Recently, a nurse left a lengthy comment on my website in response to an article where I had encouraged women to recognize their value, and demand that others respect them for it—and especially in their maternity care. The nurse who commented (I will call her Mary) was extremely skeptical of the idea that women are being traumatized by their care providers in maternity care.
She said, “These stories have been around as long as I can remember” and dismissed it all–all of the “websites, books, videos, and posts” recounting mistreatment–as “one-sided emotional testimony” and a “disrespectful escalated explosion of a conglomerate of embellished misunderstandings.” (Her full comment is here.)
Mary’s argument is constructed on the basis that women in labor are not capable of accurately remembering what happened to them, or are too emotionally invested to be credible witnesses, and that medical staff are, across the board, acting in the best interests of their patients.
I think Mary’s view gives us a pretty accurate peephole into an operating system that tells traumatized women, over and over, “Surely what was done to you was out of medical necessity. You can’t understand what was happening; there’s more to the story. You should just be grateful you have a healthy baby. Stop talking.”
I’ll just say right here that I’ve spoken with hundreds of these women, and I’ve discussed every detail of their births with many of them, and I’ve also spoken to their doulas, husbands, and birth partners. If anything, I would say that most women underplay their mistreatment.
It doesn’t take a medical degree to recognize disrespect and abuse any more than you have to have a criminal justice degree to say, “My husband beats me,” or, “That kid just stole my purse.”
But, all the same, I thought I’d reach out to some medical professionals, nurses like Mary and a physician’s assistant, to see how they respond to her comments. Their statements are here. Maybe Mary, and others who don’t believe women, will take their word for it. My apologies for the length of these comments; I didn’t want to cut a word.
In the meantime, I encourage women, once again, to keep speaking up. Do not be silenced.
Response from L&D Registered Nurse, Northeast (10+ years)
I feel like I know you. I too have worked as a nurse in Labor & Delivery, for awhile–over a decade–you are like the nurses I have worked with on many nights, weekends, and holidays. When things get tough, I look to the senior nurses like you to have my back, and I promise you, I’ve got yours. We know how to save lives, and when a mother seizes or a cord prolapses, we come together and fight like hell to save our mothers’ and babies’ lives.
Mary, I know you have worked very hard to come as far as you have in your career. It’s back-breaking, emotionally draining, really hard work. We care, a lot, or we would not have made it as long as we have in our jobs.
These women are begging for you and me to listen to their stories. It’s really, really hard to hear, and or accept, that we have ever hurt the women we care for. But the truth is, we have, and we do.
The experiences you refer to as “claims”, told by these brave women, are so common that we as medical birth workers, just can’t see them. We can’t recognize the horror, because we are numb to it. We expect it. It is our way of maternity care and birth. These stories are the tip of the iceberg.
I have a decade of stories I could tell, but haven’t, because if I do, I know I will lose my job. Have you ever had a patient come in after having had her membranes swept, but not knowing that the doctor was going to do it? Have you ever told a normal laboring woman that she can’t eat anything, or get out of bed, or go to the bathroom? Have you ever witnessed a person in hard labor sign her birth consents in the middle of her transition contractions? Have you ever done a vaginal exam on a woman who looks like she doesn’t want one? Have you ever handed the physician the Amni-hook to break a woman’s water, without explaining all the risks nor asking her consent? Have you ever left a woman on a monitor indefinitely because it was just easier for you? Have you treated a patient or known another nurse who treated a patient differently because she was young or AMA, African American, Indian, a non-English speaking person, or LGBTQ? Have you ever watched the physician grab the scissors and cut while the mother was pushing so she wouldn’t notice? Have you ever heard a nurse tell a woman to be quiet- to stop yelling? Have you ever attended a cesarean where a mother is anxious and yells out that she can feel it, and you see everyone in the room roll their eyes in disbelief? Have you ever started an induction on someone who has absolutely no idea why they are being induced? Have you ever sat around the nurses’ station and made fun of a birth plan? Have you ever stamped a cesarean chart for a patient just because she had a birth plan? Have you stood and watched the physician who reaches into the uterus of all his unmedicated mothers after they give birth, just to make sure there was no placenta left behind? Have you ever heard parents being told that they technically can refuse any treatment- but do they really want their baby to die? Have you known a physician who diagnosed failure to progress, when really, we all know it was because they had to get ready for their Super Bowl party? Have you ever strapped a woman’s arms down to restrain her from moving in cesarean? And Mary, on and on and on.
I just don’t believe that you have never done or witnessed any of these things. WE ALL HAVE.
Mary, some women are telling us that they feel like they were raped or sexually assaulted in their birth experience. Have you ever known someone who has been raped? Even if you say no, statistically it’s impossible for you to not know someone who has been raped. Victims of rape don’t feel like they can safely tell anyone about it, so we hardly ever hear their stories. Well, I have been raped. I lost a friend once when she very emphatically proclaimed that there are two sides to rape. Indeed, there’s the side of the victim, and that of the rapist. Should we give all the rapists equal opportunity to incorporate their viewpoint in the exact rape as reported by the victim? Mary, do you feel that would give us a more balanced perspective on rape as well?
Do you know how many times I have heard women say, “do I have to have Pitocin?” I have heard many nurses and physicians and even midwives say, “Yes, honey, you do. Some women just aren’t capable of doing it on their own.” Mary, have you ever been taking care of a laboring patient, maybe she’s moving slowly, but doing just fine–and you come out to the desk, and the physician’s order to start Pitocin is already written in the chart? No discussion with the mother, no discussion with you, the nurse? And have you ever then been in the situation where you have to confront the physician, or found it was just easier to tell the laboring woman that this is just how it “needs” to be?
Mary, have you ever been in the physician’s line of fire, on their bad side, in their way? Have you never known a physician or midwife who would make a nurse’s job a living hell for simply questioning their orders for starting Pit on a mother whose water broke just 2 hours before?
Do you really work in a teaching hospital? How many births? I can’t tell you how many births I’ve attended where the attending physician was fast asleep while the resident “delivered” births. Have two (or three or four+) babies ever been born at the same time in your hospital? Because they sure as heck have been where I work. Most laboring women don’t know they have the right to request a different physician or nurse.
A basic nursing tenet is that “pain is what our patients say it is.” These women are telling us about their pain. It is time we listen. We cannot pretend that we don’t know what these women are talking about. Mary, we are not bad people. Please, for the love of what’s right, please consider some deep self-reflection of the roles we play.
You said, “People experiencing life altering events such as childbirth are even more susceptible to tainted memories in the absence of understanding.” Except, Mary, those with PTSD, who live stuck in never-ending nightmares of having their trauma play over and over and over again. They never escape the terror they lived through. Many wish they would have just died, because the living hell of replaying the scariest day of their life, feels worse than the actual event.
You said, “Birth plans are wonderful and encouraged… A birth plan however is truly a tentative request. The true ‘plan’ is dictated by the acuity and current events. Looking back it seems that many of these woman had many similarities in their early OB choices all the way up to their tragic event.”
Mary, birth plans are seen as a joke in L&D. I wholeheartedly agree that birth plans are wonderful and should be encouraged- but I have never seen a birth plan that hasn’t received an eyeroll where I have worked–and many physicians flat out refuse to read them. Indeed, acuity and how the labor and birth unpredictably unfolds, will determine what interventions and decisions need to be made, but no, Mary, NO! The plan is dictated by the laboring person, the decisions are hers to make–not mine, not yours, not any midwife’s, nor any physician.
If we want to prevent trauma, then we need to stop being condescending and trust that there is nobody on the planet who cares about that baby more than the parents do. We need to meet these women and families where they are, and build a mutually respectful and trustful connection through their birth. We need to thoroughly explain all benefits and risks of any proposed intervention, and support our patients in their decision making. We need to always explain what we need to do, and ask before we perform any routine procedure. I have never had a birthing patient refuse true emergency care for herself or her baby, despite her birth plan (except in rare situations with families who hold extreme religious views.) It is only when she feels powerless and unheard and disregarded that her birth becomes traumatic. If she ever felt talked down to, was starved, was isolated, was strapped down, told not to move or to be quiet, or threatened that she would kill her baby if she didn’t comply–she will undoubtedly be traumatized.
Mary, we can fix this. The women in these stories aren’t blaming you or me. They are speaking out because they believe that by telling their stories, maybe other women will not have to go through what they experienced. You and I can play a profound role in preventing further harm. The first step is for us to listen, and be honest with ourselves. What we do, what we say, and how we treat women makes a big difference.
Response from: L&D Registered Nurse, West Coast (16 years)
As a traveling L&D RN for over 16 years, and a doula for 15 years before that (we called it “labor support”) I can tell you from my experience in hospitals all over the US, that “these stories” are not only true, subjectively AND objectively, but that for every one story we read, there are ten, twenty, a thousand more that haven’t been told. I, myself could tell you these stories all night, things I have seen, and actually participated in. I am not proud of it, either, and I am here to start to break the silence, and to bring about some big changes in this broken system.
I, too, have noticed an underlying pattern with each of these “claims,” as you condescendingly put it. The underlying pattern is, to put it bluntly, institutionalized, organized, tolerated, unspoken-about, kept-in-the-dark, obstetrical violence. The pattern of subjecting women to uncaring, often unsafe, non-evidence based, at times dangerous, humiliating, “medical” practices.
Yes, these “stories” are presented only from the “subjective” view of the birthing mother. How could a woman giving birth, present in the room the entire time, feeling every sensation, hearing every word spoken, possibly be objective! I am part of the “medical staff involved” in daily deliveries and I am here to say: believe it. Believe them. Start believing women who are hurt, injured, humiliated, embarrassed, talked down to, and deceived.
The reason we are hearing all these “stories” now is there are finally places to tell them! Just like when Anita Hill came forward with her experiences of sexual harassment by Supreme Court nominee Clarence Thomas, suddenly, women everywhere came out of the woodwork to reveal and share their OWN experiences of sexual harassment. And now, it’s time for a new generation of women to be heard.
You want balance? My two cents is this: the care they got was actually worse than they knew. The nurses at the desk talked about them behind their backs. The babies who suffered hypoxia, low apgar scores, and possibly brain injury, you know what they say? They say “Well, THAT baby isn’t going to Harvard.” They say: “That baby is going to be taking the short bus.” You show them your earnest, well researched birth plan, you know what they say? They say: “Get out the c-section consent, this one has a birth plan.” That is just the tip of the iceberg. Do you know why your baby ended up in the NICU with sepsis, on several types of antibiotics, separated from you and getting blood cultures and a lumbar puncture? Because your doctor broke your water and checked your cervix too many times, and gave you, yes, GAVE YOU an infection. Have I ever heard a doctor express remorse for this? No, not one time, ever.
You write: “From each story there is usually an initial claim that stands out as ‘impossible’ to a medical professional which instantly discredits the story.” Yes, our patients very often don’t understand how things are done. They make mistakes in their interpretation of things that happened. True. But to discredit their experience, to pick it apart like some sort of courtroom drama, to prove a victim is mistaken, or lying, or exaggerating, is dirty pool. Perhaps there has been prolonged rupture of membranes (perhaps the doctor broke her water when she was 2 centimeters, and then checked her every hour till she had a fever of 102?). What is wrong with this picture? It doesn’t matter if these women don’t get the medical details just right, the poor treatment is still happening! And you can’t discredit it because consumers aren’t medical experts.
I have had women try to decline residents, many a time, only to be told that their practitioner is not on call, or busy at another delivery, etc., and that another attending can attend them, yes. Someone they haven’t met and who is, basically, no closer to her than the resident at hand. In fact, if these attendings do catch the baby, they are often irritated and rushed. But yes, a woman can refuse it. How many women know this? And how many of the ones who do, actually exercise this right? I have seen that happen maybe three times in my 30 years at the bedside.
Your statement that a woman “truly doesn’t have a full understanding of what occurred” is correct, in that, no, she doesn’t fully understand the medical jargon, treatment, decisions, etc. Nor do the medical staff have a full understanding of what occurred IN HER EXPERIENCE. Can we at least say it’s even here? That neither side gets what the other is feeling and experiencing? We believe the doctors version, but not the patient’s? Because….? And then the patients try to speak about it, we deny that they had that experience?
I have been present for a few of the debriefings you describe, and yes, they should happen more often, and yes, they are helpful. What is always missing there is the mother and father’s feelings and experience. No one asks and no one listens. Parents who express distress are seen as a legal threat, and risk management is sent in to try and diffuse the situation before it escalates to a lawsuit. Not exactly helpful to the parents.
I can’t even begin to respond to the statement “so many seemingly fabricated traumatic birth stories.” Seemingly fabricated? I’m just going to be professional here, and say, you have got to be kidding. Fabricated traumatic birth stories?
You go on to say that women who seek out a nurse midwife for their care and delivery are doing so because of what “appears to be due to their reception of the stories found on these types of websites” (on what basis, exactly, are you making this statement?). Might I suggest, instead, that it could be that nurse midwives have a vastly better reputation for providing holistic, respectful care, that supports women and families in having a safe, empowering birth, while at the same time, being as safe, if not safer, than a physician? That these women have done their homework, looked at research and outcomes, and sought out the best care possible? And yes, they get to have a “preconceived plan” for the way they want their birth experience. Bravo for them for seeking out the best practitioner to give them what they want. In other places, this is called being an informed consumer.
And you say that these women choosing non-physician birth attendants might “simply have an intense need for control.” You think? Control over the most important day of their lives? We get to have more control over our experience shopping at K Mart, or getting our oil changed, than we do giving birth in the hospital. Yes, we should get to have quite a lot of control over our bodies, and what happens to them. Shame on you for disregarding this basic human right and need. And yes, the fact IS that birth is not predictable or controllable, and that is precisely why there must be a trust built and honored, why women need to be included in their care, and have the risks and benefits explained to them as if they were intelligent, sentient beings rather than faceless bodies lying on a bed.
And yes, these women have responsibly showed up for prenatal care, read their books, looked on the internet, and they are aware, obviously, of the risk. The blame is not about normal, tragic risks of birth. The blame and the anger are about being lied to, having their genitals touched and invaded roughly, over and over, by numerous strangers, not being told honestly about risks, not being included in decision making, as if they were less than the intelligent, conscientious, adult women they are. Personally, my patients are happy with their care, because I make sure that they are treated with respect and kindness. That’s mostly what these women want. Their so-called “one sided emotional testimony” is valid. These women’s words are NOT a “disrespectful escalated explosion of a conglomerate of embellished misunderstandings”…. they are women’s experiences. And they are true. And I see it happening, over and over, day after day, year after year. It’s time to listen to the women. Beyond time. The videos that are coming out on the internet of these kinds of births tell the objective truth. It’s really that bad out there.
So, if the woman who wrote this comment would really like me to write an article that considers the perceptions of at least the nurse in the room, I’d be more than happy to write, and write and write. But I doubt she’d like to see that article. I don’t need a “memory specialist”–I can consult the chart. It’s often spelled out there. Why do you think that OBs are sued for malpractice, more than almost any other specialty? Testimony, charting, evidence, a court of law. That tells you something.
I am so glad that women are speaking out about this and other forms of sexual violence. I believe you, brave warriors. Speak up. Keep speaking up. Time to break this system. I know that amazing, safe births are possible, and your words are slowly chipping away at the problem, and one day, the wall will come down. Thank you for your courage. I BELIEVE YOU.
Response from: Physician Assistant, California (2 years)
I would love to know where this woman works, because she should use the fact that these situations “never” happen at her hospital as advertisement.
The way Pitocin was ordered in my hospital was like this. The nurse or resident checks the patient, determines that they’re not progressing as desired and the doctor orders Pitocin. Sometimes the nurse would ask for it and the resident would agree, sometimes the resident would do so on their own. Then the Pitocin was ordered, sent from the pharmacy, and the patient was informed (maybe) that they were going to be given “something to speed up labor.” Very rarely did a resident ever go into the room to explain anything prior to or after ordering and very rarely did I hear a nurse discuss this with a patient. I can also confirm that it was unusual a patient was asked about any of this. So I suppose if a patient happened to even know what was going on, then yes, she could discuss it with the resident, assuming they weren’t in the OR or in another delivery.
Mary doesn’t believe women about non-consented episiotomies because she’s seen women say scalpels were used, rather than scissors. I agree I have never seen an episiotomy cut with a scalpel; scalpels were not a part of the “delivery” set up at the hospitals I’ve worked at, however I would not be surprised if someone told me a scalpel was used, also not certain it would even make a difference? At the end of the day: it’s still a cut to the perineum!
As far as what Mary says about vacuums and residents attending… IF a patient is even aware that a resident is “delivering them” (which my guess is they’re not as the doctor is running in the room when the baby is crowning), my experience is very little questioning or refusal is going on at that point. Now if the resident is in the room for awhile, then yes, the mom could definitely ask if they were a resident (I had a few women ask how old I was when I was present for their delivery) and request an attending if desired, but again, this assumes the attending is not in the OR or in another delivery which, at my hospital, they were probably 50% of the time. Of course this was a county hospital with 24/7 coverage with an attending and residents, so at hospitals where private physicians just come in to deliver and then leave, I would assume there’s possibly more “choice” of refusal for residents or students in training. Although if we’re being honest, the attendings did very few deliveries as the residents did the majority of them and in my experience, the residents did a better job most of the time. Also, I’m pretty sure every resident has at one point struggled to apply a vacuum to a baby’s head because they aren’t going to be perfect the first time (it’s not the easiest thing in the world to do). And there’s little room for refusal (as we’ve seen in Kimberly’s video) when you’re in a vulnerable position and people are yelling that your baby needs to come out now.
The statement “If a woman has allowed the resident and there is a need for a vacuum it can be trusted that the situation is under control and going well” doesn’t make sense to me–I don’t think this is an assumption that can be made. The only thing I agree with is that a woman is free to decline anything.
The next statement that “it is usually easily recognizable by any medical professional that was not present for delivery to know that the personal recount of the mother is not accurate and that she truly doesn’t have a full understanding of what had occurred” is only true in the fact that a mom may not have an accurate idea of what happened only because no one told her. I will attest to the fact that I have had more than one patient that has given me their account of a story and after reviewing her medical records, I can tell you I know exactly what she is talking about and exactly why not everything was mentioned in the record. Most of the time, I take the mothers word over the medical records because I’ve personally seen forced ceseareans dictated in the operative report as “elective cesareans” and have a large distrust for the accuracy and completeness of medical records in general. Yes, some women definitely have given me accounts that I can tell they’re partially confused about based on what they’re saying, but it’s usually not because of the fact that they’re ignorant women who know nothing–it’s clear to me that they weren’t given details about their condition and, therefore, didn’t fully understand what was going on. This, however, relates more to diagnoses (preeclampsia, cholestasis of pregnancy, etc.) and less with actual delivery events.
I do completely agree with her point of debriefing; I think that should absolutely be required after every delivery, traumatic or not, because sometimes there are events that occur during deliveries that, even if explained, mothers may have had too much going on at the moment to fully understand. I can imagine it’s difficult to process the exact implications of a cesarean or episiotomy, etc. when everyone is rushing around and yelling and mom is pushing and alarms are going off, etc. So, some trauma could possibly be avoided just by discussing these events with mom and confirming or distilling any misconceptions at that time.
Further Reading & Resources:
“Prevention and elimination of disrespect and abuse during facility-based childbirth,” World Health Organization (2014) (link)
#BreaktheSilence, a photo campaign by Improving Birth (link)
Exposing the Silence Project, a traveling photo project created by Lindsay Askins & Cristen Pascucci on birth trauma in America (link)
“Deadly Delivery: The Maternal Health Care Crisis in the USA,” Amnesty International (2011) (link)
“Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth,” Bowser & Hill via USAID (2010) (link)
A former communications strategist at a top public affairs firm in Baltimore, Maryland, Cristen Pascucci is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and, since 2012, vice president of the national consumer advocacy organization Improving Birth. In that time, she has run an emergency hotline for women facing threats to their legal rights in childbirth, created a viral consumer campaign to “Break the Silence” on trauma and abuse in childbirth, and helped put the maternity care crisis in national media. Today, she is a leading voice for women giving birth, speaking around the country and consulting privately for consumers and professionals on issues related to birth rights and options.