In Reproductive Rights

While tales of abuse and harassment of women are exploding in the news and social media, there is one arena in which disrespect, bullying, and, yes, even physical and sexual assault are all too common, but silence is near complete. “Who’s in control when you’re giving birth?” pulls back the curtain on the mistreatment of women in labor. The article tells the story of Kimberly Turbin whose birth video shows her doctor overriding her refusal of an episiotomy (cutting the vaginal opening to enlarge it for birth) and cutting her perineum 12 times while telling Turbin that he was the expert and if she didn’t want one she could go home to Kentucky to have her baby.

Turbin’s assault is shocking, but as with the abuses that have been making headlines, they can’t be chalked up to a few bad apples. We’re talking about a systems problem of which extreme examples like Turbin’s are one end of a spectrum. The article points us to a recent international survey of women experiencing traumatic birth. A total of 943 women participated of whom 748 responded to the question: “Describe the birth trauma and what you found traumatising.” Fully two-thirds of respondents attributed their emotional trauma to care provider behaviors. These included:

  • Prioritizing the care provider’s agenda over theirs:

“I found the comment ‘let’s get this over and done with, I have a golf game to get to’ traumatic”

“20 people in theatre and half were sitting down on phones and chatting away while I had someone training with forceps on me”

  • Discounting their experience:

“Being told to stop pushing when baby was clearly on its way. Being told I had a long way to go when baby was on the way out.”

  • Using lies and threats to gain compliance:

“I finally agreed to be induced after quite some time of being threatened with DoCS [Department of Child Safety]”

“Lots of coercion and being told my baby would die if I didn’t consent to the c-section. She was born with Apgars of 9 and 9.”

  • And, like Turbin, being subjected to procedures over their protest:

“At one point, 3 nurses physically held me down despite my protests that I couldn’t breathe and needed a minute to catch my breath before the procedure [rupturing her membranes]. They held me down until the doctor was finished.”

“The most terrifying part of the whole ordeal was being held down by 4 people and my genitals being touched and probed repeatedly without permission and no say in the matter, this is called rape, except when you are giving birth.”

This survey, I should add, is but one of a host of studies and articles with first person or eye witness accounts documenting emotional, physical, and sexual abuse of women in childbirth.

The worst of it is that the U.S. legal system doesn’t recognize abuse or assault in labor as an issue worthy of adjudication. Turbin had great difficulty finding a lawyer who would take her case as an instance of assault and battery despite the assault being captured on video. Even forcing women to undergo cesarean surgery, which violates the fundamental right of all competent adults, pregnant women not excepted, to refuse treatment, is deemed legally defensible. In evidence of this, here is the text of an update from the National Advocates for Pregnant Women on the Rinat Dray case. Dray was subjected to cesarean surgery against her will when her doctor decided time was up, and a secret hospital policy empowered him to make that call. Dray’s baby wasn’t in trouble, although even that shouldn’t give her doctor the ability to overrule Dray’s refusal. In no other case can persons be compelled to submit to even minor procedures such as donating blood, let alone major surgery, to benefit another person.

Sent: 12/8/2017 12:51:54 PM Pacific Standard Time
Subject: Thank You for Joining NAPW In Support of Rinat Dray

Dear Friends and Allies,

On Monday, December 4th four justices of the Appellate Division of New York Supreme Court heard arguments in the Dray case. As you may know, Rinat Dray is a mother who is suing Staten Island University Hospital and doctors there because, pursuant to a secret (not disclosed to patients) hospital policy, they forced her to have cesarean surgery even though she clearly refused.

At issue in the case is the question of whether hospitals and doctors may force a pregnant woman to undergo medical procedures over her objection, and the question of whether the existing judicial system is really available to women who seek redress for forced and unconsented-to medical interventions.

Michael Bast, Ms. Dray’s attorney, argued on her behalf. Other lawyers argued on behalf of Staten Island University Hospital and a doctor named in the suit. We cannot predict how the court will rule, but it is likely we will receive the court’s decision in two to three months. No matter what the decision is, the case will not be over. Further appeals and a trial on some issues are likely.

Some disturbing highlights from the oral argument include:

  • The suggestion from at least one judge that it would require “new” law to establish that pregnant women are included in the protection of the 1914 decision in Schloendorff v. Society of New York Hospital from New York State’s highest court – holding that “every human being of adult years and sound mind has a right to determine what shall be done with his own body;
  • The hospital attorney’s statement that a “woman does not have an unfettered right to choose;” and
  • The argument from the hospital attorney that the hospital’s failure to inform or engage a patient advocate for Ms. Dray was not important because the purpose of a patient advocate is not to advocate on behalf of the patient but instead to help the patient “cope” with the doctor’s decision.

Thank you to everyone who was able to attend the court argument and to demonstrate support for Ms. Dray and the rights and dignity of all pregnant women.

We will let you know when the court issues a decision. And we will be in touch about further actions that we can take to advance the civil and human rights of pregnant women in New York and around the country.

Thank you and all the best,

Caity at NAPW

While the effects are different, abuse and assault during childbirth have the same origins as sexual harassment and assault elsewhere: exploitive use of power. Both arise within rigidly hierarchic social structures in which those at the top can act with impunity, safe in the knowledge that their colleagues and underlings will close ranks to protect them. Both are founded in an objectification of women. In the case of sexual harassment, women are reduced to providers of sexual gratification, and in the case of labor abuses, to containers for, and potential obstacles to, expedient delivery of a baby. Finally, both depend on an institutional culture in which the behavior is tolerated and thereby normalized.

There is, however, one major difference. However, difficult the path to justice, at least in other arenas, society and the law have come to consider harassment, abuse, and physical and sexual violence against women intrinsically wrong and worthy of redress. These same occurrences in labor aren’t even recognized as problems, let alone crimes.

The Take-Away

While marginalized populations such as women of color or low-income women may be more likely to experience abuse in childbirth, no one is immune. Two-thirds of the survey respondents had a college or postgraduate degree. And while certainly not universal, abusive treatment in labor is as common as sexual harassment and assault elsewhere. You can, however, reduce your odds of becoming a victim. You can ask your care provider: “If I decline a recommended treatment, what happens next?” If your care providers work on-call, you will need to ask the question of everyone in the group because attitudes may vary. More importantly, though, evaluate interactions during your prenatal visits. Ask yourself:

  • Do I feel rushed?
  • Do I feel listened to?
  • Does this person respect my right to make the ultimate decision about my care?
  • Were there any red flag responses? Did she or he . . .
    • use scare tactics: “We can do that if you don’t care what happens to your baby.”
    • bully you: “This is what I will and will not permit.”
    • give you only vague answers: “I only do that when it is necessary.”
    • get angry: “And what medical school did you go to?”
    • patronize you: “Don’t worry; just relax and let me take care of everything.”
    • ridicule you: “Natural childbirth? Why would you want to suffer in this day and age?”

If the answers to these questions are unsatisfactory, don’t make the mistake of thinking that it will be OK at the birth. Find somebody who will treat you with the dignity and respect you deserve.

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