moment I look forward to with each birth.

When I was eventually allowed to visit him, my son had machines and wires everywhere, and we were told we could not hold or even touch him. I asked again, “When can I feed him?” I was told he had to be cleared by the neonatologist… who didn’t come in until the next morning.

Now I was frantic, but I got to work. I started pumping right away and kept going through the night so I would be ready for my baby. I called the NICU several times during the night to check on him and discuss his first feed with his nurse.

Finally, after a long and exhausting night, I called at the time instructed by his nurse to see if I could come to the NICU.  The news broke my heart.  She told me that she had actually already fed him–two hours earlier than she told me she would.

I was distraught and hurt that I did not get to give my son his first meal earthside. When I contacted the supervisors, I was told to “calm down if I wanted my concerns to be heard” and the nurse “didn’t realize it was such a big deal.”

Why would feeding my child for the first time not be a big deal to me? Why disregard my request to exclusively breastfeed?

I spent the remainder of his stay on eggshells.  I could not wait to take my son home and never return. It is easy for others to say “but your child is home and healthy,” but those traumatizing experiences imprint on memories that are supposed to be joyous.

I sent a grievance email once my son was home and my thoughts were organized. I received an email from their communications coordinator with her deepest apologies. She offered an opportunity to join a community committee that would improve the treatment in the NICU. I was excited about her proposition. 

That committee was never created, and I never got a call back.

NO REAL ACCOUNTABILITY

I figured the best way to contribute to health equity was to participate in the care of patients, so I decided to put those experiences behind me and get involved on the inside. I accepted an opportunity to work in the hospital as a lactation counselor and educator. As a certified lactation counselor, I love helping families reach their breastfeeding and parenting goals.

Corporate training was a week long, and it was difficult to hear the hospital talk about their high standards for patient care–knowing my sons and I didn’t receive high-quality care there. During the training, we had to watch a video that spoke about empathy, which you can watch here.  It seemed like the only lesson on interacting with patients.

I started training at Madison Hospital for more in-depth training for my title role, learning to dress wombs, use restraints, and calculate urine measurements. When it was time to learn telemetry, the trainer shared a color coordination tactic to help us remember. She told us to remember the color white as “white is right.” She said this in a room with four people of color.  She said it again: “see it rhymes, white is right.” I stated that is not something they should be teaching, but she did not understand my discomfort with the statement. I immediately let my supervisor know and was met with, “Oh that’s just how we have all learned it,” and, “She did not mean it like that, she is really nice.” I repeated my discomfort with the statement and was told they would make sure she did not use it again.

The Alberta Civil Liberties Research Center has a complete list of the many forms of racism. They share the definition of systemic racism as “policies and practices entrenched in established institutions, which result in the exclusion or promotion of designated groups. It differs from overt discrimination in that no individual intent is necessary.”  Indeed, this trainer has been teaching this to multiple employees who maybe still using the terms in the workplace, and when I reported it, I was met first with dismissal and then with no meaningful followup action taken. No internal memo was ever sent out, and no diversity or sensitivity education was ever implemented to my knowledge.

How will Black patients receive respectful care from a system that can’t see why this phrase is problematic and doesn’t really address it when a Black person alerts them that it is?

But trainers are not the only ones contributing to systemic racism. A practicing doctor at Madison Hospital posted on his personal public Facebook page that “lay midwives are the dumbest thing since pet rocks.” Now, there is historical importance to Black “granny” midwives (now called “Grand Midwives”) in the U.S. south, some who had the responsibility of not only caring for slave owners but also enslaved Blacks. They were not medically trained but passed down the history of care through generations. After a coordinated campaign by white men in the early 1900s to discredit their skills, cleanliness, and safety, granny midwives became virtually non-existent as families were funnelled into hospital care.

You see, the racism goes deep and has such a long history.  Part of the reason we are mistreated in hospitals is that we don’t have options for care in our communities other than hospitals!  Our own Black midwives were taken from us.  So why would a healthcare system change when it knows patients have nowhere else to go anyway?

Of course, it is difficult to prove mistreatment, and even when it has happened, there are no real consequences for the people who have committed the offense. Reports and grievances just are not taken seriously.  There is no way to follow up with a hospital about changes without getting back, “We decided to handle it internally”–even though, as a Black woman, I am 3 to 5 times more likely to die giving birth compared to my white counterparts according to the CDC.  These issues are real and urgent and not fixing them literally costs lives.  The stakes are highest for people like me.

I wanted to end this blog with some helpful tips to make you feel more confident about reporting mistreatment:

1. Take a picture of your room board. This has all the names of people assigned to your room.
2. Keep a notepad on your phone of incidents when they are fresh in your mind.
3. Ask to speak to the head nurse or supervisor.
4. Report everyone who mistreated you, from the doctors to the nurses. REPORT!
5. You are allowed to ask for a new nurse and fire your doctor at any time.
6. Send emails and keep copies of them.
7. If they are requesting a meeting, write a letter on paper to read out loud–this way you have all your thoughts in one place.
8. Quote their policies!!  If you are told something is policy, ask to see it in writing.
9. Trust your gut.
10. This is truly a global issue. Multiple families document their mistreatment by way of the “Obstetric Violence Map” on Birth Monopoly’s website, from medication not consented to, to not being given all the information or options to make their healthcare decisions. Add your story to the map.

Author: Sabrina Butler, CLC | What started out as a journey in parenting propelled Sabrina into her true calling of community advocacy and empowerment. Self-describing herself as “the nerd who became cool after having kids” has spent the past 6 years building community relationships, assisting companies and programs in anti-racism initiatives, and introducing families all over to alternative ways to parenting, motherhood, and service. She continues to offer lactation services in surrounding areas of Tucson, Arizona while pursuing her doctorate degree in Public Health at the University of Arizona. Follow Sabrina on Twitter or visit www.rsbstratagies.com to schedule a virtual or in-person appointment.

The post An Experience of Racism: As a Patient, Employee, and Advocate appeared first on Birth Monopoly.

Today I came across this video post by Sarah Wild, CRNA, who says her intention on Instagram is to “set an example for young women, moms & wives to be the best version of themselves and enjoy life.”

Make sure your sound is on.

These kinds of posts by providers used to make me furious; now they make me deeply sad.

The casual misogyny here!  The trauma being perpetuated.

And coming from a woman, who cares for other women in one of the most vulnerable states they can be in.

The problem here is nothing to do with choices around pain relief, but the mocking of patients in a setting where abuse and disrespect are already well documented, fueled by paternalistic views about women making their own healthcare decisions.

For me, the knife twists a little more when it is a woman normalizing the disrespect.

I know some people will look at this and think, “It’s just a joke, calm down.”

My guess is those people haven’t studied trauma in maternity care, and haven’t listened to women and birthing people cry as they relate what  (or who) traumatized them during birth, like:

– Being condescended to

– Being infantilized

– Not being listened to

– Not feeling cared for by people they trust to care for them

– Being made fun of

– Being dismissed or ignored

– Having their provider’s preferences determine how their birth goes, rather than their own

This is obstetric violence.

We don’t joke about rape, and we don’t joke about obstetric violence.

READ MORE: OBSTETRIC VIOLENCE

One in three birthing people describes their birth as “traumatic.”

Around one in nine has PTSD from birth.

According to research, the *majority* of birth trauma is not from the act of birth itself, but from how we are treated by those caring for us—who have power over us—during this vulnerable time.

When we feel unsafe.

Trauma can be created when we feel unsafe, period, whether the threat is physical or psychological, real or perceived.  The brain doesn’t necessarily distinguish between “This person has a knife to my throat” and “This person’s words are threatening my sense of self.”

Of course, in birth, virtually anything that happens in the room can be interpreted by the birthing person as a threat to our own safety or our baby’s, which is why providers must take care to protect our emotional space, as well.

As universally powerful as the bond is that connects a baby with the person who gives birth to them, imagine how damaging it is for both those souls when that bond is compromised.

A traumatic birthing experience can impact our lives in a multitude of ways.  Just a handful are…

– impeding bonding with our baby

– loss of trust in, and avoidance of, medical care

– overwhelming grief and guilt

– nightmares and intrusive thoughts

– withdrawal from a spouse or partner

– increased overall anxiety

– unexpected triggers that make the world feel like a more dangerous place

Some of these effects will be temporary; some, without healing, will last forever.

READ MORE: BIRTH PLANS ARE NEVER A JOKE: TRUST, BETRAYAL, AND MISOGYNY IN MATERNITY CARE

I wonder if Ms. Wild entered the healthcare field with this attitude or if it developed as a response to the traumatic setting and the moral injuries she herself has suffered.  Some of it surely is mean girl behavior with deep historical and cultural roots—internalizing messages about ourselves like, “Women are silly creatures whose decisions don’t matter,” and letting those harmful beliefs ripple out to others.

Regardless of the reason, the cognitive dissonance is staggering: her stated intention to “set an example for young women, moms & wives to be the best version of themselves and enjoy life,” while publicly disrespecting those groups and perpetuating trauma that steals their joy and tears at family structures.

It just makes me so sad that people with these kinds of attitudes have so much power over people who are so uniquely vulnerable.

To Ms. Wild and those who have the privilege of attending births:

– Until you have learned to respect the humanity of women and birthing people, please leave the room.

– While you are gone, dig into your beliefs about yourself and women as a group.  How much respect do you deserve?  Do you deserve respect as a woman?  Do women?  Do you have a heart of contempt or love for birthing people and their babies?

– Learn about birth trauma and obstetric violence and how these things especially harm BIPOC and other marginalized groups.  Read Sabrina Butler’s story and this 2019 study on inequity and mistreatment in birth.

– Get brave and face up to how your behavior may have impacted (traumatized) others.  Go slowly; this will hurt.  In his book My Grandmother’s Hands, Resmaa Menakem calls this “clean pain”: pain that we lean into so we can grow, develop, and heal.

– Remember that you, too, deserve respect and humanity.  Believe that deeply.  I believe that about you—it’s why you make me so sad instead of just angry.

– Know that you can heal, you can forgive yourself, and you can do better.

If you were traumatized by your care providers in birth and find this post distressing, please use this opportunity to do the most healing thing you have space for today.  It can be as simple as closing your eyes and remembering to forgive yourself for things that were done to you, that were out of your control, that you might have done differently or didn’t do more.

You deserve care, compassion, and respect, and you can heal.

Lots of love,
Cristen

The post A Woman Provider Normalizes Obstetric Violence on Social Media appeared first on Birth Monopoly.

Please read our companion article to this piece, “Birth Trauma, Obstetric Violence, and the Human Cost of Caring,” on the Obstetric Violence Blog, Durham University (U.K.).  Thank you to the brilliant Dr. Camilla Pickles for inviting me to write on this topic!

My son has huge brown eyes and yellow curls that make him look like a cherub.  He’s not quite three years old, and he’s asking me to feed him.

I’m trying to work on my computer, remotely triaging a very pregnant woman who has been told by her doctor that she has 24 hours to report in for a Cesarean before he sends police to her house to force her.  I have calls and messages out all over, rallying legal and community support for this woman while trying to reassure her that we won’t let anyone cut her baby out of her body against her will.

Henry and Mommy, Oregon 2013

It’s 2013 and I’m vice president of a national consumer advocacy group working on urgent birth issues around rights, fielding questions and calls for help from pregnant folks and our hundreds of volunteers around the U.S. at all hours.

As my son presses me for what he needs, my shoulders tighten up towards my ears and my chest feels like it’s cramping.  My ears buzz and everything in me says: “Get him away!  Don’t let him come any closer!”  I feel defensive and hostile.  He feels like a threat.  He’s one more person standing between me and this woman who is falling off a cliff.

I’m having a physical reaction to my son as if he is a rabid dog snarling at me, and I feel like a rabid dog snarling back.  I am fearful and angry and I yell at him until he cries.  Then I feel guilty, but panicked, too, because I’ve been pulled away from my computer.  I don’t have time for this; after this woman, I’ve got two other women waiting for me to call them back and I’ve been sick all week.  I’m so behind and there are so many more out there, traumatized, bullied, alone.

Looking back, I feel sorry for both me and my son.  It kills me to think of that little boy frightened to ask his mother for something so basic and feeling rejected and uncared for.  Who knows what that left him with?

I can still vividly remember the panic I felt in these moments, being pulled in two impossible directions.  I had no control over my physical reactions to Henry and no control over the endless stream of messages from around the country.  He and I were pitted against each other as my work consumed everything.

It took a group intervention by some close colleagues within that next year or two to open my eyes to just how dysfunctional the relationship was among myself, my son, and my work.  They pointed out that I was painfully thin and seemed sick all the time.  And it’s true; I was laid out in bed for about a week every month with some illness or another, my only chance to catch up on sleeping and eating.  My parents and my neighbors–a young nurse, a retired parole officer, and an empty-nest mother–were constantly pitching in where I couldn’t hack it.

Companion article: Birth Trauma, Obstetric Violence, and the Human Cost of Caring
on the Obstetric Violence Blog, Durham University (U.K.)

That intervention started a long journey back to health that revolved around recognizing my own trauma and how my symptoms overlapped with those of the people I was serving.  I remember sitting in a doctor’s office for my first appointment and when she said gently, “I’m seeing signs of PTSD in you,” I thought, “What???  No, I’m the one HELPING people with PTSD!”

That same doctor ran all kinds of diagnostic tests and I was stunned to see on paper how trauma was showing up in my body.  It was making me sick.

She said, “With these numbers, I can’t believe you’re able to get out of bed.”

Henry, Rita, and Blue, 2015.  Photo credit: Melinda Freas-Wester

As anyone who works in maternal health knows, there is no clear line between the psychological and the physical.  There are countless stories of pregnant people being scared out of labor by an aggressive care provider or suddenly able to release for birth when they felt safe.  I experienced this myself.

All of us, pregnant or not, constantly respond to our environments with hormonal shifts that impact blood flow, muscle tension, and organ function.  This can mean acute symptoms in response to stress, or more serious chronic illness that develops from experiencing stressors over a prolonged period of time.  (More information is here: https://www.apa.org/topics/stress/body)

So, it makes sense that my healing has been (is being) accomplished across many dimensions of what it means to be human, and delving into other traumas from childhood and young adulthood that I thought were long over and buried away.  Basic physical needs like good food, regular movement, and adequate sleep are just a start.  Just as important are trauma counseling (Holistic Peer Counseling is my go-to) and re-education around processing feelings, holding boundaries, and forgiving myself.  I need jigsaw puzzles, embroidery, and gardening to decompress.

I am learning to listen to my body and follow its lead even when it prompts me in ways that may seem strange or unrelated.  If my neighbors heard me and Henry laughing in our backyard as we smashed glass in a trashcan last summer, I doubt they would recognize that trauma healing was what was happening for us.

Healing in these many different ways has transformed my relationship with my work and how I show up in the world.  I no longer feel victimized or helpless in the face of so much violence and abuse; I feel confident that I will accomplish what I set out to do.  I don’t worry that it’s only a matter of time before the trauma pushes me into a safer line of work.  I do recognize that it is a never-ending process to absorb the incoming horror and grief and find ways to work it out of my body and psyche–I am in physical therapy now for my own symptoms related to an overload of other people’s trauma.

I had been intimately familiar from years in birth advocacy with how unnecessary birth trauma–specifically, trauma inflicted by coercive or abusive care providers–impacted the parenting, partner relationships, and life trajectories of those who had experienced it.  Later, especially working with doulas across the country who agonized over the most fraught part of their jobs, I learned about secondary trauma, trauma experienced by those who witness the abuse of others.  Now, I can see so clearly how trauma spills over into the lives of everyone who sees it, who is complicit in it, who is conflicted about their role in it, who fights with everything in them against it, who perpetrates it.

Trauma is not linear.  Nor does it respect limits.

Trauma is uncontained and self-perpetuating.

It bounces off everyone in its orbit, revealing our weaknesses and triggers and old hurts.  It can be incredibly destructive when it is unleashed but it also allows us unprecedented access to the places where we need to heal and love ourselves the fiercest.

Now in 2021, it’s early morning and, as I write this, I’m sitting by the fire in a little cabin on a farm in the misty hills of southern Kentucky.  I retreated here overnight for the solitude I can’t get at home, so I can wrap up this long overdue pair of articles on secondary trauma.

Companion article: Birth Trauma, Obstetric Violence, and the Human Cost of Caring

But, life being what it is, things haven’t quite worked out how I planned, and I’m not even close to done yet as the minutes tick away towards check-out time.

I am acutely aware of my lack of progress, frustrated, and trying hard to focus.  I start and stop typing more than once.  Finally, inspiration dawns and I find my groove for just a few minutes–when nine-year-old Henry flings open the cabin door with a whoop.  “Mom!  Come see what I did!  I drew art all over the stones outside!”

That old familiar tightening starts to creep up my abdomen–“Not now!  Get away!”–before I consciously release those muscles and pull a breath in and push it out.  “My son is more important than my work, my son is more important than my work,” I tell myself.  After a second or two, my brain makes a distinct shift from, “He is a threat,” to, “Oh, RIGHT!  He IS the most important thing and I LOVE him!”

I wait a breath as my heartbeat slows to normal and the world seems safe again, then turn to my son with a smile.

I’m so happy he’s here.

Henry and Mommy, Jamaica 2021

If you have experienced secondary trauma as a birth or medical worker, you may be interested in the trauma healing program Birth Monopoly is building in collaboration with Holistic Peer Counseling.  Click here to get on the waitlist.

The post Secondary Trauma and Birth Advocacy appeared first on Birth Monopoly.

Join the waitlist for our new course, Obstetric Violence: What It Is and What Community Can Do About it, opening January 2022

Foreword

I wrote this article to publish in 2017 and never got it out.  Now putting it out in 2022, I thought I should update the 2013-2016 examples I used throughout.  So, I went to our map of obstetric violence stories, starting with the very last entry we have there –from eight days ago (December 21, 2022). 

A doula described a doctor about to do a cervical exam on her patient without consent, then pressuring the patient to have the exam, then repeatedly touching the patient without consent during the final pushing phase, until the patient yelled at the doctor to stop touching her. I thought, what is the point of updating these examples when they look the same today? 

The other reality is that it’s emotionally difficult and heavy for me to dig through story after story of violence against birthing people.  It takes a lot of energy, and it takes me to a place of sadness and hopelessness.  In 2022, almost 2023, I need that energy to work on solving the problem and in forward movement.  

So, I chose to add just that one example in from 2022, do some light editing, and give you the rest of the article as-is.  It might read a little funny because of its age, but I also think it’s interesting to see this pre-Trump, pre-COVID, pre-Roe-being-overturned snapshot in time.

Birth in Rape Culture

“He starts rolling my blanket up and I’m like, no, don’t, holding the blanket down. . . . I was like, please… So he moved my legs apart and he’s like it’s not going to hurt.  I said no, no, and put my legs together.  He actively pushed my leg to the side and stuck the thing in me.  That was the most traumatizing thing, I had just said no and he did it anyway.  He said, stay still!  I was really upset and after that . . .  I remember crying and falling asleep.”  – S., New Jersey, about a doctor at her child’s birth

Rape culture is about the normalization and tolerance of sexual violence against women, and that culture is alive and well in maternity care, where the appropriation and control of the pregnant body is ubiquitous.  We call this obstetric violence.

Exacerbated by the power imbalance that naturally exists in healthcare settings, women and birthing people are told from early pregnancy through birth what they are “allowed” and “not allowed” to do, from how long they are allowed to be pregnant to eating and drinking in labor to how long they may push and the actual position in which they are compelled or instructed or even forced to do so.  In Labor and Delivery, anything can happen to a woman’s body, and she will be told, implicitly and explicitly, to be grateful.

Join the waitlist for our new course, Obstetric Violence: What It Is and What Community Can Do About it, opening January 2022

Choice and Consent

Take the case of Caroline Malatesta, who filed a lawsuit after the 2012 birth of her fourth child at a Birmingham, Alabama, hospital that used words like “autonomy,” “options,” and “choice” in a massive advertising campaign aimed at mothers like her who were looking for a woman-centered model. 

She and her husband described how a nurse grabbed Caroline’s wrist and yanked it out from under her to pull her onto her back from hands and knees; at the same time, another nurse forcibly held in the baby’s head to prevent his birth until the doctor arrived.  A straightforward, unmedicated birth became a wrestling match that left a woman with permanent, incapacitating internal injuries.

The freedom of movement and choice the hospital and her doctor had promised Caroline were just marketing tactics.  Contrary to everything she had been told, Caroline’s nurses were actually under standing orders for all women to be on bedrest–apparently, by any means necessary.  Meanwhile, in court, the hospital simultaneously stood by their marketing claim that they support women having the choice for position while also arguing that choice is “not determined by the mother’s preference” alone.  It was “unreasonable,” they said, “for Ms. Malatesta to have read [our marketing claims] and said . . . she has the right to choose to go to hands and knees with no other consideration.”  Caroline’s own doctor said that even “without medical emergency or medical risk to the momma or the baby, the doctor gets to override the momma’s [sic] choice about how she labors and delivers.”  

In a landmark verdict, the court found for the Malatestas–an unusual outcome in a system where violations of patients in the obstetric setting are routinely ignored and dismissed.  The $16 million award was intended to punish the hospital for lying about its services as well as compensate the couple.  Caroline can never again have sex and will need round-the-clock medical management for the rest of her life to manage her nerve pain.

Another woman in New York state, who was not able to bring a lawsuit, describes here the unmedicated 2013 birth of her healthy baby, which her medical records characterized as “uncomplicated” [link]:

The nurse screamed “GET ON YOUR BACK NOW” and two nurses grabbed my arms and legs . . . flipping me onto my back.  They wrenched my legs open, forcing my knees toward my ears . . .  The doctor put her hand in my vagina which caused a great deal of pain. I was filled with terror as the nurses held me down and I pushed my baby out. . . .  The noise, pain . . . and unknown people’s hands touching my vagina and my thighs terrified me and I still have PTSD symptoms.

What happened next confirmed to this woman that the hospital, in fact, did see her body as theirs to manipulate during labor and birth.  When she contacted them to ask why she’d been treated so violently, “they firmly stated that all women deliver on their backs in that hospital, legs immobilized in stirrups or held by nurses, and if a woman is not on her back when the doctor wants her to be, she will be forcibly moved into that position.”  The woman followed up with the Joint Commission, the body that accredits the majority of U.S. hospitals, who determined that the hospital’s “response is acceptable at this time” and did not reply to the woman’s subsequent questions.

In 2014, hundreds of stories were shared through a grassroots social media campaign called #BreaktheSilence I helped create as vice president of a national maternity care advocacy group.  One was this, from a doula:

One of my clients had narcotic pain relief and was napping.  The on-call OB came in, did a cervical exam, and ruptured her membranes when she was asleep.  When I realized what he was doing, I asked if he was going to wake her first.  He said, ‘I don’t need her permission.  I would do it anyway.’

In 2016, a Kentucky woman reported that, during a vaginal exam in early labor, her doctor decided to do an elective procedure without her consent. This procedure, done while the doctor’s hands were still inside her after checking her dilation, was meant to “speed up labor.”  To no avail, the woman tried to stop it, screaming in pain, pushing away, and begging the doctor to stop.  After an investigation, the hospital justified the doctor’s actions in that the woman hadn’t said, “No,” to the surprise procedure before it happened, but only during it.  In addition, they alleged she had implied consent by not objecting to the idea of that procedure as an option weeks before.

A woman in Utah complained to her hospital about a doctor performing a non-emergency vaginal procedure on her without consent during her 2016 birth.  She says the response from the head of Labor & Delivery was that the “blanket” consent form she signed upon admission gave them all the permission they needed.  A subsequent internal hospital review confirmed that view, finding her care to have been “appropriate.”  This is crucial: if the hospital maintains that signing a consent form means your basic consent rights no longer apply, and all pregnant patients must sign such forms in order to be admitted, the hospital has formalized a policy of violating the consent rights of their pregnant patients.

This idea flouts human rights and U.S. constitutional principles, as well as guidelines from the obstetricians’ professional organization.  The American College of Obstetricians and Gynecologists (ACOG) has roundly and repeatedly rejected attempts to lessen or remove basic rights from pregnant patients, such as in a 2016 ethics statement when they stated: “Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life.” [link]

Join the waitlist for our new course, Obstetric Violence: What It Is and What Community Can Do About it, opening January 2022

Vilification of Victims

I have observed that anyone who speaks up about their mistreatment in maternity care will find they face all the barriers of a pre-feminist society.  They will find, as with so many rape victims in previous eras, the onus is on them to prove their story, their motives, and their damages, while the accused is innocent until proven guilty.  They will be told “there must have been a reason” their care provider did what they did. Surely, it must have been “for their own good” or the baby’s good that their rights were violated.

A woman named Katie in Arizona lost both her twins immediately after their unexpected premature births.  What compounded that tragedy, however, was what happened as she and her family sat crying and holding the babies’ bodies in the delivery room.  A male resident entered the room and, without asking, inserted a hand up her vagina to her uterus to start “cleaning her out” (his words).  In pain, she begged him to stop but he did not, dismissing her cries by saying she shouldn’t be able to feel it even as she said she could.  When she finally opened up about this experience to a coworker:

She told me it’s selfish people like me who can’t get over things is why there aren’t any good doctors anymore… because we ‘sue for everything.’  I did not sue and wasn’t planning on it. It wasn’t about that, it was about my consent, my worth as a person, and how I was treated in those awful moments right after I had to watch my babies die.

Another Alabama woman, E., says her doctor actually laughed at her screams of pain as E. followed instructions to hold back from pushing while the doctor prepared herself for delivery.  When E.’s distress turned out to be founded in a true emergency, the doctor panicked and mismanaged the crisis, resulting in an injured baby.  Her son required several surgeries and daily physical therapy in his first years–care E. vigilantly oversaw as she dealt with her own PTSD from his birth.

I was called “absolutely disgusting” by someone I considered a friend because I expressed ambivalence concerning my feelings of guilt surrounding the birth.  I expressed that I felt like the outcome was all my fault but at the same time… I trusted my care provider completely.  Apparently I deserved everything that happened because I trusted the wrong person and yes, everything was, in fact, all my fault.  Then there’s the gaggle of people who dismiss my entire experience because I must have misunderstood what was going on because emergencies are scary and confusing and a board certified OB would never do anything that wasn’t in my best interest.  And I really should just stop talking about all this because it makes me look like a bitter, angry woman.

E.’s last comment frames another typical response: that to call out abuse in birth, one must be a “doctor hater” or “anti-hospital.”  But each of these examples is of someone who willingly chose hospital care administered by medical professionals.  They felt hospitals would provide the safest setting for them and their babies and they assumed that they would receive competent, humane care from skilled providers.  Instead, they discover they’ve entered a world where their consent rights are the trade-off they make for care.  It’s no different than the reality we encounter as women when we date men and end up assaulted or work hard to earn jobs in male-dominated fields only to be harrassed.  These are the experiences women have existing in the world, and they should reflect on the abuser rather than the victim.

In 2015, I interviewed dozens of women last year about their traumatic births [link].  It was striking how many of them described being “gaslighted” when they tried to talk about what had happened afterwards.  They described being dismissed, ignored, talked over, and even personally attacked when they expressed grief about how they’d been treated during childbirth.  That lack of validation is a second trauma on top of the first.

The ways victims of obstetric violence are silenced are strikingly similar to what victims of sexual violence report.  We need to be aware of the cognitive dissonance when we treat obstetric violence victims as less trustworthy, less sane, or more deserving of violence than any other group of survivors.

Join the waitlist for our new course, Obstetric Violence: What It Is and What Community Can Do About it, opening January 2022

Maternity Care as Sexual Violation

“I want to say to my doctor, ‘I think about you every time I have sex with my husband.  Was that your intention?’ See, he didn’t ask before he put his fingers in my vagina just as I was trying to push out my baby.  Then he refused to remove them when I asked, then pleaded with him, ‘Take your fingers out of my vagina!’  Actually, he said to me, ‘You don’t need to talk to me like that.’” – J., Delaware

Medical professionalsl administering what they consider routine care can in fact be sexually traumatizing their patients in pregnancy and birth when they act on their sexual organs without explicit consent.  The potential for trauma is even greater for the significant number of women who have already been abused or sexually victimized in their lives.  ACOG advises that for this group of people, “past feelings of powerlessness, violation, and fear” can re-emerge in a setting where they are “in the lithotomy [back-lying] position and being examined by relative strangers” [link]

At the 2013 birth of her first child, Kimberly Turbin in California let her care providers know she was a two-time rape survivor and asked them to be extra patient and communicative with her.  Instead, her doctor made fun of her and took a pair of scissors to her perineum against her will.  She said “No! Don’t cut me!” and he did, twelve times, like he was slicing a pizza.  The entire interaction was caught on video.  Kimberly’s mother, off-camera, can be heard encouraging the doctor to ignore her daughter and admonishing Kimberly to listen and obey.

The PTSD Kimberly had already been fighting from her rapes re-emerged following the birth.  She said afterwards, “I dealt with those assaults by going to therapy.  Birth, I thought by letting everyone know about those assaults, they’d respect me considering they were professionals.  But [birth] was the worst assault I’ve ever faced because it was the most violent and took 6 months to heal from the worst of it and three years to even get a diagnosis!”  No one in her immediate circles supported her in her trauma.  For months after the birth, she repeatedly sought medical care for additional physical injuries and was dismissed out of hand.  One healthcare worker told her that if she couldn’t engage in vaginal sex any more, she could satisfy her man with anal sex. And above all, everyone told her, she had “a healthy baby,” and that was really what mattered.

Not too long ago in the United States, domestic violence, marital rape, and sexual harassment were considered fairly normal life experiences for women. The law allowed little or no protections, and society, for the most part, shrugged and accepted these unfortunate realities. The legal protections we have against them now are relatively new and still inadequate, but they are far more than what our grandmothers and great-grandmothers had.  It is no longer socially acceptable to joke on TV about beating your wife or to grab your secretary’s rear end.

Today, obstetric violence is one of those fairly normal life experiences that hasn’t aged out yet.  Every young person on a college campus has heard “No means no” in the context of sexual consent.  But when that same person is giving birth in a contemporary medical setting, we remain firmly in an era where “No means just get it over with faster” and “If she didn’t want it, she wouldn’t be here.” It reminds me of what a doula shared about a birth in 2022:

Finally, my client yelled at Dr. G to stop touching her without her consent and Dr. G responded by saying something along the lines of “This is why you are here. You are giving birth in a hospital because you wanted a doctor. If this isn’t what you wanted, why are you here?”

I hear a doctor saying that your consent rights are the trade-off you make to receive medical care in birth.  That is the jist of it, the normalization of the violence.  That maternity care means the appropriation of your body and erasure of your humanity. It breaks my heart that so many people believe this without critical thought, and can’t conceive of maternity care that is not violating.

The Obstetric Violence Culture Pyramid model is adapted from rape prevention literature.

Birth may be traumatizing, but maternity care doesn’t have to be.  Models like community-based midwifery and the emerging concept of Trauma-Informed Care center the birthing person, their rights, and their choices as a whole person.  We don’t have to continue perpetuating rape culture in birth; we can choose something different.

Whatever the model and whatever the setting, we must be clear about our affirmative responses to the questions, “Do our bodies still belong to us on the day we give birth?  Does our consent matter?”  We must stand behind birthing people when they say they have been traumatized and abused and when they assert:  My consent matters–in all settings.  I own my body–at all times.

Join the waitlist for our new course, Obstetric Violence: What It Is and What Community Can Do About it, opening January 2022

The post Birth in Rape Culture appeared first on Birth Monopoly.

Today, July 13, 2023, is the much-anticipated hearing in Montgomery, Alabama, about proposed birth center regulations in a state where there are currently zero.  As folks flood the hearing in person, we are hosting an action call via Zoom to support Alabama families’ and birth workers’ efforts for sound and reasonable regulations that would allow birth centers to open. (Register here to join.)

The proposed birth center regulations in question today, created by non-midwives and non-experts, are neither sound nor reasonable.  Most notably, they require physician authority and explicitly forbid the authority of Certified Professional Midwives–the only licensed professionals specifically trained to attend births in a birth center setting. Advocates are demanding the department rescind the proposed regulations and redraft them with input from midwives and experts.

Follow Dr. Stephanie Mitchell on Instagram as she fights the proposed regulations that would block her efforts to open Birth Sanctuary Gainesville.

 

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Below are some actions you can take, and more information on the proposed regulations themselves.

Alabama advocates’ demands

Alabama families and communities deserve midwifery led birth center care.  The state is in the middle of a maternal and infant care crisis and to deny these families this critical access is shameful. The proposed birth center regulations from the Alabama Department of Health would effectively prevent any birth centers from opening.  They are outdated, non-evidence-based, and represent clear harm.  In response to these terrible proposed regulations, we have two demands:

1. We are demanding they be abandoned with the intent to draft new regulations that support the midwifery led birth center care model.
2. We are demanding that these new regulations be drawn up by a committee of local and national stakeholders with expertise in birth center and midwifery care.

Here’s what you can do:

Advocate collectively in person at the hearing on July 13 at the Montgomery County Health Department, 3060 Mobile Highway, Montgomery, AL 36108.

Sign the petition at https://www.change.org/p/birth-sanctuary-gainesville

Call the department at (334) 206-5366 or (334) 206-5868

Email the department at

Denise.Milledge@adph.state.al.us

Scott.Harris@adph.state.al.us

Brian.Hale@adph.state.al.us

Carolyn.Bern@adph.state.al.us

Latisha.Kennebrew@adph.state.al.us

Kaye.Melnick@adph.state.al.us

Jamey.Durham@adph.state.al.us

Michele.Jones@adph.state.al.us

Karen.Landers@adph.state.al.us

Gary.Pugh@adph.state.al.us

Sharon.Jordan@adph.state.al.us

Write
P.O. Box 303017
Montgomery, AL 36130-3017

The Proposed Regulations

View the proposed regulations at https://www.alabamapublichealth.gov/about/assets/420-5-13.pdf

Comments by Barbara Christians BSN, RN, PMH-C, CLC, CBE:

The current proposed regulations of essential health services and facilities provided by midwives and free standing birth centers creates significant barriers and hardship for the people and families of Alabama. The regulations are restrictive and unsafe, unethical, and potentially illegal.

Specifically: 

• requiring physician oversight while there are notably several counties in the state of Alabama that do not have any licensed OB-Gyn MDs available for oversight or competent in overseeing midwifery practices; this gap is worse in the area known as “the Black Belt”;
• completely excluding Certified Professional Midwives in a state whose population wouldn’t exist as it is without the knowledge, skills, and actions of community based midwives, who were historically Black; 
• requiring written contracts for transfer of care between birth centers and a hospital are unethical when the Emergency Medical Treatment and Labor Act of 1986 “imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.” (CMS, 2022) This also applies to critical access hospitals such as those in rural areas that would be served by free standing birth centers. 
• limiting CPMs to assistance personnel required to work under MDs or CNMs, an action against Alabama’s own CPM scope of practice. 
• requiring two nurses to be present for births, this is not a routine standard of care in hospital based birth (labor units are historically understaffed and rarely consistently implement patient ratios that meet safety thresholds defined by the Association for Women’s Health Obstetric and Neonatal Nurses (AWHONN); in addition labor/ obstetric nurses are not educated or trained in midwifery models of care. 

These regulations are NOT aligned with National Birth Center Standards or Accreditation requirements. They are also at odds with regulations in other states whose maternal morbidity and mortality rates are significantly better than those in Alabama. With this context, it is clear these regulations are racist and medically neglectful to the health and welfare of the public of Alabama. Hopefully the direct impact of these proposed regulations was unintentional and the Alabama Department of Public Health will pause the integration of these unsafe and unethical regulations until a midwifery peer review can be conferred with and have midwifery oversight of proposed regulations of midwifery/birth centers. 

Midwives provide a variety of services beyond prenatal, childbirth, and postpartum care. These can include but aren’t limited to preventative reproductive services and education like screening for cervical cancer. Restricting midwifery practice additionally conflicts with ADPH’s own strategic plan to reduce and eliminate cervical cancer as evidenced by one of the overall strategic actionsImproved availability of appointments for cervical cancer screening/follow-up and HPV vaccination at County Health Departments, Federally Qualified Health Centers (FQHCs), and other local health care providers (midiwves being local health care providers). ADPH continues with the rationale by reporting Alabama ranks thirdwhen it comes to mortality and incidence of cervical cancer in the U.S., with great disparities across race and counties.1, 2 In fact, cervical cancer age-adjusted incidence and mortality in Alabama have not changed in the past 20 years (10.1/100,000 in 1999 compared to 10.1/100,000 in 2019). Unfortunately, age-adjusted cervical cancer mortality shows the same pattern (2.6/100,000 in 1999 compared to 2.5/100,000 in 2019).1

Midwives as community based and centered providers are uniquely equipped and capable of addressing the ADPH’s identified barriers to the state’s priority regarding cervical cancer screening:

1. 1. Lack of perceived risk – (e.g., monogamous, no sexual partner, belief that family history is a risk factor for cervical cancer)

• Lack of knowledge that cervical cancer is preventable

1. 1. Lack of understanding of what cervical cancer screening consists of – Patients do not know the difference between a pelvic exam and a Pap, and much less about HPV testing
   2. Pap tests being “coupled” with STI screening – Either patients do not get screened because they do not have STI symptoms and/or perceive Pap and STI screening as the same
   3. Primary care providers who do not perform cervical cancer screening – (particularly in rural areas) The reasons provided by primary care providers included lack of time, lack of a place to refer in the event of abnormal results, complex reimbursement process, and dealing with so many other health problems among their patients

• Limited availability of gynecologists – Particularly in rural areas

• Women do not go for regular check-ups after they stop having children or during inter-conception

• Limited capacity at the County Health Departments – Some counties have a nurse practitioner who provides family planning and screening 2-3 days per month

1. Lack of communication between local primary care providers and the County Health Departments – Resulting in a lack of continuity in care and difficulties in tracking screening results
2. Confusing cervical cancer screening guidelines as well as frequent changes (including age)
3. Stigma – Survivors do not share their stories and women do not
4. “know” anyone with cervical cancer

The proposed regulations conflict with Alabama Perinatal Excellence Collaborative’s (APEC) mission statement:

To lower infant mortality and improve maternal and infant health in Alabama through

1. Implementation and utilization of evidence-based obstetric care guidelines (ACOG supports and recommends midwifery care for low risk individuals)
2. Assessment of meaningful quality benchmarks (midwives are capable of contributing to community health assessment and quality improvement initiatives)
3. Enhanced communication and collaboration with providers, both primary and sub-specialty, and patients 

Proposed regulations go directly against the state of Alabama’s own laws regarding midwifery scope as publicly outlined and clarified by the state attorney general.

The post Alabama Birth Centers: Action Call appeared first on Birth Monopoly.

Warning: parts of the following birth story may be very difficult to read, especially if you have experienced birth trauma or sexual trauma.

For years, hospitals around the U.S. have co-opted the language of birth centers by quietly renaming their hospital-based maternity wards “birthing centers” in order to appeal to a fast-growing demographic of folks seeking gentler, lower-intervention care.  Hospital advertising–using language about “choice,” “autonomy,” and respect for birth plans–has evolved along with the changing demands of a more informed birthing population… but how reliable are those promises?

The Malatesta case in Alabama ripped the lid off a hospital marketing scheme when an injured woman sued the hospital that had defrauded her and potentially thousands of women in her community.  That hospital advertised a specific philosophy of care and services (“autonomy,” staff “specially trained” in natural birth) while actually having policies and practices in place that explicitly forbade those things from happening.  Caroline Malatesta went to the hospital in labor with her fourth baby having been promised water immersion for pain relief and freedom to birth in the way her body directed, but instead was put in a room with no tub, ordered to stay in bed, and wrestled onto her back–the doctor’s “preferred position”–to push her baby out.  Meanwhile, her son’s head was forcefully held in to prevent his birth because the doctor hadn’t arrived yet, and some combination of that force and the physical restraint used on Caroline to keep her on her back resulted in a devastating nerve injury to her, including the permanent loss of her sex life and ability to have more children.

A jury awarded the Malatestas $16 million for what happened to them, even as countless women in the community who will never receive justice came forward to say that they, too, had experienced coercion and abuse at that hospital and others around town.

More Bait & Switch

Today, an ongoing case in California has remarkably similar themes to the Malatestas’.  A mother, Jane Doe, alleges that fraudulent hospital advertising led her to give birth in a place she would never have gone to had they been honest about how they practiced.  She chose a Sutter Health facility and what it called a “birth center,” which claimed to offer “24/7 midwifery” from “highly trained” Certified Nurse Midwives.  The marketing used words like “privacy,” “autonomy,” and “respect.”  Jane says she confirmed multiple times in her prenatal care that they supported natural birth and options for natural pain relief, and that her privacy during birth would be respected.  Specifically, Jane asked that men other than her husband be kept from the room unless their presence was absolutely necessary and she gave permission.

According to Jane, however, the “evidence-based,” “low-intervention” care she expected did not materialize once she was in labor. Jane describes multiple instances of coercion and procedures being done to her without explanation or permission.  She says her birth plan was ignored–the piece of paper was literally pushed back at her when she held it out in her hand.  (You may want to skip the following quotes if you are sensitive to birth or sexual trauma.)

This is all from the complaint:

Later:

In the midst of all this, an unidentified man entered the room and peered at Jane’s exposed vagina; later, she alleges, he placed his ungloved hand on her buttock, took a “long look” at her vagina, and “grimaced in disgust.”

Finally, a vacuum was used to force her baby out of her body.

Jane was left with debilitating Postpartum PTSD and a pelvic nerve injury–just like Caroline Malatesta.

Reading Jane Doe’s story, I can’t help but wonder how many other families have experienced obstetric violence and preventable birth trauma at Sutter Health facilities calling themselves “birth centers.”

What birth centers are meant to be

Birth centers emerged in the 1970s and ‘80s as alternatives to hospitals for birth, and “professionalized” by 1985 with the establishment of national standards, a national membership organization, a national accreditation body, and a national research study showing impressive benefits from their use.

Birth centers are midwife-run facilities, usually with a low volume of births, serving women and birthing people who desire support and options (like water immersion, birth balls, privacy, freedom of movement) for physiologic (natural) birth.  Women who need or want epidurals or Cesareans must transfer to a hospital for those procedures.

According to the American Association of Birth Centers (AABC), a birth center is “a home-like facility” providing “family-centered care for healthy women before, during, and after normal pregnancy, labor, and birth,” guided by “the wellness model of pregnancy and birth” and “principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness” (read more here).  Nationally accredited birth centers are subject to certain standards (read them here) that govern everything from how they operate to whom they serve.

Probably the single most important characteristic of a birth center is that it follows a Midwifery Model of Care.  This is a “wellness model” that means pregnancy and birth are treated as physiologic processes, with medical intervention only when necessary.  The person giving birth is the center of care and the decision-maker, with an emphasis on informed consent by a care provider whose role is one of support rather than management.  (Read more here.)

Recent high-quality national research done specifically on accredited, freestanding birth centers shows excellent health outcomes and high patient satisfaction.  Superior outcomes include a 6% Cesarean rate, compared to a 27% national rate for low-risk women, with no increased risks for mothers or babies (read more here).

According to the late Kitty Ernst, midwifery pioneer and co-founder of what is now the American Association of Birth Centers, birth centers are meant to be “maxi-homes, not mini-hospitals.”

Birth Centers: “Few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety.” – From the National Birth Center Study, published in the New England Journal of Medicine (12/28/89)

Bait & Switch is Obstetric Violence

Bad-faith promises around sex and reproduction are violence against women.

A “sailors promise” is an oath you don’t intend to keep, named after the men who sailed from port to port getting women into bed with promises of love and marriage.  Once they got what they wanted, the men would sail on to the next destination free from consequences.  The consequences for the women, however, could be devastating in many ways.  You might be considered “ruined” and unmarriageable…  You might feel violated to learn that you consented to sex on the basis of deception… And, of course, you might be left with a lifelong commitment to the child of man who will not be your husband.

Likewise, hospitals lying to birthing women in order to “get what they want”–our business–is violence against women.  It is luring women into a sense of safety and support, to leave them at least disappointed, but at worst severely traumatized around a singular life event.  In cases like we’ve described here, the physical injuries these women received, on top of the psychological injuries, permanently altered courses of their lives.

How many more of us are out there?

Our Stories are the Evidence for Bait & Switch Practices

It’s difficult to prove bait & switch because it is simply a story about what we were told versus what we got.  When women express that they feel lied to, we are often gaslit by being told we heard wrong, our expectations were too high, or we just can’t understand the complexity of the circumstances that ended up happening.  Yet, there are tens of thousands of stories out there about bait & switch in maternity care, especially around promises made to support “natural” or low-intervention birth and vaginal birth after Cesarean (VBAC).

Our stories are the proof.

Interestingly, when I shared about the California case with my friend Rebecca Dekker of Evidence Based Birth, she instantly remembered a podcast interview she had done with a family who mentioned they’d been forced to labor in an awkward position at a Sutter Health facility (here) and another who went to one of their “birth centers” but were required to submit to continuous fetal monitoring (here).  Since Sutter Health is now being sued for misleading the public about their services, I wonder what other stories are out there?

Have you experienced or witnessed bait & switch tactics like what Caroline and Jane have described?
Birth Monopoly’s Obstetric Violence Map is a place to share your story, anonymously if you like.

PARENTS, DOULAS, NURSES, MIDWIVES:
CLICK HERE TO SHARE YOUR STORY NOW

Collectively, our stories have the power to advance medical research and legal advocacy.

The post Fake Hospital Birth Centers: Sutter Health Bait & Switch? appeared first on Birth Monopoly.

Hot off the presses: The first paper published on obstetric violence in the U.S.’ #1 perinatal nursing journal, Nursing for Women’s Health. Out August 13, 2023, Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence is free to download HERE until October 3, 2023, after which date it will live behind a paywall.

This paper was written by me, Cristen Pascucci, and three labor nurses whom I would also call activists: Maggie Runyon (@yourbirthpartners on Instagram), Mandy Irby (@thebirthnurse on Instagram), and Paula Rojas Landiver (@nursebrowngirl on Instagram).

Some excerpts:

• “The policies and processes we have in place and the dominant hospital birth culture continue to undermine bodily autonomy and consent.”
• “[Nurses’] complicity in provider-led abuse and mistreatment is in direct contrast to our stated ethical obligations. Our involvement can result in a deeper sense of betrayal in our patients when they anticipate our support in our role as their trusted advocate.”
• “Trauma-informed nurse actions to prevent obstetric violence include asking every time before touching or performing an action on a patient’s body. Clinicians need to reject paternalism and to believe that patients have their own best interests in mind.”
• “[Perinatal nurses] have long ignored our contributions to obstetric violence and high rates of birth trauma. We must step forward into our collective power and demand action from our fellow clinicians.”

Download for free HERE until October 3, 2023

The role of nurses in preventing obstetric violence is just one of many moving parts of a deeply entrenched problem; ultimately, it is going to take major institutional initiative and support for any meaningful shift to happen. How are nurses supposed to practice respectful care across the board when they are penalized or lose their jobs for practicing that way, or for reporting others who mistreat patients?  One critical step hospital administrations must take toward creating a culture of safety for patients is to actively support and protect nurses who advocate for their patients and whistleblow on abusive providers.

If you are a nurse who finds yourself feeling offended, angry, helpless, or personally attacked by this article, check out the amazing work by two of its authors at @thebirthnurse — a safe place for nurses to process those feelings and address their root, which is trauma.

The post Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence appeared first on Birth Monopoly.

Birth Monopoly is excited to announce we are now a licensed Continuing Education Provider approved through the State of California Board of Registered Nursing, able to provide nursing contact hours within the U.S.

That means we can help nurses, nurse midwives, and doulas around the country fulfill their ongoing education requirements with innovative, trauma-informed education, ideas, and practices.

Right now, our two signature courses for maternal health workers, both available online, are Know Your Rights: Legal & Human Rights in Childbirth and Obstetric Violence: What It Is & What You Can Do About It.

Coming in 2024: in addition to current online offerings, we will be rolling out in-person institutional trainings on patient rights and eliminating obstetric violence with the new year. Birth Monopoly’s team now includes three amazing Nurse Educators to take our curriculum right into hospitals (read about Barbie, Mandy, and Paula at birthmonopoly.com/about).

If you are a decision maker at your hospital interested in improving the patient experience and quality of care at your facility, message us at birthmonopoly at gmail dot com.

The post We Are Now a Licensed Continuing Education Provider appeared first on Birth Monopoly.