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- PTSD, It’s not just for MothersLast Updated: 10/5/2011
** Warning: Trauma Triggers
One of the reasons I started serving women in birthwork was to help empower them. I enjoy teaching and seeing those wonderful "ah-ha” moments when a woman realizes that SHE is the Conductor in the great orchestra of her experience. When she goes from saying, "I asked him (the doctor) IF I CAN do this-or-that” to "I told him I want to do this, and asked him if/how he’ll support my choices.” Semantics ARE incredibly powerful and most surely do set the tone for a person’s outlook. If a woman thinks the doctor is in charge of her, she’ll do whatever he tells her to do. A good number of women operate with this mindset. I work to help a woman realize that it is actually HER experience, HER choices, HER responsibility and SHE will live with the consequences of the choices that are made, whether by her or by her provider. It is HER power and the provider can only have it, if the woman gives it to him/her. I spend a lot of time in my childbirth education classes discussing informed consent/informed refusal. You cannot consent to something to which you cannot also refuse. You must be able to make that choice. Personal liberty means we each own our own body and are entitled to make all of the decisions regarding it, whether or not anyone else agrees with them. That includes medical choices. You do not HAVE to do what a doctor tells you to do. They are a paid consultant. You are paying them for their OPINION. Since they have a medical degree and a vast amount of education and experience and should be keeping up with research and updated studies, their opinion should be more educated than a typical layman’s opinion. That said, you are still the one that is most knowledgeable about your body and your baby. Because the results and consequences are yours, the choice is also yours. The only ones who have to follow doctor’s orders are nurses and doctor’s kids. Not patients. I tell my childbirth education students/doula/midwifery clients to think of themselves as consumers, rather than "patients”. This is especially true in regard to pregnancy and birth because neither are pathological conditions. They will normally not even require medical assistance. We will role-play a lot of different scenarios to help a couple decide what choices they will/would make if different situations/complications occur. We talk about typical obstetrically-used medications and their risks/benefits/side effects. We talk about interventions and indications for the use, their benefits/their risks and what happens as a result of them. I help a couple decide what THEY want to occur, and help them put it into words and put it on paper in the form of a birth plan if they are going to a hospital with an OB for their birth. I have taught them that no means no, and that if you use your voice, then providers must honor your choices. If you say "NO” then they won’t "DO” what they’re proposing to do. So if you see a doctor pull out an amnihook, you know they’re going to break your water. They may not ask; they may just do. If you have a doula, or another support person who recognizes what is happening she can point that out and ask if you want that. At that point, you can tell your OB that you do NOT want your water broken, if that is your choice. Then he will honor you, even if he wants to do otherwise. He may argue with you and try to get you to change your mind, but if you’ve said no, then he’ll stop. He has to; to do otherwise would be assault. That is what I USED to teach. I had to change my tune because it didn’t work anymore. Saying no proved futile several times, but this one time especially. I am going to use names and places in telling this story and I did ask the mother for permission to tell her story, use her name and her pictures. She graciously granted it and said she still tells it all the time. I told her I’d be telling it from my point of view especially regarding the disrespect and abuse. She still granted permission. I didn’t ask the provider for her permission. I’m pretty certain she would not have granted it.
Geri and Zak came to me near the beginning of her 3rd trimester. Zak’s mother was in my homeschool support group and she asked me if I’d teach them a childbirth education series. They are very young adults, very polite and kind, a very sweet couple. We met and they were very excited about their upcoming birth and their new baby. They had chosen Genesis OB because they had a scripture verse in their yellow pages add, so they thought they must be Christians. However, the physician they had chosen was incredibly authoritarian and insisted that Geri have weekly ultrasounds. These ultrasounds were "required” because Geri was a smoker and the OB stated that she was going to have IUGR from smoking, so he had to monitor it to know when baby needed to come out. It was causing incredible stress to them, and she didn’t have any signs or symptoms that baby was too small. She measured standard for her gestation and had adequate weight gain. The ironic thing is that repeated ultrasounds for IUGR is not either medically indicated or does it provide improved outcome. I suggested to Geri she could refuse any more ultrasounds if she wanted, she didn’t HAVE to go, it was her body/her choice. She could call and cancel her next appointment. So she did. Or she tried to. She called to cancel and was told, "You can’t cancel, you MUST come in today.” So she did. She figured she just had a couple more weeks to go and didn’t want to deal with the conflict. They hired me to also serve as their doula, believing that I could help provide the kind of experience they wanted. She really didn’t like her provider and mustered up the courage to change to another more natural-friendly provider but because she was so far along, there wasn’t a local one that would accept her transferring in. Then a very funny thing happened when she hit 40 weeks. All of a sudden, that baby went from "too small” to "going to be WAY too big” so she was going to have to be induced by 41 weeks, non-optional. Imagine that! At her 39 week ultrasound he’s still in danger of being too small. Then magically at 40 weeks it changes. Now he’s in danger of being too big. In just one week, even though her fundal height was exactly where it was supposed to be, and even though her weight gain was just typical, that baby absolutely HAD to come out so he wouldn’t be too big for a vaginal delivery. She WOULD be induced by 41 weeks, and not a day later. We talked about refusing, negotiating a later date, just not showing up. I assured her they could not FORCE her to submit to an induction. She really did not want the conflict so instead she chose to do a castor oil induction herself at home. She looked it up and made that decision because she feared a chemical induction with her provider. She had met one of the provider’s partners, Dr. Rosalind Jackson, and she was really hoping she would be the one to attend her during her birth. She described her as very nice and friendly and she said if she was the one that attended her birth, she’d help her achieve her birth plan. Her labor kicked right in with the castor oil, and even though she was fearful of the pain and not having the ability to do it, she labored just beautifully. She never faltered in managing her contractions and staying in control. She and Zak worked well together. I found her laboring over the birth ball when I arrived at their home. She would moan softly through the contractions and was remaining hydrated and coping beautifully. A very short time passed when she started having bloody show. She was ready to head to the hospital. We arrived at Kettering Medical Center and went through the admission process. The nurse was very jittery about Geri moving around instead of lying in the bed. She didn’t want to get her a birth ball or have her up out of the bed. When she did the initial cervical exam she found her 9cm. The nurse experienced quite a bit of nervousness at this point, calling the OB, running around getting things set up. In retrospect, I realize this is because she was terrified of the OB. She already knew what was in store. In attendance were Geri’s parents and Zak’s mother. Geri wanted to use the bathroom, so we moved toward there. The nurse told her she couldn’t go that far from the bed. She said it just isn’t done. She had worked there for 31 years and you just don’t DO that. We were a bit flabbergasted, but continued to negotiate with her. She finally agreed to "allow” it as long as Geri promised NOT to push and I would watch her. When she was in the bathroom, her water broke. We informed the nurse, who came and checked the fluid. She insisted Geri come back to the bed immediately. About this time, Dr. Jackson entered the room. Geri was so excited to see her and that it wasn’t her primary doctor. She told her to "get in the bed”. I asked if it was okay if she stayed near the bed and leaned on the birth ball, that she was coping very well that way. She said, no, it was not okay, that that is NOT the way SHE DELIVERS babies. She needs to be ON her back. The DONA scope of practice for a doula does not allow the doula to speak for the client or to perform any clinical duties. Looking back, I see that by getting into the bed, Geri was giving implied consent, regardless of what words she used. When she "obeyed” the directions that implied consent. She didn’t HAVE to get in the bed. She shouldn’t have gotten into the bed. She really should NOT have gotten into that bed. I looked to the father and asked, "well, would YOU like to catch your baby, since she can’t except in that way” He was just not comfortable doing that and said he couldn’t. As a DONA certified doula, I couldn’t even offer. Geri’s labor was moving rapidly along and she was starting to push. The doctor instructed her mother and myself to hold her legs up and open. We both also obeyed her. Zak was near Geri’s head. The others were in the distance, with the nurse next to Geri’s mother, near her head as well. Dr. Jackson started stretching Geri’s perineum. She was incredibly forceful and it was very painful for her. She told her to stop. She told her repeatedly to stop. She wouldn’t. She didn’t say anything, she just kept doing what she was doing. She then turned to the nurse and told her to get a foley catheter. I said, "She just used the bathroom, not more than 10 minutes ago, her bladder is empty.” She continued opening the package. I looked to Zak and said, "She’s proceeding to use a catheter now, to empty her bladder, that is not on your birth plan do you have any questions? Did you want that?” He said, "NO, STOP, do NOT do that!” Geri looked at her and said, "I do NOT want that, don’t use it.” She continued opening the package. I said, "You are going against her expressed refusal with that procedure.” She glared at me and said, "YOU are INTERFERRING, STOP!” I just could not believe what was happening. I had no more words. Zak continued to yell at her, as she prepped her and inserted the catheter. Nothing came out. She snorted and said, "humpf….nothing in there, I guess it was empty.” Baby was moving down nicely and Geri was continuing to do an incredible job, despite the disrespect. Dr. Jackson continued the forced perineal stretching. I leaned over and whispered to Zak, you’re going to have to tell her NOW not to cut the cord” and so he did. She asked why, and he told her their reasons. Then she asked, "Well, for how LONG?” "Until it stops pulsing,” he said. She replied, "That won’t be until after the placenta is out.” "That’s perfect,” said Zak. She pretty much just glared at him. She didn’t say a word. A few pushes later she asked the nurse for scissors. I again looked at Zak/Geri and said, "She’s preparing to do an episiotomy, do you want to ask her any questions? Do you want that?” They both began to yell at her to stop it, they did NOT want that. She said, "I have to or she’ll tear.” To which Zak replied, "then let her tear, it’s her choice.” She looked at us and cut the whole length of the scissors. Baby quickly emerged and he was beautiful. Geri was so happy and proud. She was just triumphant and radiant having accomplished her labor and birth without any medications. She hadn’t believed she had the fortitude to do it. As soon as he was lifted on her belly, Dr. Jackson told the nurse to clamp the cord, as she clamped the other side. Zak was yelling at her to stop, and even put his hands up to stop her. She shoved the scissors into his hand and said, "here….CUT!!” It was already clamped in 2 places, and he was so defeated that he just did it. His shoulders slumped and his countenance fell. At a time when they did the most incredible work of their lives and God presented them with the most exquisite individual baby-person, a doctor violated their wishes, their commands, their expressed refusal and performed procedures on her body and her baby that she did not want or need. All I could think of was trying to redeem the time, and concentrate on that sweet baby. We got him ready to nurse, and Dr. Jackson began stitching her up. She was not adequately anesthetized and was feeling every stitch. Even with her wincing and crying, she continued with her job. I was so appalled and disgusted. I said, "She feels every stitch, can’t you PLEASE give her more Novocain? Please?” She rolled her eyes, and snorted, but she did give her another injection before finishing the stitches. I asked the nurse later if she is always like that, and she said, "Oh yes, we don’t usually say anything because if we do, she treats them even worse.” I encouraged them to file a complaint. I don’t believe they ever did. I think that they just wanted to concentrate on that sweet baby. I don’t blame them. It makes me sad to know she is repeatedly doing this to women, every day, and nurses watch. I watched. I was powerless to stop her. Or was I? It took me WEEKS to be able to sleep through the night without waking up and reliving the birth over and over. I kept replaying it in my mind and in my dreams, wondering WHAT could we have DONE to make her listen? I thought back over and over and over and over and just could not think of ANYTHING. They said everything right. They SHOULD have been respected. But they weren’t. There were no clearer words than "No, STOP!” The only thing she could have done was refused to get on the bed; refused to obey her orders and not let her near her body. So now when I hear other birth workers teach, "just say no” I always think….it’s just not enough anymore. I don’t teach that anymore. You’ve heard of defensive driving? Well, you have to practice defensive birthing with some providers. The problem is you just don’t know who they are. You might have an idea, but sometimes you just don’t. Sometimes they act one way in the office as evidenced in this case, and then totally opposite/different in the birth. This isn’t the only birth abuse I’ve witnessed, or the only provider I’ve seen do it. It was, by far, the worst though. It totally changed my mindset and philosophy. It is one of the main reasons I no longer take many doula clients. I just cannot watch it. I need to be fairly certain that it’s not going to happen to this extent again for me to agree to be there. I will not stand by and watch it again, that is for certain. I would DO something next time, even if it gets me thrown out, even if it makes me lose my certification. I feel so very badly that I did not make a difference for this couple. I know what I would do differently now. I would not stand by. I would NOT stop interfering. As I prepared and began writing this story, I again suffered repeated flash-backs and feelings of powerlessness and several sleepless nights. I’ve mostly written in the early morning hours, well before 5am. Birth trauma and PTSD is not just for mothers, it affects others as well. This is another reason I’m investing in Birth Freedom Network of Ohio. It should be clearly written in our law that women have the right to birth HOW, WHERE, and with WHOMEVER they choose. Hospital policy or provider preference should have no bearing on a woman’s position during birth or whether or not someone’s hands or instruments are inside her vagina manipulating it. It should be HER choice, and hers alone. I completely understand why some women call it "birth rape”.
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