How Doctors Cross the Line in the Delivery Room

Birth stories are a rite of passage. Across cultures, mothers have long taken pride in sharing the tale of their child's birth. As a woman in her early 30s with two kids of my own, I'm no stranger to them, and I'm always fascinated by how a mother seems to remember every detail of how her baby came into the world, as if she had absolute clarity in those moments, no matter the pain. But while birth stories have long been celebrated, many of them in modern-day American culture aren't happy ones to tell, even when there's a healthy baby. Some are marked by forceful events that caused the birthing woman to feel her rights were being compromised, or violated altogether. I know women who've been forced (sometimes physically) to labor on their backs (a dated practice that many hospitals still prefer in spite of the fact that is not evidence-based and leads to longer labors and more cesarean births). I've even spoken to friends who were threatened with child protective services investigations because they wouldn't consent to a c-section without cause.

And seven years ago, as a first-time mother, and the first in my social circle to have a baby, I, too, was forced into a bed and onto my back, and subjected to painful, yet routine, procedures that went against up-to-date evidence. One of those procedures, an episiotomy (a surgical cut to the perineum just before delivery), caused me agony for months, and sent me back to the doctor's office twice because of the large, poorly stitched incision that was neither necessary, nor consented to.

The struggle to maintain bodily autonomy—rights to our own bodies during childbirth—is real. And I know without question that my birth story makes many women's birth stories look like a spa day complete with mimosas, and maybe those little fish that nibble dead skin off your toes. Take Caroline Malatesta for example—the Alabama mother who won a huge battle against obstetric violence in August of 2016. A jury found Brookwood Medical Center at fault after she suffered a permanent nerve injury at the hands of a hostile nurse who wrestled Malatesta onto her back while she was giving birth and held her baby's head inside her body for six minutes.

Two months earlier, Kimberly Turbin of Los Angeles proceeded with her case against a doctor who cut her twelve times in a forced episiotomy after she repeatedly said, "no, please, don't cut me,"—a brutal account which was documented on video, and went viral. There have been other lawsuits in the US over women's rights to their own bodies during birth, but while the number of cases that make it to the courtroom are slim, and the number of mothers able to prove injustice even slimmer, the incidences of women who say their rights were ignored during childbirth are not few.

Helen Loeffler, a certified nurse midwife who works at a Baltimore hospital, says she believes there are some reasons why this happens to women more in delivery than other forms of care. "One factor could be the cultural and technological separation of mother and baby into distinct people/patients rather than viewing them as a unit; providers focus heavily on fetal well-being, especially in hospital setting with CEFM (constant electronic fetal monitoring), and end up 'prioritizing' the baby's status sometimes at expense of [a] woman's autonomy." Constant electronic fetal monitoring is not an evidence-based practice, though, and has also been shown to lead to more cesarean births than when intermittent monitoring is used.

Serious permanent injuries that result from forceful births, like Turbin's and Malatesta's, are infrequent (though longer recoveries from more intervention during birth are quite common). But emotional trauma from birth is shockingly widespread, and some experts believe it could have links to bodily autonomy being dangerously overlooked. According to The American Psychiatric Association's criteria collected from 2000-2012, between 25 and and 34 percent of mothers say they felt traumatized by their child's birth. A third of those women may meet the criteria for PPTSD (Postpartum Post Traumatic Stress Disorder).

In late 2016, Katherine Morrison, Buffalo, NY-based OBGYN addressed what birthing women are often subjected to in a passionate New York Times letter to the editor that went unpublished but was later picked up by The Buffalo News—a response to an article on maternal death rates in the US that failed to mention the rate of unnecessary, sometimes forceful practices as a cause. "Your editorial passed over the real reason behind the unconscionable rise in deaths among childbearing women in the United States—American obstetric practices. As a Board Certified Obstetrician-Gynecologist, I see first hand that pregnant women are subjected to multiple unscientific physician and hospital protocols." Morrison went on to list the dangerous common practices, like early inductions (inductions that take place prior to 42 completed weeks), the use of continuous electronic fetal monitoring, refusal of food and drink in labor, drugs and procedures to speed up labor, and vaginal birth after cesarean (VBAC) policies that discourage or deny women the right to a vaginal birth altogether. "All of this despite copious scientific evidence," she adds, "that it does not help babies, but harms their mothers, has led to an insane cesarean section rate and the increasing maternal death rate and 'near misses' (i.e. women that don't die but come close)."

There's been an uptick in the conversations about bodily autonomy during delivery in recent years, especially since cases of abuse have made the news. But changes to actually prevent it have been slow going. One issue that may cause the cycle of abuse to continue is that women who've had traumatic experiences during delivery don't often talk about them. Emiliano Chavira, a maternal fetal medicine specialist who practices obstetrics at California Hospital Medical Center, says that's because if they do, their concerns might be minimized. "One of the common thought processes is 'ya know, well, at least you have a healthy baby,'" he says. "The concept there is that whatever was done to you during your pregnancy, it had to be done that way in order to ensure that mom and baby came through okay, when it in fact, that's not true."

Organizations that exist to fight for better birth have long been pushing for mothers to open up about their experiences. Improving Birth's "Break the Silence" campaign, for example, called for women to document the abusive words said to them while giving birth in a photo series. It sparked other efforts and creative expressions and shed light on some of the coercive, forceful, or otherwise demeaning procedures that were happening to women in the delivery room, leaving many of them traumatized. Projects like these are deeply important in changing the conversation about women's rights in birth, but they have a big job to do—they have to reverse the damaging discourse about birthing rights.

Too often, birthing women who want to make their own educated choices during delivery get pegged as being selfish or even irresponsible for wanting some say in what happens to their bodies. We've all heard the generalizations of the unruly woman who wants the "perfect, natural" birth and puts her baby's life in jeopardy by refusing a doctor's advice. Words like "natural" or "unmedicated" have become almost dirty words.

But the shaming directed at those wanting to make informed decisions about their healthcare, specifically birthing women, persists. "Don't confuse your google search with my medical degree" was a meme that went viral a few months back. I saw it shared countless times in Facebook groups for new and expecting mothers being praised for its suggestion that a doctor's authority should never be questioned. Bobby Ghaheri, a Portland, Oregon-based ENT who specializes in tongue and lip tie issues in babies (and is therefore frequently in the company of postpartum mothers) saw it, too and felt inclined to weigh in.

"The era of paternalistic medicine is over," he wrote in a Facebook post. "No longer will parents and patients just accept with blind faith everything said by their doctor (nor should they). If mutual cooperation to optimize a patient's health isn't embraced, I truly feel like the doctor is failing. We as a medical profession need to suck it up, swallow our egos, and start striving to learn more."

Good doctors and strong-willed patients who believe in bodily autonomy are sorely needed in the realm of maternity care. Chavira believes putting pressure on the system—the doctors and the hospitals, is crucial for changing it. One thing is increasingly clear—the more women talk to one another about bodily autonomy in birth, the greater the space for our rights to be maintained in the delivery room, and in the process, everywhere else.