It finally happened… I’ve heard many stories of a nurse or doctor not stopping a vaginal exam even when the mom is yelling stop. But it never happened to me until now, almost six years of doula-ing. The Dad wasn’t nearby enough to act fast, so I did. Frankly after all these years there’s little that can force me outside of my doula role and speak for a client aggressively. I’ve gotten pretty creative to work around having to do that. But when I have a client who’s a survivor of childhood sexual abuse, and you’re shoving your hand in her even harder after she’s screaming stop – I’m going to cross the line right over too. I raised my voice, but didn’t yell. And I said, “she said stop.” The nurse said “I have to…” I interrupted and said “she said stop, take your hand out of her vagina right now, she said stop!” The nurse complied but was so angry with me she told me I have to leave. Thankfully, the Dad pipped up and said “no you leave.” In the past a situation like this would have had my heart racing and made me very afraid. But I’m grateful for the experiences I’ve had because I was able to calmly go over to the nurse station afterwards and say to her, “hey I want to make sure we’re okay can we please talk this out.” Of course the nurse was still blowing smoke out of her ears and not wanting to talk to me. But I was still able to explain this mom is a survivor and she asked me to protect her from further trauma. The nurse said, “it doesn’t matter you don’t act like that in a hospital.” And I just reiterated, “but she said stop.” Thankfully, the rest of our experience there was pleasant and I believe the nurses were even over compensating with how sweet they were for this first nurse experience. My client went on to overcome a very typical survivor-type apprehension with pressure and second stage, and I believe it brought healing to see her push through fear and still birth her baby without anesthesia or an epidural – the way she wanted.”
What you’ve just read is an account by a doula about a birth she attended in December 2018, originally posted in a private group for doulas and shared with permission here. I would like to point out a few things about this story.
1. This is normalized assault and battery, also known as “obstetric violence.”
Obstetric violence is normalized mistreatment of women in childbirth, which this story describes. There is no recognition here of the birthing woman’s human or legal rights over her body (to say, “No” to any kind of touch) or her healthcare (to receive full information about the risks and potential benefits of the exam and make a choice whether to allow it or not).
It is clear from the doula’s story that the nurse’s behavior was normal for her. When the doula pointed out the person with the hand in her vagina was saying, “Stop,” the nurse replied with, “I have to.” The nurse was angry in that moment and afterwards. The nurse clearly believed that her professional duty to make this assessment overrode the woman’s consent, and stopped only when the doula insisted.
On the original thread, I stopped counting after 20 replies from doulas saying, “This happened to me,” or, “This happened to my client.” They described everything from a provider about to do a non-consented vaginal exam and stopping when requested, to women screaming and clawing away from the provider and being held down as they were forcibly subjected to these exams. I share these anecdotes here without specific permission only because they are not unique–I have spoken with countless women who have described these exact same scenarios. (See “Letter to an Obstetrician: Forced Vaginal Procedures are Unethical, Traumatic”) I have reached out to hospitals and helped women reach out to their hospitals following forced cervical exams and membranes strips, to be universally dismissed by hospital representatives who–wrongly–maintain they do not need women’s consent for procedures during birth, and do not believe women have the right to revoke consent once it is given. (See “Being Admitted to the Hospital or Signing Consent Forms is NOT Implied Consent”)
Contrary to what these providers and administrators believe, everyone has the right to say, “No,” in Labor & Delivery. This is a human and legal right. The national obstetricians’ group reminded its members of this in its 2016 ethics committee opinion “Refusal of Medically Recommended Treatment During Pregnancy,” which included this statement: “Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life.”
2. This is a sexual assault for this woman.
A sexual assault survivor is screaming stop while someone forces their hand in her vagina. This is sexual assault. It does not matter to the person having the hand forced in her vagina that the context is a medical one. It is her body, and it is being violated by someone who is not listening to her scream, “Stop!”
Whether someone is a survivor of sexual abuse/assault or not, this could feel like a sexual assault. (See the video for “Birthrape and the Doula”)
3. Note this sentence from the nurse: “You don’t act like that in a hospital.”
The nurse is not talking about her own assault on a survivor, but about the doula speaking up to stop it. She is chastising the doula for stepping out of the hierarchy that puts the birthing person and doula at the bottom, and the care providers higher up. This nurse felt empowered to first assault a patient in full view of her husband and support person, and then to instruct the support person (the doula) to leave the room and abandon her client. It seems that in her view, that IS how you act in a hospital. To challenge an assault on a patient is how you do NOT act in a hospital. Again, it is clear that the nurse’s behavior is normal and acceptable for her.
4. Providers can be well-meaning and caring, and still traumatize a patient.
A provider may genuinely think he or she is being helpful by completing an assessment that they see as valuable; they may believe the procedure is necessary for the patient’s own good; they may be coming from a place of concern.
Unfortunately, good intentions don’t prevent the traumatic effects of assault. Intent and impact can be very different things–especially on someone who is a survivor of a previous assault.
It can be difficult and emotional, even traumatizing, for providers with good intentions, who believe they are helping people, to realize their actions have traumatized a patient. This realization–that a certain “help” is actually a “harm”–can trigger anger and outrage as well as guilt and grief.
Those of us who have the capacity to do so must make space for the fact that most providers are trained within a system that incentivizes dehumanization. (See “Physician Trauma: A Doctor Answers, ‘Why Do We Sometimes Do Terrible Things?'”) They are confused and reactive when confronted with something that challenges a belief system in which they have invested their professional lives, money, and identity. We need to continue having conversations about how we can change this system and how providers can recover their humanity.
5. This is an empowered doula who knows her client’s rights.
This doula was able to confidently stand with her client because she knew her client’s rights. I will admit that I got a tear in my eye when the doula told me that she knew this was assault because “of people like you. You’re the reason I can verbalize things I didn’t know there are words for–now I can protect others by calling assault what it is!” This is why I do what I do at Birth Monopoly.
Because she was empowered, the doula was calm in the moment. She followed up afterwards to communicate further with the nurse for a teaching moment. She describes the rest of their experience there as “pleasant” and “sweet” and I will bet this incident caused some behind-the-scenes chatter in Labor & Delivery. That is a wonderful thing.
On behalf of birthing people and sexual assault survivors everywhere, I want to thank this doula for her calm, strong advocacy in this moment. She ran an intervention that may have prevented a great deal of trauma to her client. She made space for the partner to speak up for his wife when he told the abusive nurse to leave the room. This is a great example of a professional stepping into her role as a valued member of the birth team, putting her client’s needs front and center, and breaking a pattern of abuse that will have ripple effects for every person involved.
So many times in this article, it is stated that the nurse is shoving her hand up into a woman’s vagina to check the cervix. This description is inaccurate and certainly terrifying to any woman anticipating a cervical exam whether a survivor of sexual abuse or not.
Many a first time mom has asked me “are you going to put your hand in me?” And I have no idea where people might be getting this obviously inaccurate and terrifying information. Except for articles with this misinformation,
Two fingers are used to find and asses the cervix, NOTones entire hand.
I certainly agree that no means no.
And request that you describe a digital exam NOT A WHOLE HAND IN THE VAGINA, as that is very inaccurate.
Donna, my OBGYN had to put her hand in my vagina because my son’s head was so low in my pelvis that it was obstructing the cervix from view. She pushed his head up with her hand and it caused severe pain. She did not stop until my husband told her to.
I am sorry that happened to you. And yet most exams are a digital exam using two fingers and not the whole hand.
Donna, that is not accurate with everyone, my nurse did put all four digits into my vagina to assess my cm and would move them around to ensure the entire cervix was clear, this was tramautizing and painful evey time, all nurses are different and mine was aggressive. This is what caused part of my trauma.
Don’t come on to a forum for survivors of abuse and invalidate their trauma smh. They’ve had enough people telling them that they’re lying or exaggerating
What exactly is a “birthing person?” You mean a WOMAN?Let’s not disrespect WOMEN by dehumanizing them with this double speak.
“The future of birth is non-binary.
What do I mean by that?
Non-binary folks and transmen are giving birth. They have always been a part of birth and parenting, and we’re making room for their stories.”
-Refuge Midwifery
Maybe your particular life experience hasn’t brought you into contact with nonbinary or trans folks. That doesn’t mean that the only birthing people in the world are women. These are real lives, real experiences, and the current landscape of birth is changing to include, validate, and honor all these lives. If you have personal beliefs or judgements about gender identity, you don’t belong in this space, particularly not in the comments section in an article about birth trauma. I hope this comment prompts you to learn more, ask questions, reach out to people with different views, question assumptions. Wishing you well.
This happened to me. I am 3 weeks postpartum and my husband thinks I have baby blues. But im actually crying because seeing him and my baby are constant reminders of what felt like r*pe to me. I felt r*ped by that nurse. And she told my husband to hold me down while her fingers r*ped me. And my husband did. He didnt advocate for me when i was scared and in pain, screaming and crying and unable to breathe through contractions let alone voice my consent (or lackthereof)
I was in labor for an entire day, so I saw three shifts of midwives. The day shift midwife who I had only met that day, did a cervical check while I was in the middle of a transition contraction. I screamed at her to stop. I told her I was in mid contraction and that was not the time. She was not pleased with me and made some disparaging comments about how I didn’t have what it takes. In that moment, I did not know my rights.