What do I do now?

I orginally got a copy of my medical records from my daughter's birth just a few months after she was born. At that time, I read them, discussed them with my family practice doctor, and decided to enter counseling to learn to cope with my experience. I put the records away, and completely forgot about where they were.

Last summer, things were really getting to me again, and since I couldn't remember where my records were in addition to them being somewhat incomplete, I requested a new more complete copy of them. By the time I received them, I was back in counseling, and I'd relaxed enough that I didn't really feel the need to read them.

When I was sick over Thanksgiving, I found the new set of records. I paged through them, re-read the narratives, and threw them out. I noticed that they specifically mentioned me "consenting" to procedures. However, I didn't remember that being in the original set of documents. However, the other day, I noticed the original set of the records was buried at the bottom of a drawer in my daughter's changing table. I made a note of their location in the back of my mind, and went about my business.

Yesterday morning, I woke up a little bit before the alarm went off. As I was laying in bed, it suddenly hit me. They'd changed the original records. It bothered me a bit, but I had work to do, so I put the thought aside.

This morning, I grabbed my original copy of the records, and re-read the notes on my daughter's delivery. In the original narrative, there's no mention of the doctor obtaining consent for the D & C, manual removal of the placenta, or fixing the uterine inversion. However, I'm positive that the current records have been altered to include "consent" issues.

What do I do? I don't know if I should request another copy of the records. I'm not sure if I should file a complaint with the hospital, state medical department, or find an attorney. I had registered a complaint with the state medical department a couple of years ago, and I'm sure my records were altered to avoid punishment at that time.

I don't know. I'm perplexed, frustrated, and angry right now. I feel like I've been re-violated because they're unwilling to face up to their own actions.

Snapping Turtles in Truck Beds

One of my most vivid memories from the year I started first grade, is of a huge snapping turtle in the bed of a pickup truck. One of the men on the indian reservation had captured this turtle, and he'd brought it over to the church to show it off to all of the other families. He found this big stick, actually a good sized tree branch, and was poking it at this turtle. I remember watching the turtle snapping at the branch, he was angry, scared, and trapped. The turtle just kept spinning around in the bed looking for new threats.

The year I turned six was a crazy year. I lived in 4 houses and 3 states, one of those houses was on an Indian reservation. I attended three different schools, and I was physically attacked by my little sister nearly every day. My family went from being solidly middle class to living in subsidized housing because my father decided to get out of the military and go back to college. There was so much instability and upheaval in my life.

Using EMDR yesterday, I was 5 again. The fear, the anger, the hatred, the pain, and the feeling of being dismissed that I’d bottled up so many years ago, erupted from their hiding place as a result of my daughter’s birth.

I felt like that snapping turtle – everyone poking at me, no place to go, no place to hide. I was trapped, angry, fearful, hurting, and confused by all of the changes in my life. At 5 you have no control over your parent’s choices. You live where they tell you to live. You wear what they tell you to wear. You act the way you’re told to act.

I don’t want to be that scared 5 year old anymore.

I am a 38 year old woman. I am a wife and a mom. I own my own home. I have a career. I have friends. I am only trapped by my mind. I no longer live in an abusive home. I no longer have to worry about a roof over my head, food on the table, and clothes on my back.

I am not a turtle fighting to get free.

Birth Rape Rears its Ugly Head Again

After two years of living with the consequences of my OB’s actions I really should know better than to Google Birth Rape. It seems like every 9 – 12 months something stirs up the discussion fires on this topic. This time, Café Mom seems to be the instigator. There’s poll, a forum, and a journal / blog post on the topic. Now, at least one L & D nurse is weighing in on the subject as well.

There seems to be some misconceptions about what women are referring to when they define their birth experience as a birth rape.

1. Just because someone, a nurse, midwife, or doctor, breaks your water doesn’t make it a birth rape. Just because birth is painful doesn’t make it a birth rape. Just because you have a cervical check doesn’t make it a birth rape. Most of the time, healthcare providers ask permission to do these things. If you consent, it’s NOT rape.

I had my water broken, but I consented. That procedure was not birth rape. I had an IV, but I consented. That procedure was not birth rape. I had several cervical / vaginal exams, but I consented. Those procedures were not birth rape. I was asked to lie on my side during the majority of my labor, but I consented. That was not birth rape. I had continuous fetal monitoring and EFM, but I consented. Neither of those were birth rape. I had a vacuum assisted delivery, but I consented. That was not birth rape. As long as you consent to the procedure whether it’s verbal or written it’s not rape. Just like when I consent to having sex with my husband it’s not rape.

2. Women who call it birth rape deserved what they got. After all if the baby has to come out, so whatever is done in that process is acceptable. If you go to the hospital as long as someone with an ID badge does it to you it’s okay.

Where I live, we have a Patient’s Bill of Rights. Competent patients have the right to decline any and all medical procedures. Competent patients have the right to be told what their diagnosis is, what the treatment options are, what are the risks associated with those options, and allowed to make their OWN decision. Therefore, the doctor, midwife, or nurse is not always right. They don’t have the power to force a woman to submit to procedures that she doesn’t want. They don’t have the right to coerce a woman into submitting to any procedures, and they don’t have the right to abuse their patients.

3. Women are just whining because they didn’t get the experience that they wanted to have.

What? There are a lot of things about my daughter’s birth that didn’t go the way that I wanted. I didn’t want to be induced. I wanted to go into labor on my own. However, complications prevented this from being possible. Did that traumatize me? NO! Did that result in a need for counseling? NO! It was simply a disappointment. Do I label any of those procedures that I didn’t want, but consented to, as birth rape? ABSOLUTELY NOT!

4. If it’s a rape, why don’t you report it, and have the perpetrators prosecuted?

I did report the actions of my doctor. I reported them to the State Medical Board, the hospital where he practices, and I sent him letter. However, the State Medical Board has the same attitude that a lot of women on this forum have- he’s the doctor, so he’s right. My report was denied because I didn’t have enough evidence to prove it. Doesn’t that sound like a typical rape case? It’s my word against yours. It doesn’t make what happened to be less truthful or less traumatizing. As to why I didn’t sue him, well like a lot of rape victims, I didn’t want to re-live it. I didn’t want to sit in the same room with him. I didn’t want to bare my emotions, and mental issues in front of a jury that doesn’t believe that birth rape happens.

5. You don’t develop mental issues from a bad birthing experience.

Actually, I did develop mental health issues as a result of his decision. I spent 18 months in counseling for PTSD. PTSD doesn’t go away. You learn to live with it, you learn to cope with it, but it doesn’t go away. I’ll have these scars for the rest of my life. They’ll gradually fade with time, but they will never go away. I live with nightmares, flashbacks, dissociation, and anxiety. I have panic attacks when I go to the doctor. I have had flashbacks during sex – what a mood killer. I’ve denied my husband sex because I’ve been terrified of having another child. My marriage was nearly destroyed because of the severity of my symptoms.

6. So what do I call my birth rape?

For me, birth rape refers to a specific procedure at a specific time that was performed without my consent.

My daughter was born at 11:32 pm. Approximately 15 minutes later my doctor asked the nurse to tell him when ½ hour had passed after the baby’s delivery. At that point in time, he knew that the placenta wasn’t detaching properly. Did he discuss this with me? No. He just kept biding his time waiting to see if it would change. Shortly thereafter, I notified the doctor that his ½ hour was up. Did he tell me then, that there was a problem with the placenta? No. He attempted cord traction to get the placenta to release. The umbilical cord tore off the placenta leaving the placenta attached to my uterus. Did he notify me then that there was a problem with the placenta, and offer me the opportunity to choose between treatment options of having him try to manually remove it or have it surgically removed? No. He just shoved his hand inside me, and tried to pull it out himself. Why wouldn’t I have seen this as a rape? He wasn’t saving my child. She was already born. He wasn’t saving me since at this point he didn’t see this situation being emergent. I was competent, and capable of consenting. He chose not to allow me to consent.

The pain of this procedure was extraordinary. It’s beyond the realm of anything I had ever experienced. It sent me into a place where I was incapable of providing consent for any additional procedures. Even though I didn’t consent to the D & C, even though I didn’t consent to the re-installation of my uterus, even though he spent almost an hour with his hand elbow deep in my hoo-ha trying to shove my uterus back into place, I’ve never considered those procedures to be birth rape. The situation had become emergent, I was mentally incapable of providing informed consent, and I was at the mercy of his skill, knowledge, and competency.

You see, Birth Rape is about power and consent. It’s not about sex. It has nothing to do with sex. In some ways, birth rape is worse. You’re in a place and surrounded by people who are supposed to keep you safe, but you’re not. You can’t advocate for yourself if they don’t tell you first what they’re going to do. You can’t fight for your rights when they deny them. My doctor wasn’t evil. He wasn’t trying to harm me. He got caught up in the complications, and all he saw was a problem. He forgot that I was a person, and only saw the complications.

Birth rape is real. Birth rape is evil, and eventually it will become prosecutable. Right now it’s impossible to get anyone to believe you.

Besieged? You don't know the meaning of Besieged.

I read a blog post the other day by a doctor talking about medical (doctor) writers. She happens to really like a specific author, and the quote that she included in her blog was about a doctor feeling besieged.

Besieged is kind of a triggering word for me. I felt besieged at the hospital. Therefore, it’s not a word I’m comfortable hearing in this context. I read through the entire post, and looked the word up in the dictionary. The specific meaning of the word in this context referred to being overwhelmed. I can understand a doctor feeling overwhelmed at times. There are times I feel overwhelmed at work. Everyone from the burger slinging cook at Mickey D’s to the President of the United States will feel overwhelmed from time to time. However, there’s a huge difference between feeling overwhelmed and feeling like your castle walls are being breeched.

I don’t think people really understand what being besieged feels like any more. When the army surrounds your castle, when the gates hang crookedly from the hinges, when the larders are empty, when the well has gone dry, when the foundation is cracked, when the attackers have you strapped to the rack, and your family, friends, and army are being slaughtered then you know the true meaning of being besieged.

This is the way I felt in the hospital. I was surrounded by medical personnel who were supposed to keep me safe, and instead I was nearly destroyed. My personal gates were violently breeched with no warning by the doctor. My soul was emptied, and my emotions had run dry. I felt like I was strapped to the rack with all of the tubes, monitors, and paraphernalia I was attached to, and being tortured by the pain between my thighs. My marriage was in tatters, and my brand new family was hanging together by a thread. I faced endless nights of nightmares. I faced flashbacks during the day. At that point in time you have to make the choice to pick up the pieces, or wallow in the pain, fear, anger, failure, shame, and rage.

I made the choice to reach my hand out for help. I had to rebuild the foundation of my being one stone at a time. I had to learn how to live again, how to love again, and how to have fun again. I had to learn to harness my anger and control my rage. I’ve had to face the reality of my fears, and build a tomorrow I believed was gone. I’ve learned to cope with the anxiety, and I’ve grown stronger.

I’ve been besieged. I’ve been betrayed. I’ve been violated. My new castle walls may not be pretty, they’re pitted and pocked by the previous battles, but they’re much stronger than they were.

In honor of Valentine's Day

My husband has been really great during this journey. It's not one that either of us intentionally signed up for, but he's handled it far better than I expected. He's the one who recognized when things were spiraling out of control. He's the one that prodded, and poked, and harassed me into seeking help. He's the one who kept poking and prodding and harassing me into not accepting that medication was going to solve everything. He's been willing to do whatever it takes to get me healthy and happy again.

One night stands out for me. It was the first night that he was staying home with our daughter so that I could have a night out with the girls. He came home with a present. He sat me down on the couch, told me that he loved me, gave me the present, and told me that he wanted us to recommit ourselves to each other.

You see no matter what, he loves me. It doesn't matter to him if I'm fat or thin. If I'm damaged or normal. He accepts me the way that I am right now.

It's an amazing feeling. I can't begin to tell anyone how important or essential that has been to me over the last 21 months. Whatever it takes, he's there.

I wear the watch that he chose for me gladly. It's not my style. I'd never have picked it out myself, but it reminds me that I'm never alone. He got a matching one for himself, and it's just one more sign of our commitment to one another. We wear them like our wedding bands.

So, thanks for being there for me. I love you.

The Power of Surrender

One of the things I’ve worked on is seeing what I perceived as my failures during my daughter’s birth as surrendering to the medical professionals. Surrendering is choice. Surrendering is recognizing that you’re in a losing situation, and making the choice to cut your losses. It doesn’t require that you like it, enjoy it, or are at peace with it. It doesn’t give the people who forced you into the position as pass or a “get out of jail free” card. However, there’s great power in making the decision to surrender.

So, when did my surrender occur? It happened when the pain consumed me. It happened when I realized that I was incapable of making decisions for myself. The initial moment of surrender came just seconds before the doctor tried to remove the placenta. It came in the moment where I told the nurse I didn’t want to hold my baby. At that point in time, I knew something was wrong, really wrong. I knew that I needed professional medical treatment. I couldn’t put my finger on what it was. I didn’t know the words to describe the way I was feeling. I didn’t have time to voice my concerns, but I recognized that without further intervention things were going to hell. While I recognize that I was surrendering to the medical personnel at this time, it doesn’t absolve my doctor of his decision. It doesn’t give him a pass on not communicating to me what he was going to do and why he was doing it. He still had a responsibility to communicate my diagnosis, propose a treatment option, and give me the opportunity to consent. Yes, things went to hell, but that doesn’t mean that he was free to do whatever he wanted to my body.

I also surrendered a second time. I surrendered to my fate, and that occurred when they rolled me into the operating room. I remember that moment, the feeling of giving up, of being willing to die, knowing that I’d given life to my daughter. I hate thinking back on it. It’s painful, scary, and hopeless, but it was surrendering. Even before I’d accepted this concept, I’d written about it. I wrote about the pain after my daughter’s birth just after she turned one,

The pain is all consuming. You can't think. You can't breathe. You can't hear what they're saying. You can't process what's happening. It wraps around you smothering you in a cloud of darkness and fear because you know it's not supposed to be like THIS. You can't form the words to question what's happening. You're sucked down into the black void of semi-consciousness not caring what they're doing to you because all you can focus on is the pain. It's the only thing that exists. They're pricking you with needles, people come running in and out, and someone straps a mask over your face. You feel the doctor's hand shoved all the way inside you. How the heck did it get there? The pain sucks you away. You struggle to breathe and continue to fight. Try to breathe through it, but you can't ride the waves. It's consuming your body. Don't quit. Don't abandon the baby. Keep fighting. Some comments break through. You can hear the anger and fear in the doctor's voice, and it scares you even more. But you're sucked back down into the depths of hell wondering what's happening. You feel the bed being wheeled down the hall. You sense the bright lights of the operating room beaming down on your eyelids, but the pain pulls seductively at you. Just give up. Stop fighting. Surrender to your death. Abandon your baby. Just let go. And then the anesthesia sucks all your thoughts away.

In the fourth sentence from the end, I wrote, “Surrender to your death.” Even then, I was recognizing that I had a choice to make. Even senseless, strapped to the operating room table, in agonizing pain, I had the power to surrender. It was my choice to give them, the medical personnel, the power to save me. It was my choice to submit to their will, it was my choice to accept the treatment that would ultimately save my life. Even when I was at my weakest, I had the power. When I felt like the biggest failure, I surrendered. When I believed all was lost, I submitted.

There’s nothing more powerful than making that decision. I surrendered to live. I surrendered to support other new moms. I surrendered to fight for patient-centered maternity care. I surrendered to share my story with others, so that we can all learn from the mistakes of the past. I surrendered to care for my newborn daughter. I surrendered to raise her, God willing, into adulthood. It was always my choice.

Giving up my Power?

I was reading a Birth Trauma forum the other day, and the question posed to their site was, “When did you give up your power?” There were some interesting answers. Some women said they gave it up in their childhood. Some said the medical establishment slowly eroded it. Some women blamed their spouses for not agreeing with or supporting their vision of their birth.

Personally, I’m struggling with the question. I think there’s a bit of shame associated with it. It blames the woman by assuming that “she gave up her power”, like it’s always in our ability to have a great birth experience. That no one else or nothing else can violate us if “we just don’t give up our power”. I don’t see choosing to see an OB or choosing to see a midwife is “giving up our power”. I don’t see choosing a hospital or choosing a homebirth is “giving up our power”. You don’t automatically lose your power by making a choice.

I don’t think that’s the way they mean the question. I think they’re assuming that the women responding had typical, uncomplicated pregnancies. They’re assuming that there are no complications that can or should be taken into consideration when making the decision.

However, complications, while sometimes over-diagnosed, can be real. There are times, not all the time, when having your child in the hospital is the safest place for mom to be. There are times when having a birth attendant is the safest situation to be in for both mom and baby.

I have to say the question’s been bugging me. You see, I don’t think I gave up my power by choosing an OB. I didn’t give up my power by choosing to listen to him when complications arose. I didn’t give up my power by choosing to have my baby in a hospital. I didn’t give up my power by choosing an epidural. Let’s face it, I argued myself into an epidural despite the anesthesiologist’s objections to providing it. The doctor stole my power when he chose to perform a procedure without my consent. I didn’t give it up, it was STOLEN.

There’s a huge difference between those two concepts. I have to admit that I didn’t fight to get it back during the remainder of my stay, but that was my choice. I chose to focus on healing. I chose to focus on getting out of that hospital as soon as I could. I chose to focus on me. I didn’t want anything to get in my way, but there again; I guess that is taking back my power. It was my choice; therefore, the power was mine. I didn’t fight for answers; I chose to save my energy to fight for healing.

Maybe having a choice is having the power. Except for the procedures after my daughter was born, I made the choices. They might not popular in the home birthing community, but they were my choices.

Am I an advocate or a wimp?

So, I feel like I wimped out by choosing to not speak to the doctors tomorrow. I know that it's not so much a matter of wimping out, so much as it's a matter of choosing to focus on fixing myself. However, I tend to use negative phrases or comments to describe myself instead of positive ones, so it's easier for me to say I wimped out.

My counselor told me that I'm becoming an advocate because I chose to provide my doctor with my writings instead of just cancelling. I'm not sure how I feel about that. I don't want to be an advocate. I don't want to be an activist. I just don't want anyone else to feel the way that I do right now. I don't want another woman to feel like she's powerless. I don't want another woman to feel like she's been coerced into procedures that she doesn't want. I don't want another woman to feel as isolated as I do. I don't want another woman to feel like she has no one to talk to, or no one who understands her. I don't want another woman to feel like the nurses are re-traumatizing her by their dismissive attitude. I don't want another woman to believe that she's worthless, like she's a vessel, like she's nothing. It's a horrible feeling to know that no one believes you count for anything.

I'm tempted to show up at the hospital tomorrow even though they're not expecting me. I'm tempted to see if I can make it through the discussion without breaking down. I don't know. I know that it would be incredibly hard for me to be strong enough in my beliefs that I don't feel like I'm being judged as worthless, ignorant, or unreasonable in my expectations.

In 37 years, I've learned that problems don't go away by themselves. Ignoring a problem won't make it go away. Not talking about a problem doesn't get it resolved. There's a problem in our maternity system. When 10% of women test positive for PTSD after their children's birth there's a systemic problem with the maternity care in the US.

I don't know how we fix it. If there's anyone that understands that complications can be real, that some women need more care or interventions than others, it's me. I know that homebirths aren't the answer to the problem. I know turning care over to midwives isn't the answer to the problem. I know that birth abuse can happen at home, in the hospital, or in a freestanding birth center. I know that midwives, doulas, and doctors can all be perpetrators. I guess that's why I cringe at being called an activist / advocate. Too many people see the solution as being so simple as making homebirths the norm, or midwives the norm.

Maybe it's a simple as making sure that doctors, nurses, midwives, and doulas are making the decision to provide patient centered care. Maybe if we had a more open dialogue between caregivers and their patients on their childbirth philosophies we'd have better outcomes. Maybe if caregivers were more open about how they really practice their craft patients would be able to find a caregiver that provides them with the type of care they desire. Instead we get blind-sided. The on-call caregiver delivers your baby instead of the person you've developed a relationship with. We get stuck with a nurse who's having a bad night, and doesn't want to be at work, so she takes it out on her patient.

It's so hard to make the right choices. No matter what we choose, someone says we're being too inflexible. We're taking risks by having the baby at home. We're taking risks by having the baby in a hospital. We're taking risks by breastfeeding, or we're taking risks by formula feeding. It's enough to make your head spin. Why don't we support each other instead of questioning each other? Why don't we bond together as a team instead of looking for the saboteur?

Advocate or wimp? I don't know. I know I won't let this drop.

“It is often easier to ask for forgiveness than to ask for permission.” Grace Murray Hopper

That quote makes me crazy. It’s what happened the night my daughter was born. People, well doctors really, seem to think that they don’t need to ask for permission. They seem to think that once you’re in their place / hospital / care / etc. that they can take charge and do what ever they wish. Once you’re on their turf, the game is over, the power is stolen. A birthing woman is less than nothing. She’s an incubator. Her wishes can be ignored or over-ruled if she’s even given the opportunity to participate in her own care.

I need to add a comment about this quote to my birth plan. It’s fundamental to why I was so traumatized. There was so much rationalization on the doctor’s hand that night. “She had an epidural, she’ll never feel it”, “I’m the doctor, and I know what’s best”, or my favorite, “it’s just a medical procedure” to having a hand shoved elbow deep in your uterus with no communication. It sure didn’t feel like a medical procedure to me. I didn’t grant permission. I didn’t say, “yes. Go ahead”. I didn’t say, “I understand the placenta is stuck, and you need to try to get it out”. I wasn’t given the option to say yes or no. Permission? What’s that? Those consent forms cover it, right? Yep, just like a marriage certificate guarantees that my husband can have sex anytime he wants. I wonder what my doctor will think about the addition?

Here’s my revised birth plan:

This isn’t the typical birth plan. I know that things can go wrong very quickly. I don’t care about IVs, pitocin, dim lights, or vaginal exams. I expect that I’ll be trapped in the bed by a multitude of cords coming out of nearly every orifice. I expect that things will go wrong, all hell will break loose, locusts will descend upon the earth, and the plague will rage throughout the land.

However, I would like this experience to be better than my last birth.

Communication

Please talk to me constantly, especially when I can’t see what you are doing.

Please follow this protocol when explaining interventions to me because I may not ask the appropriate questions.

• Get my attention! Call me by name, grab my hand, look into my eyes, and talk to my face - not my cervix or anyone else in the room.
• Why do you want to intervene?
• What intervention do you want to implement?
• Are there any long-lasting side effects or consequences of this intervention?

While, “it is often easier to ask for forgiveness than to ask for permission”, it is not the right choice to make when it comes to breaching my reproductive organs. Ask before placing anything inside / through my cervix, hands, electrodes, amniohooks, etc.

If there is any disagreement between caregivers over what treatment option is appropriate, please work it out between yourselves. I don’t wish to take sides, or argue with either of you. If there is a legitimate choice for me to make, please present me with both options in a non-confrontational manner, and allow me a few moments to reflect upon my options prior to making a decision.

If I tell you that something isn’t right or isn’t working, please believe me instead of dismissing my comment as a fallacy because I’m not acting the way YOU believe I should be acting to make that comment a truth.

Please tell me the name of every medication that you are giving me whether it is given orally or through an IV at the time you administer it, and write it down for me before I am discharged.
Please write down any complications you diagnose prior to my discharge, so that I can research them after I get home if I have any questions about them.

Procedures

My uterus has a history of flipping inside out, so please don’t pull on the umbilical cord.

I only consent to manually removing the placenta if I’m fully anesthetized. Please verify this with me prior to proceeding with the procedure.

If I’m hemorrhaging, have another accreta, and my uterus has inverted again, then don’t take extreme measures to save my uterus. I won’t be using it again.

Birth Rape?

Birth Rape

Isn’t that an ugly term? The first time I heard it, I thought a bunch of radical feminists were making a big deal out of nothing. How can those two words possibly be spoken together? Birth is about innocence. Is there anyone more innocent than a newborn baby? Rape is so ugly, so violent, so brutal. It offended me at the core of my being. However, I think there may be something to it.

Some people believe that birth rape can only occur if a woman has been previously assaulted. They believe that the birth itself isn’t a rape, but that the woman is experiencing a flashback to a prior criminal act. This flashback is so real, that they transfer their feelings about the original assault to the act of giving birth.

This experience impacted me the night my daughter was born:

I’d met this guy six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the bed while we were talking. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Doesn’t this sound like a date rape experience? I trusted this person. I invited them into my personal space. I didn’t give permission for this to happen. I tried to get away. I was violated. I must have had a flashback to this prior crime during my birth if I think birth rape is a valid term.

Now, let me change six words:

I’d met this doctor six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the hospital bed while we were talking after my daughter’s birth. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Does that change you opinion of my experience? Do you believe this behavior is suddenly acceptable? Why is it that behavior that is unacceptable every where else in society suddenly becomes acceptable in a delivery room? Before my daughter was born, I’d never been the victim of a violent crime. I’d always been treated respectfully by the men in my life. No one had ever touched me in an inappropriate manner. This wasn’t a flashback. It’s my reality.

Birth is an incredibly intimate act. It requires you opening parts of yourself that you keep hidden from the world in order for it to happen. It’s deserving of the same respect that women expect when giving themselves to their lover. It’s something to be treasured. If consent is so essential to a healthy sexual experience, consent is also necessary to healthy birthing experience.

It took several months before I admitted that my daughter’s birth had resulted in my birth rape. I didn’t want to admit it had happened. I tried hiding from it. I tried ignoring it. I didn’t report it. I blamed myself for it. But I’ve learned that this doesn’t help, so now I’m talking about it. I’m not sure yet if I’ll discuss this when I meet with the doctors at the hospital, but I’m thinking about it. I know they don’t want to admit that this happens. I know they want to bury their heads in the sand, but someone has to speak out. There was a time when people didn’t believe that one spouse could rape the other, but now we recognize this as a truth. In this time we live in, people believe that a woman in labor cannot be raped, but a time will come when we will believe in this truth also.

Building Relationships

If having a relationship with your physician is essential to building trust, who should initiate the relationship? The patient? The physician?

I didn't form a relationship with my former OB. I went to my appointments. I was honest. I took his advice. I asked questions when I had them, but being the last of my friends to become a parent left me with most of my questions answered. I read books. I searched the internet. I didn't write a birth plan because I recognized that each complication eliminated choices, and there was no point in getting myself hung up on a specific vision of the birth when I knew how quickly things could change. Was it my fault we didn't form that relationship?

I walked into my first appointment with him scared because I'd spotted over the weekend. It stopped after an hour, so I didn't feel it was necessary to go into the ER to get it checked. I simply set up an appointment for right away Monday morning. Throughout my whole investigation into choosing a new doctor, it had never occurred to me that I would stay with this one. My thoughts from the get go were simply to find someone to help me get this baby out safely. I had every intention of going back to a family practitioner after the baby was born. Was that the "fatal" flaw in my thinking? Should I have been committed to this relationship before it started?

I saw the situation similar to that of needing any other specialist. The family practice doctor refers you to a specialist for a specific condition. The specialist helps you resolve that condition, and you go back to your original doctor. There's no need to see an ENT if you sprain your ankle, right? Was I wrong in considering my pregnancy to fit this model? Or, was he wrong in not instigating it? Should he have done more than ask the specific diagnostic questions that helped him guide me down the path. Was he responsible for bringing up his birth philosophy to me, his patient?

After I left his care, I interviewed several doctors around the metro. I checked out doctors at the large urban hospitals. I checked out doctors that my co-workers saw. I didn't "click" with any of them. Instead of being reassured, I felt devalued. Instead of being calm, I felt anxious. Instead of feeling autonomous, I felt trivialized. Even my family practice physician, someone I'd seen for 15 - 20 years, contributed to my feelings of betrayal. He made a huge mistake in referring me to my former OB's wife for counseling, and this destroyed our relationship. I felt uncomfortable seeing him. I was afraid to be betrayed again, so I kept trying to figure out what to do since I knew I couldn’t remain in that relationship.

I was surprised when I met Dr. B for the first time. She really initiated the beginning of our relationship. When I tried to trivialize my experience, she forced me to expound on it. When I tried to change the topic, she circled me back around to the problem. She made sure I was getting help. She offered different options for treatment based on my current issues like flashbacks, anxiety, and dissociation. She made sure I was comfortable. She didn’t rush me out the door. She made sure I was okay with my daughter. She made sure I was okay with my husband. She looked for emotional well-being as well as the physical which ended up being easily cured.

As for my old OB, well, I have to accept some portion of the responsibility for not building a relationship with him.

Maybe we failed each other.

Trust

Do you trust your doctor?

Is trust essential to the doctor – patient relationship?

I’ve read several blog posts by healthcare providers talking about trust. In one, the author basically requires trust from her patients. She believes that she works hard to develop a trusting relationship throughout her client’s pregnancies, and in an emergency those clients should immediately acquiesce to her demands because she’s built a relationship on trust, and in an emergency she shouldn’t have to stop to explain the complications, the patients should simply react. In another blog, the caregiver demands that patients who don’t trust him should find other care. In a third blog, the caregiver wants to find a way to study a trusting relationship, and bring the concept into evidence based practice. However, is trust too strong a word for what they really want?

Trust is difficult for me to give. I don’t trust my parents. I sometimes trust my husband, but not always. I don’t trust my daughter. After all she’s only one, and she doesn’t have any concept of the long term consequences to her behavior. I don’t know that I’ve ever trusted a physician. I respect them. I’ve found most of them to be well-educated in matters that I’m not educated in. I’m willing to take their advice because I believe that they’re actually looking out for my best interests, although I have been willing to negotiate other treatment options with them when I believe it’s justified. Isn’t that enough?

I lost all trust I had in my former OB after my daughter’s birth. His lack of communication in an emergency destroyed my respect for him. Without communication, information, or knowledge there is no consent. Without consent, there is only anger, fear, and violation.

My husband lost his trust as well. His was lost due to non-verbal communication during the emergency. He recognized the "Oh shit, I'm fucked" look on the doctor's face before he started verbally communicating. At that point, my husband checked out of the room. It brought up all of his barriers, and he never heard anything the doctor said after that.

Communication, especially during an emergency, diminishes fear. It keeps the patient feeling like they’re still in control even though chaos may be swarming around them. It gives them something to cling to when they’re fading in and out of consciousness. Open and honest communication during an emergency, even if it’s not a full explanation, can keep a patient calm, focused, and rational enough to comply with the needs of the medical staff. Knowing what and why things are happening helps patients to process the event as medical procedures.

It took me several months to find a new caregiver after I left my former OB and my former family practice doctor. I found that I couldn’t stand the thought of having a man examine me. I just kept waiting for the other shoe to drop despite the 15 – 20 year relationship I had with my former family practice doctor. Our relationship wasn’t strong enough to withstand the distrust I now experience with male doctors. I even interviewed a new OB at a different hospital. He tried to sound positive and uplifting, but instead came off as patronizing. The last thing I needed was another doctor who believed that he is or was infallible.

It was a fluke that I found this new doctor. I called the clinic to make an appointment to see any female doctor, and this is the one that had an opening. It wasn’t well-researched, but she listened to me. She didn’t let me off with the dismissive practiced answers I had for my pregnancy. She ferreted out answers, and as a result I switched my and my daughter’s care to her. Patients need to develop a relationship with their doctors. I don’t know that it has to be built on trust. I do believe that respect is a strong enough bond. However, it’s difficult to build a relationship when you only see a physician once or twice a year. By having her care for my daughter I increased the number of times I see her in a year to almost once a month. I don’t trust her. I don’t trust any doctor, but I respect her knowledge. I respect her training. I respect her ability to listen to my concerns, and help steer me down a path that meets my needs.

Maybe it is trust, I don't know. Personally I think it's too strong a word, and yet when I researched this issue for the presentation I'm giving at the hospital, this is the word used in all of the articles I found on improving patient care. Patients who trust their doctors are more compliant. Patients who trust their doctors are less likely to file a malpractice claim. Patients who trust their doctors get better care. However, hospitals are adding patient advocates to help facilitate communication between doctors and patients. I wish my hospital had instigated this program before I was a patient.

If it is trust, I know it takes a long time to build, and only seconds to destroy. It's kind of like handing your sixteen year old the keys to the car for the first time only to have them call you 5 minutes later to tell you they've been in an accident. More than likely it will be a long time before you let them drive by themselves again. Eventually you might give them a second chance. I never let my doctor have one.

A letter to my doctor

I wanted to take a few minutes to let you know why I decided to file a complaint against you this winter, and explain to you the lasting consequences of your actions the night of May 11, 2007.

I trusted and chose you to be a part of my transformation from a woman to a mom. I know for you it was just another delivery. It was just another series of complications to overcome, but for me it was a life changing event. For 32 minutes, I experienced the joy that comes with that transformation, and then you forced me into another transformation, a rape survivor. I know that wasn’t your intent. You were trying to avoid worrying me with another complication when you believed that you could easily and painlessly eliminate it. However, a yellow plastic gown, latex gloves, and a medical school diploma hanging in your office don’t make you God. It was my body that you violated. You humiliated and shamed me in front of my husband, daughter, best friend, and the nursing staff. I was vulnerable and trusting, and you betrayed me. Instead of treating me like an adult capable of making decisions, you treated me like an unfeeling object. Epidural or not, labor or not, my vagina is private. It’s up to me to decide who and what invades it. You abused your power, and denied me the opportunity to consent. You denied me the ability to process the event as a medical procedure. There was no warning, no understanding. The pain was indescribable. I know you tried to explain what was happening afterwards, but the pain was an incredible barrier to my understanding. The blood loss was too great, the change in blood pressure too rapid for me to process what was happening. I became legally incompetent so rapidly, that I can’t even figure out who signed the consent form for the D & C.

My primary care physician told me once that he really enjoyed delivering babies. It’s one of the few times that someone goes home with something after being in the hospital. I went home with a lot of things. I went home with a newborn. I went home with nightmares. I went home with flashbacks. I went home isolated because births like mine are not to be discussed. You don’t discuss birth rape over a cup of coffee at Caribou with an infant beside you.

Do you want to hear my version of Jennavive’s birth? I’m sure my version differs from yours?

“One more push to get the shoulders out.” I hear the doctor say. Despite not having any breath left, I try once again to push. I feel myself tear as the baby slides out, and they lay this gooey baby on my stomach. I’m in shock, she looks like an alien. There was nasty gooey mucus covering her whole body along with streaks of blood. I wish I could say I loved her at the point, but I was appalled by how she looked. I was relieved when the nurse took her away to be measured, weighed, tested, and cleaned up. At 11:45 pm, the doctor asked the nurse to tell him when 15 minutes had passed. I thought it was kind of odd at the time, but I was really starting to feel a sense of accomplishment and joy. I was watching the nurse cleaning her up while my friend took pictures. I was starting to feel a little odd, but I remember telling the doctor that “his 15 minutes was up”. The nurse asked me if I wanted to hold the baby, but I said no because I was feeling really woozy. My friend brings her over for me to touch. I reach my hand out to her. PAIN!!!! My hands are fisting in the sheets, and I’m fighting not to scream. My breathing is ragged, and I don’t know why the doctor’s hand is in my hoo-ha. I try to get away, I’m scrabbling with my hands trying to drag my body up the bed, but with the numbness in my legs I can’t escape. My vision is blurry, and I start seeing spots when I hear the doctor tell the nurse to get the surgical team. I’m struggling to stay conscious to focus on my daughter, but everything fades to black. Why do I need surgery? I don’t know what’s happening. The baby’s already here. I can’t leave her. I hear the angry voice of the doctor, “what took so long, where are they?” The nurse answers, “They left for the night. It will take an hour to get back to the hospital.” Why is he so angry? I don’t understand what’s happening. The pain is so intense it takes my breath away. They strap the oxygen mask over my face, and I feel the pricking of needles. Are they doing a hysterectomy? I still can’t see. Where’s my baby? I can’t abandon her. I hear fear in the doctor’s voice. “Where the hell are they”, he yells at the nurse. I’m so scared now. Am I dying? I can’t abandon my baby. My husband will never forgive her if something happens to me. I have to stay here to raise her. Do whatever it takes, but keep me here to raise her. Alarms are going off. What’s happening? I hear a new voice, and I feel the bed moving. They’re rolling me down the hallway to the operating room. I sense the bright lights, and feel myself being transferred to the operating table. The voices are frantic. I feel more needles pricking me, and everything fades to black…

This is what you left me with. Each year on her birthday, this is the story that I will remember. Do you remember your children’s births? Do you remember the joy you felt? I don’t. It was so fleeting. I remember the pain, anger and fear. I’m glad that you’re skilled enough to have kept me alive. I’m glad that I’m here every day to enjoy my daughter, but I can’t forgive you for the pain you caused.

I wrote the complaint to the state medical board because you crossed a line that should never be crossed. It’s my small attempt to remind the medical establishment that patients have rights. I wanted to remind you of the Hippocratic Oath. Isn’t there a line in there about “doing no harm”? You caused harm that night. It’s my small way of facing my attacker, and while you’ll probably get off scot-free at least I tried to change it for the women who will tread this path after me.

I wrote this several months ago, but I'm finding myself struggling again. My co-worker's induction is scheduled for next week, and I'm worried about how things will go for her. I just don't want to see her end up in the same place I am.

Reading this today made me realize just how much anger I still harbor towards the doctor. I guess the PTSD comes in waves. I feel strong for a while, but then something sucks me back down. I know part of the problem is a story on my SOLACE forum that really struck a nerve. A mom went through a post-birth experience similar to mine, and has never felt validated in her feelings. Reading her story, and feeling her pain, anger and fear radiating through it just smacked into me.

Sometimes criminal activities take place in the bright lights of a hospital. It's not intended to be that way. I know there's no intent, but the action itself is criminal. If a patient is fighting to get away from you, they're in pain. If they're screaming at you to STOP, stop. If you're more worried about what their family members are seeing there's something wrong with your morals. Patients are humans. We're autonomous. We have feelings. We're not objects. Treat us with the respect that you expect us to treat you with. Listen to us. Answer our questions. Allow us to trust you. Don't betray us in the heat of battle.

Advocacy, smadvocacy

I've been trying to figure out where the trauma actually came from. I keep circling around in whenever I try to figure out and work through my feelings about advocacy. In nearly every birth story, I keep seeing that no matter what procedure was performed, induction, vaginal assisted deliveries, cesarean sections, episiotomies, or NICU stays, over and over again there's a comment about being unfairly treated. Is it possible that if we changed the way women were treated during labor that the procedures themselves wouldn't matter?



If doctors and midwives took advantage of their 12 prenatal office calls with each patient to discuss what their theory on birth was, and referred women who wanted a different experience to other providers, would that help? If they treated us with respect, and allowed us the opportunity to be true advocates for ourselves by making choices about our care would that help? I've talked to women who attempted home births with a midwife, who had midwifery care at a birth center, had midwifery care at a hospital, had a family practice doctor, or had an OB that suffered trauma. It doesn't seem to matter if your at home, or a hospital, or a birth center. It doesn't matter if it's a midwife or a doctor. You can have few interventions or many, and still be traumatized.



It seems like sometimes we focus on trying to control the procedures because we can't control the way we're treated. That seems to be one of the many problems. For a long time I wanted to blame the doctor for attempting to manually remove the placenta. It was concrete, and didn't take much effort to blame that procedure. After all, it was painful, scary, and horrific. However, that wasn't really the cause of the trauma. The real trauma, for me, came from being treated like an object, a future mal-practice suit, an imbecile, an over-demanding patient, a failure. If the doctor had asked permission and I had consented, I don't think I would have been traumatized. I wouldn't have enjoyed the experience. I might have had a few rough nights, but I wouldn't have been traumatized.



Maybe we should be advocating for true informed consent. Maybe we should be advocating for patients being treated with respect. Maybe we should advocate for patients being allowed the right to make their own choices. Maybe we should advocate for patients and doctors developing a relationship built on trust that would see us all through the ups and downs of birth.



I'm not talking about blind trust. I'm not talking about women believing that their doctor is a god - a know all, be all, decision-maker. I'm talking about having an open and honest relationship with their caregiver. I'm talking about having a caregiver that helps a women refine and build their birth plan at each pre-natal appointment. I'm talking about a relationship where if the doctor cannot provide the patient with an experience that they want they'll refer the patient to someone whose birth philosophy more clearly aligns with their patient. I'm talking about a relationship where the doctor actually educates their patients about birth, instead of leaving us to ferret it out of medical texts, baby books, home birth books, internet sites, or any other resource we can find.



I don't know, maybe it's off the wall. It's far easier to argue for no epidural, no pitocin, no episiotomy than it is to argue to be an equal partner in the relationship. It's easier to change procedures than it is to change attitudes, but it's the attitudes that caused my trauma.