Ask The Labor Nurse: It's Not Birth Rape; It's Birth Trauma | Fit Pregnancy

It’s Not Birth Rape; It’s Birth Trauma

05.17.12 Coming to terms with traumatic birth experiences

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There’s a term being batted about right now that I find very disturbing: birth rape.  It’s describing some truly traumatic birth experiences where women felt disempowered, bullied and abused by their healthcare providers.  They felt they had no choice, but to submit to medical procedures done entirely against their will.  They felt violated, betrayed, shamed and terrified. They experienced their births as violence perpetrated on their bodies by people they’d trusted.

These birth experiences were horrible, but were these women raped?  No.  They may have been abused, manipulated and victims of malpractice, but they were not victims of sexual violence.  That’s what rape means and in deep respect for women who have been raped, I think the term “birth rape” is inappropriate. Instead, I’d use the term “birth trauma.”  The rage, despair and feelings of violation some women experience after a traumatic, out-of-control birth are valid and powerful, but aren’t the same feelings women experience after rape.

Over the many years I’ve worked in labor and delivery, I’ve witnessed a few births where a heartless, control-freak doctor ignored his patient’s wishes and rights to privacy and respect, bullying her into following his own agenda.  I’ve seen a doctor or two treat patients with disturbing behavior ranging from clueless insensitivity to unkindness to abject cruelty.  I’ve seen doctors disregard courtesy, modesty and informed consent.  I’ve seen some implement interventions without telling patients what they’re doing or why.  I’ve seen patients cry when they’ve felt abused by something some jerk-doctor did.  

I’ve seen it, but I haven’t seen it very often and that’s saying something because I’ve seen thousands of births.  Those jerk-doctors usually get their karma returned somehow.  One doctor got sued time and again for malpractice and abuse and was eventually fired by the hospital.  Another doctor was such a jerk no other physicians would take call shifts for him. He wound up in a solo-practice, on call every day, night and weekend.  That ruined his marriage, alienated him from his children and cost him the respect of the medical community.  Karma, dude…it’s powerful stuff.

More often, I see doctors; midwives and nurses bend over backward to supply the best, most compassionate care possible. I see them working as teammates with their patients and families. Most healthcare providers are in it because they have hearts of gold, crystal clear minds and the best intentions. 

I’ve also seen patients come in to labor with very rigid ideas about how their birth will go and what they will and won’t allow to happen.  I’m thinking about a woman who came to our unit years ago dead set on a 100% natural birth.  She labored at home until her contractions were strong and her water broke in a thick, brown puddle on her bed.  She started bleeding a little too heavily right after that and her husband insisted she come to the hospital for a labor check.  When her doctor examined her and told her she was only 2 centimeters dilated and her baby didn’t feel like she was in the right position, the patient accused the doctor of lying.  She refused an ultrasound and fetal heart monitoring and demanded a new doctor.  When a midwife and the OB chief of staff consulted with her, she refused their care too. The midwife had a doula on her staff come in to explain why her birth plan couldn’t work for her.  The midwife wanted to touch her abdomen and listen to her baby with a Doppler (a handheld device that amplifies baby’s heart beat) and still she refused.  No matter what interventions they suggested, she refused; convinced her care providers were out to get her.

Her husband, on the other hand, wanted the midwife, doctor, chief of staff and anyone else the hospital could provide to find out what was wrong with his baby. Even he couldn’t persuade his wife to accept medical care, despite the fact that she was bleeding heavily and oozing meconium. 

Finally, when he begged in tears to please, PLEASE, let the doctor do an ultrasound, she agreed, though resentfully and begrudgingly.  The ultrasound determined her baby was in an awkward breech position, her placenta was separating, and at 2 centimeters with a first baby, she was hours (or days) away from a vaginal delivery. The doctors advised an immediate C-section.  This did not go over well.  The poor woman was terrified and furious that the doctors weren’t honoring her no-intervention birth plan. She accused them of bullying her into a C-section she felt strongly she didn’t need. The doctors respectfully and thoroughly explained their recommendations and concerns. Her husband flat-out yelled at her.

It wasn’t until the bleeding got heavier that this woman finally got scared.  All of a sudden, she got it! She and her baby were in deep, deep trouble. It wasn’t her doctors who weren’t honoring her birth plan.  It was her baby and her body.  

After the C-section, her baby spent several days in the NICU. The woman remained angry about what happened, but gradually, realized while her experience had been traumatic, out-of-control and against her wishes, it wasn’t because anyone had victimized her.  Sh** happens… Birth trauma happens and sometimes, post-traumatic stress disorder. Reconciling what’s happened to your body with what you thought would happen is a complicated emotional challenge that requires time and attention to process.

I’ve taken care of patients who’ve actually been raped. In all the hospitals I’ve worked, there are policies set in place to create the safest, most respectful and gentlest birth experience possible, not just for patients who’ve been raped, but for all mothers.  We supply extra special care whenever needed. In the end, it’s the birth process itself that garners the most respect.  Sometimes it’s powerful, overwhelming and yes, even violent, but that’s not rape – that’s trauma.  There’s a big, difference.  Let’s choose our words wisely and with due respect to the legions of women who know what the word “rape” really means.

 

Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

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