Are you in an abusive relationship - with your OB?

I am convinced that some women are in abusive relationships and don't even know it. They would never tolerate emotional or psychological abuse from their husbands or boyfriends, yet they put up with it for nine months from one of the people who is supposed to support and protect them the most: their obstetrician.

After reading some of the abysmal comments from My OB Said What?!?, it's painfully obvious that many (not all) obstetricians and labor and delivery nurses are psychologically and emotionally abusive towards patients. Perhaps it's subtle; maybe it's not. But it's still there. I refer to this website continually because I feel it's a cross-section of reality - comments coming from real doctors, from real women and their real experiences. Some span the decades; most are recent. It's a telltale sign that the maternity system continues to be broken, and has been for a very long time.

We can easily draw some comparisons between an abusive spousal relationship and one between doctor and patient. I've taken some basic points from websites that detail spousal abuse and replaced the word 'partner' with OB.

Some of the biggest ones are:

• Does your OB frequently criticize you, humiliate you, or undermine your self-esteem?
Humiliation comes in many forms, including medical staff assuming you don't know who your baby's father is (even though he's present in the room), a home-birth turned transfer when they assume you've had 'no prenatal care' (even though you bring extensive medical records), or being treated like a child  who has no ability to assess the situation or speak for herself.

Telling you things like "You'll never be able to birth any baby vaginally!," "Don't you think your husband would rather you had a cesarean? " or "Are you from Africa? " serves to do nothing except undermine your self-esteem and make you think your body is defective. Many women are told this even though they've already birthed vaginally, something I find particularly mind-boggling.

• Are you afraid of your OB?
This one reminds me of a woman who was about to be induced with Cytotec, but had read warnings about uterine rupture and was very nervous. She decided to stand her ground about the induction, but yet was "afraid of making her OB mad."

• Do you sometimes feel trapped in the relationship?
This often happens when you know your doctor is a jerk, but you feel helpless, especially as you approach the end of your pregnancy. Often, doctors will threaten to drop you from their care, which is illegal, but still we feel obligated or threatened into continuing with something that we obviously don't want. Little do women know that they can find care late in a pregnancy, but often it is very difficult and stressful.

Brainwashing and mind control are also hallmarks of emotional and psychological abuse. (Replace the word 'brainwasher' with OB)

• The OB keeps the patient (victim) unaware of what is going on and what changes are taking place.
I once heard a comment that basically amounted to, "Forget about reading those pregnancy books; I'll tell you everything you need to know." Limiting access to outside information by creating a false sense of security often convinces women that they don't need to research birth because their doctor will give them all the details. My doctor tried this with me when I asked him about having absolutely no urge to push. He basically said, "We'll help you when the time comes," and that was all that was said about it. Puzzled, I thought, That's not much of an answer, and left there feeling confused and doubtful.

• The OB creates in the patient (victim) a sense of powerlessness, fear and dependency. In obstetrics this is often accomplished by threats (the dead baby card, it's often called) and coercion to get you to comply with his wishes. There are probably too many examples to cite or we'd be here all day if listed them. Some that  I've heard recently are "You can't have a due date without one," from an L&D nurse when a patient didn't have an ultrasound done. Another prime example is homebirth, where doctors, nurses and just about everyone else are under the impression that you can't birth without a doctor present. And if you do seek their care, they often sadistically withhold it from you as a means of inflicting punishment, or inflict pain intentionally - like stitching up cuts or tears without anesthetic after a natural birth. (This happened to me, and it didn't help that I saw the needle, either. I expressed pain and discomfort, which was pretty much ignored.)

• The OB puts forth a closed system of logic, and allows no real input or criticism. "In other words, what he says goes." Again, I could spend all day with this one, from the super-exaggerated "exploding uterus" claims that VBAC is too dangerous , to the VBAC candidate who goes through an entire pregnancy and then shows up in labor, only to find a replacement doctor who dashes all her hopes without so much as a word. Typically, in my experience, I ran into this behavior when I dared to ask questions at appointments, and got answers that made no damned sense but ended with "Trust me!" or something equally inane. Either way, they are using manipulation and outright lies to get you to comply, which are also signs of abuse. (Although a little extreme, check out the link to find out how your OB might actually display psychopathic traits . Scary but somewhat true!)

• Your OB has a great capacity for self-deception. He can not only fool you into thinking he supports you and your wishes, but also convinces himself that what he does is not wrong, but required and very necessary - even to the point of putting mother and baby at increased, needless risk. (Unnecessary inductions and unnceseareans are a prime example.) Jennifer Block brings this up in Pushed: A doctor that's pushing for a cesarean because the patient's fluid levels were low, and afterwards cheerfully announces when Block asks, "Oh, her levels were fine!" Another example: Block asks the doctor if he thinks the induction will work, and he says, "No." So why are you doing it?

• And as part of the last criteria, he projects the blame for his (relationship) difficulties onto his patient (partner). "If only you had agreed to an epidural sooner , we would have been done by now!" Another classic: "A natural birth can take all day, and I just don't have time to do that." 

The abuse can go beyond the emotional and psychological into the physical. From denying emotional distress  or physical pain , to purposefully inflicting pain as a way to almost punish the patient for her wishes - like intentionally not numbing the perineum while making repairs, or forceful but unnecessary removal of the placenta .

Often emotional and psychological abuse in a spousal relationship culminates in a physical altercation, such as rape. It's extremely important to note that rape does not always have a sexual connotation, but can mean several things:

1. To seize, take, or carry off by force
2. an act of plunder (to rob, despoil or fleece), violent seizure, or abuse; despoliation (stripping or taking by force); violation.

Synonyms listed include "violate", "strip", or "ravage". 

This type of rape can happen in obstetrics: it's often called "birth rape." Having a c-section against your will - which can and does happen, contrary to those uninformed people who think it doesn't - is almost like the culmination of many of these key points into one event: the forced birth of your child. Your doctor has used scare tactics and fear to get you to comply, often when the actual risk level is so minute as to be almost non-existent; and/or used physical means to force you into a suboptimal birthing position - does this sound like rape to you? - (one mom on the My OB Said What?!? forum says she was strong-armed by two nurses and had her limbs held down in the lithotomy position). He may have withheld information from you on his c-section rates, or perhaps created in you a sense of protection that he personally would prevent such a terrible thing from happening and there was no need to educate yourself any further about your choices. Perhaps you're attempting a VBAC, and he was supportive of you at first, but isn't any longer. 

It's important to remember that, to some people, that's exactly what it feels like to have a vaginal exam that you don't consent to (and nor do you have to, either). Or an episiotomy they don't want (or need) - Tina Cassidy mentions this in her book "Birth", where the mother refused the procedure and told the doctor not to do it, but he'd already begun. Those people who tell the patient to shut up and get it over with ("just have the section already!") are enablers to the abuse. People who criticize women who use the term 'birth rape' are forgetting that abuse comes in many forms, and are devaluing the traumatic experiences that these women had - much like abuse deniers try to devalue the trauma of sex abuse as a means of justifying it. 

Some people attribute it to a lack of compassion or understanding for their patients, almost like their common sense filters have been turned off, causing them to say stupid, heartless things without even thinking. Maybe, but I'm not totally convinced. How come there's no "My cardiologist/neurologist/gastroenterologist said what?!?" website? My family and I see a number of specialists for different things, and I've never been treated even remotely like this by any of them. 

I'm not even sure how to tell women to avoid an abusive OB, because it's easier said than done to just switch providers. Often the new doctor is just as bad or worse than the first one. Gaining knowledge, information and perspective on your situation can be helpful in encouraging you emotionally and physically, as well as knowing when your doctor is giving you a line of BS. Having information about providers and your choices before you get pregnant - because it can often be a long battle that draws out over the entire duration of a pregnancy - is probably tantamount, even though it sounds extreme. Being active in your birthing community by maintaining relationships with birth-friendly people, whether they're friends, midwives, doulas or whomever, can help you establish contacts that can prove very helpful in having a good birth experience. 

Even after three pregnancies, I'm still learning how to do this.