Last week’s post about the terms birth rape and birth trauma generated one heckuva conversation. As a few readers said, “it’s a sensitive subject” that needs to be looked at, talked about and debated. Whereas one reader said I was trying to “silence” women from discussing their negative birth experiences, I think instead I was encouraging women and healthcare providers to talk, talk, talk about it. Here are a few themes that came through our online conversation:
Most responses and emails I received said, “thank you” for differentiating between rape and trauma, for shining a light on some women’s extremely negative experiences and for calling out doctors who act like jerks (or worse). Several said “thank you” for describing what some healthcare providers go through when a patient refuses reasonable medical care. Some were glad to know providers understand that women who have been raped need extra sensitive care. Some readers were just grateful they’d been treated kindly and with deep respect, even though their births hadn’t progressed as expected.
Several e-mailers were fairly ticked off. They disagreed with my terminology or didn’t think I’d presented enough cases of real doctor-patient abuse. Some suggested I had my head in the sand (or up somewhere else) if I didn’t notice that abuse was going on at an alarming rate. There were those who said extreme abuse cases certainly are rape and my definition of rape was too narrow. One or two figured I just don’t know what rape or trauma is and therefore I’m not qualified to write about them.
I don’t need to address each passionate response because that’s not the purpose of this blog. The purpose is to open a dialogue, share information and highlight issues that are important to readers. It’s a common blog phenomenon that readers who feel angry or strongly disagree post more comments than readers who agree with what’s written. Readers for whom a blog resonates hit the “share” button. This particular post generated a lot of shares. I’m not at all unhappy with the angrier comments, because in large part, I agree with their disputes.
We don’t have the right words yet to describe some birth experiences. We don’t have a lock on treating all women with respect, dignity and high-quality compassionate care during every birth. We don’t know yet how to bridge the gap between what’s currently considered best medical practice and what women want. We haven’t eliminated all abusive practitioners. Can we do all that? Frankly, I don’t know. What I do know is what I said last week:
“More often, I see doctors; midwives and nurses bend over backward to supply the best, most compassionate care possible… Most are in it because they have hearts of gold, crystal clear minds and the best intentions.”
Do they get it right every time? Nope. The American birth industry makes it near impossible to meet every patient’s individual needs. There are too many hospital and insurance restrictions, interventions and rules and way too much stress, fatigue and burnout. There are too many frightened patients and doctors. Oh hell yeah, doctors are frightened too, even when they have decades of experience. Lives are at stake and they sometimes shoulder unbearable responsibility. Ultimately everyone wants what’s best, but don’t always know exactly what “best” is.
As I mentioned, the birth experience itself warrants the most respect. It requires a loss of control over our own bodies to deliver someone else’s. Sometimes it’s gentle and beautiful and sometimes it’s not. It will be conversations like this that will pave the way for kinder, safer and gentler births in the future.
There was one comment I found kind of funny. The writer suggested if I didn’t see abuses going on every day, then I didn’t know my business. On this point I couldn’t disagree more strongly. I’ve been at thousands of births over almost twenty years – home, birth center and hospital births, no-intervention, low-intervention and all-intervention births with midwives, doctors, nurses, doulas, families, single moms, teen moms, lesbian moms, parents going through divorce, mothers from other cultures, mothers who will adopt their babies out and mothers who won’t get to take their babies home. Not all, but most, have been safe, supportive, respectful, joyous, and ended up with happy parents, beautiful babies and families who felt they were given excellent care.
I don’t see abuse everywhere because it’s not part of most births. When it is, it’s the exception, not the rule.
Just to wrap things up, I’d like to ask healthcare providers this:
Please: remember the excitement you felt at that first birth when you decided to make a career of it. Carry that into every birth you attend, even when you’re exhausted and worried. Remember that kindness, courtesy and respect count as much as all your years of medical training. Ask permission, explain what you’re doing and wait for permission to be granted. Listen at least as much as you talk. Remember that most patients are normal and healthy and probably don’t need all the medical tools at your disposal. Your work is valued, important and highly respected. The work your patients and new mothers do is too. Let’s be kind to each other. Let’s build trust.
To patients, I’d like to ask this:
Please: choose a provider you trust to help you make the best healthcare decisions. Educate yourself about all the options and interventions available at your birth setting. Participate in your health and healthcare because ultimately, they are yours, not something your providers give you. Remember a birth plan is important, but it’s a wish list, not a contract. Understand if your birth experience isn’t what you imagined, that doesn’t mean it’s anyone’s fault. Birth is like that - so powerful it creates new lives. It’s hard to imagine that power until you’re in the middle of it. And finally, expect to be treated well because chances are, you will be treated kindly, compassionately, professionally and with respect and dignity. If you aren’t, take action to help yourself heal and prevent other women from being treated poorly too. There’s no room for abuse in the delivery room.
Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to email@example.com and it may be answered in a future blog post.
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