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Tuesday, February 8, 2011

The Obstetrical BS Series: Membrane sweeps without permission?

What your doctor - and everyone else - is essentially saying
is that because you're pregnant, you have no rights.
So "get over it."
This topic has come up every now and then: mom is going in for her routine (eyeroll) cervix check, but something is different about this one. It's taking longer, the doctor's really rooting his or her hand up in there, and it's wayyy more painful than what you're used to. What could possibly be going on?

Ten bucks says Dr. Pitocin is doing a membrane sweep. And unless he bothered to ask you what you thoughts were about having one, or bothered to explain what he's doing (before he does it!), he has no business whatsoever being up there like that. I repeat: no business. Your body, your vagina. Period.

Just today I saw this question come up in the Yahoo Answers pregnancy forum: "Unbearable pain from internal exam?"
this Dr came shoved her fingers in me really hard i was gona jump out of the bed!! it was soooooo painful and she kept pushing her fingers in and tells me to open wider! which i didnt, i was in so much pain! i couldn't even breath! she took long time checking i did felt her fingers inside my cervix the whole time. she said i am 1 CM dilated with long thick cervix, baby is not even engaged yet. so, why did she take that long to check my cervix and why was it breath taking pain???? now am way to scared to give birth! the pain was unbearable!
I think my blood pressure went up a few points after I read that one. I try so hard not to get furious, or at least not to let it show, slinging harsh words around, but it's so hard. Sometimes you feel you have to simply to drive the point home that this is not normal. Not even close. 

I was prepared to get a million thumbs down, and one reader told her to "suck it up." I wanted to reach through the screen and slap her into cyberspace. 

Thankfully someone spoke up and agreed with me - which made me breathe a sigh of relief that yes, someone else gets it and no, I'm not being alarmist or paranoid. 

I've heard a number of laughable, startling and downright hideous answers to this perennial question, like:
Yes, they can and they will. Do not be surprised that you are not consulted on any procedure. 
And why not? Are you any less human once you become pregnant?
Are you serious, or just looking for a way to sue for some free money because I don't think that a doctor would do that without consent.
This was after a woman asked if it was considered sexual assault. Because everyone knows women just make up stories about things their doctors have done to them, just to get attention.

This person seems to think there must have been something wrong with the mother, as if she were apparently stupid or something for not realizing what was happening:
I find it hard to think of a situation under which that would happen. Did you think he was doing something else? How do you have your membranes stripped without consent. Was he holding you against your will?
And at least this person realizes that it's not the sign of a "good doctor," but doesn't agree that it's assault:
I think that's a bit of a stretch. Its not a sign of a good doctor, but its definately not sexual assault.
Then what is it, exactly?

One woman, who had her baby at home, "dealt" with the OB at the six-week checkup, surprisingly:
My husband was the one that confronted him on the issue and he apologized.
(Yay for awesome husbands!) And just the fact that this OB apologized acknowledges that he knew what he did was wrong.

It's important to note that many - probably more than half - of the stories I came across were from mothers who weren't even 38 weeks pregnant.

Just because he's your medical provider, doesn't mean he has any right to do anything to you without your consent. You are more than just a pod ready to eject a foreign body; you are a human being, who is carrying another human being inside of you. If you don't want to be induced, don't want checks of any kind, then doing an uncalled for membrane sweep is a violation of your rights, as well as the rights of your baby: because it's done in an effort to basically evict your unborn child from its cozy, warm surroundings, where 90 percent of the time, it's better off anyway.

Unfortunately because people think "vaginal exam" when they think obstetrician, they consider this part of the job, and part of the highs and lows of pregnancy. Some of the time, the mother might not even know what's happened, and that kind of creeps me out. I wonder - if a physician does a membrane sweep but yet it hasn't been mentioned to the patient, and she doesn't really express concern, does it get documented? What if mom were to go back and look at her records?

Perhaps this is just another reason why many doctors are reluctant to show you your records: because they don't want you seeing that they did something without your permission.

If this woman were in an empty parking lot at midnight, loading her car with groceries and approached by a stranger who attempted to rape her, this would be assault. But because the man is her obstetrician, that's supposed to make it okay, I guess.

Just like with rapists, these "professionals" get away with it because no one complains. And in this case, the reason why no one complains is because much of the time, no one is quite sure what's being done to them is a problem. Or that it's really being done to them. Too much trust is placed in their hands, and just like a sexual perpetrator, they continue to abuse because they have your trust. I'm not comparing OB's with perps in the sense that they necessarily get off on what they're doing, but in a psychological sense, perhaps they do enjoy the sense of superiority it brings them. I don't think that's limited to obstetrics, but perhaps medicine in general. While there are very fine physicians out there in all fields, no doubt many of them do have a power-tripping God Complex.

No one would ever tell a rape victim to "suck it up." We realize it for the violation that it is.

It's also important to realize that by justifying these procedures as "part of the pregnancy routine," you are normalizing the abnormal: it represents an erosion of the pregnant woman's rights. This is not the first time such a thing has happened in obstetrics (or other medical disciplines), and certainly won't be the last, I'm sure. Take for instance:

• The case of Dr. Allan Zarkin, who carved his initials into the abdomen of a patient after her cesarean. While his lawyers argue that Dr. Zarkin was suffering from a brain disease that impairs his judgment, one wonders why, then, he was practicing medicine in the first place, especially considering he had shown strange symptoms and bizarre behavior up to a year before the incident. No one reported it. In fact, he was made medical director and continued to perform botched operations during his tenure, and was also granted hospital privileges somewhere else after Beth Israel Hospital in NYC revoked his privileges. According to one site, he continued to practice medicine after this case.

• The case of a Kentucky woman who sued her physician after he branded the initials of his alma mater ("UK") into her uterus and then had the nerve to show her the video footage of the surgery. Not surprisingly, many people commenting on the case think that the woman was only out to make a quick buck, and really didn't have a case.

Dr. James Burt routinely performed disfiguring genital mutilation on patients for years, even after admitting to having done so without their consent or knowledge. This wasn't in some jungle colony where people practiced FGM as a matter of culture or religion; this happened in the United States. Burt supposedly chose "weak women" who were unlikely to press charges. Apparently a break came in the case when a retired nurse finally spoke up, after years of silence for fear of losing her job.

What do you do, when not only can you not trust your physician, but the nurses who work with him? The last line of defense in protecting you from dangers that you can't fight against, because you're not even conscious? And why did it take so long for patients to come forward?

The answer is probably as complex as it is simple: because we tolerate this kind of behavior among those in positions of authority, simply because they're in that position. Whether it's a simple vaginal exam or a surgery, it's essentially the same thing - a violation of your bodily rights and your trust.

Just like you were taught when you were a child, no one should touch you inappropriately without permission. Not even your doctor. If he's worth his salt, he will explain to you what he's doing before he does it, not during.

Don't assume that your doctor "would never do anything like that" to you or anyone else.  It sounds weird, ridiculous, maybe even paranoid. Ask yourself, "Why does his being a doctor make this okay? Just because he's a doctor?" Sorry, not a good enough answer.

Don't worry about making your doctor "mad." Remember, he's not your daddy. He's not going to ground you for breaking curfew. The more you know ahead of time, the more it will help you to make the best decisions possible. You can change doctors up until the last minute, and do not feel badly for "firing him" as your care provider even while you're in labor.

If your doctor does do something that you feel violates you, speak up. There is no reason why this stuff should be considered normal or acceptable, just because you're pregnant. Again, it helps to know what's truly normal and what's absolutely necessary before agreeing to something, but unfortunately you might not get the chance. Do not be afraid to say something, even if you think "it won't do any good." When OB's routinely do these things without so much as the blink of an eye, they probably never expect that someone would complain, and they usually don't - which is why they continue to get away with it.

• Practice informed consent, and if necessary, informed refusal. Just because your doctor says so, doesn't mean you absolutely must do something, no matter how unpopular it might make you become among him or his staff. If your doctor suggests doing a particular procedure, inform yourself as much as possible about it whenever you can. Would you undergo major heart surgery without researching it first? Would your doctor even entertain the notion before doing the surgery. Definitely not. Pregnancy and childbirth shouldn't be any different.

More reading:
A License to Rape - Birth Without Fear Blog
Dr. James Burt - Wikipedia 
Uninformed Non-consent - The Deranged Housewife
Doctor brands woman's uterus during hysterectomy - Owning Pink
Doctor sued for 'branding' patient's uterus (a different story from the Kentucky case)


Wendy said...

Excellent blog post. I especially like the action items at the end. Thank-you.

Anonymous said...

Here is another doctor - 76 counts of rape and sexual assault.

The reason why I'm "anonymous" is because I have info regarding this physician for the trial. I worked in one of his offices and witnessed inappropriate patient-physician sexual behavior.

Anonymous said...

I had this done with my second child. I had no knowledge that it was going to happen, what it was she did or why she did it (on a Tuesday before a long weekend). It happens all the time and I do tell people about it with the hope that it does not happen to them!

Smrt Mama said...

This happened to me during my second pregnancy. I was planning a home birth, but seeing an OB for shadow care. I hadn't consented to any internal exams, but was involved in a pretty bad car accident at 37 weeks, which led me to consent to a single exam (along w/ a NST) to make sure everything was ok. While she was in there, I remarked on the high level of pain she was causing, something I'd never experienced during a pelvic, pregnant or otherwise. "Oh, I'm just sweeping your membranes." WHAT? I yelled, "NO! YOU ASK FIRST!"

She then stuttered that she had only swept a little bit and hadn't gotten far -- the amount of pain, bleeding, and cramping suggested otherwise. I'm pretty sure she did the "stretch and strip" technique some OBs do, which involves manually stretching the cervix along w/ the membrane strip. I was so upset, cramping and passing a lot of blood, shaking; my husband called her that evening and laid it out for her -- what she had done was assault, she was incredibly lucky he was calling her and not a laywer, and that if I went into labor at 37 weeks, she could be her ass that the next call WOULD be to a lawyer.

She told him that she hadn't started stripping my membranes yet, that I'd stopped her before she started (a different story than what she told me) and that a membrane sweep wouldn't cause labor to start. When he told her what she had done was assault, though, she started crying. I guess she'd never thought about the fact that aggressively stretching another woman's cervix without consent, making her bleed and hurt, wasn't a nice thing to do.

Anonymous said...

Had a "sub" OB at about 36 weeks with my 6th baby. I had never had a painful internal exam before, and afterward had bleeding, cramping, and lost chunks of my mucous plug. Next week I talked with my OB and said I think the other stripped my membranes, and she said, "she'd never do that without consent." My OB gave me exams and they were NOT painful and I had no loss of mucous plug or extra bleeding and cramps, so I know the other OB had truly done something more than just a check. Ugh. And at that time she thought my baby could possibly be in a breech position, and I had a sonogram to show otherwise. Ugh. Why would you be so rough if you thought the baby was in a bad position? (One they would likely have given me a c-section for???).

sara r. said...

When discussing my birth plan with my favorite doctor at the practice I was at, he made a note of the "no stripping membranes" and said that I should remind the other doctors if I saw them, because it was common practice. At least he was honest (and I think that all-in-all, this practice was pretty good). I just decided to forego any vaginal exams altogether- no reason to risk it. As it so happened I made it through the whole birth with no exams since I labored at home for so long. Sara- 1, stupid ob procedures- 0.

Rachel O. said...

When signing all the new patient paperwork at an known natural-birth friendly OB's office, I was shocked to find a waiver, written in plain English, that stated that I agreed to any treatment that the doctor found necesary. I was shocked at this broad of a statement. I refused to sign the waiver; the girl behind the desk scoffed at my refusal. After getting to know the doctor and midwives better, I don't think they would mess with a patient's body for their own personal convenience. But I know that some do. My own mother was told that she was going to have her baby NOW, because the doctor was not going to miss his scheduled tee time.

I teach The Bradley Method(R) of Natural Childbirth. I have heard many stories of membrane sweeps and amniotomies performed without a mother's consent. I warn my students of such things.

I said that these procedures were performed without the mothers' consent. If by signing a blanket waiver as a new patient such as the one I described above, does that give the doctor the legal right to do such things without telling the mother first? Legally, I think maybe so. Morally, I think not. Informed consent! Know what you are agreeing to. YOU are the one that has to live with the consequences of your care giver's actions.

How many of us know what exactly we signed as a new patient, perhaps years ago? Did you sign a CYA waiver such as that? If so, would it hold up in court if you sued for assault after an uninformed, undesired membrane sweep?

The Deranged Housewife said...

One of the most painful comments I read after posting this was from a mom whose doctor did this to her at 35 weeks - and it put her into labor. :( Her son was okay, but did spend time in the NICU, which I find disgusting. That's grounds for malpractice!

Anonymous said...

I never had my membranes stripped without consent, I was never anything but long, closed and thick in the pregnancies before I stopped consenting to routine cervical checks.
I was assaulted by a gyn when I was a teen though and in front of a member of his staff.
Her reaction? To touch my knee and apologize for him and that ' he shouldn't have done that' and when my mother confronted the female gyn in the practice?
'oh, sorry about that, we try to keep him from our teen patients, he doesn't relate well.'

All doctors aren't kind, altruistic men and women with nothing but the desire to heal.
Sadistic, cruel, narcissistic doctors are a distinct minority but they leave a wake of frightened, scared, scarred women behind them.

The Deranged Housewife said...

OMG that is so horrible. I am so sorry. :(

t_winterholler said...

I ran across this page while trying to find out more on membrane stripping- even though it has been over two years since my experience with it, it still bothers me. First off, this was my 1st pregnancy and I had never been to a gynecologist prior. I was 21 at the time, as well as the father whom attended every appointment and was almost always in the room. I answered all questions with complete truthfulness. I feel like that might have been the start of my issues with the clinic- we looked like 16 year olds with no financial stability that might "make risky choices"... I am very aware of how our profiles appeared, no matter how unfair or untrue. In any case we were obviously scared kids, with no points of refference. During my first exam, my OBGYN noticed a wart. 'I am concerned about a wart on your cervix because it could be cancerous.' She told me that she was giving me a cervical biopsy- take a small sample of and get it tested for abnormal cells. That I had to sign a form to give them permission to take and send out the sample to the lab. She said it would not have any affects or risks on the baby. Around a week later, I woke up with a fever and cramping. When I went to the bathroom, a big clump of solid black fell out into the toilet. The receptionist at my clinic told me to go to urgent care or e.r. becaus eof possible infection. In the e.r.,I explained what was happening and mentioned the biopsy, as it was the only thing out of the ordinary over the entire pregnancy. They seemed a bit shocked that a doctor would perform that during a pregnancy- at my age, and considering I was almost 6 months along already. But they were just as quick to silence about it and move right along, which red flagged me. All I have heard on the issue is that I was almost too far along for an abortion, (which I wouldn't have done even if I had had cancer)so treatment would have had to wait anyway. I have always been unsure as to whether this was strange, if she was just being "extra cautious", however I think it seems strange that she wouldn't tell me all of my options, the risks of the procedure (infection, miscarriage)and truely give me informed consent.

t_winterholler said...

(continued) Weeks later my OBGYN told me she was pregnant too, waiting until she undoubtedly showed, she had practically the same due date. I thought it was kinda rude to take on a patient you couldn't keep without asking what their feelings were. Sure enough weeks later she had early contractions and went on leave. I met my new doctor who explained she was taking on a lot of patients, and my appointment dates might be changed. Fine. Then on my second to last check up, she started talking about how she was worried cause a lot of us were due around the same date. Then she continued with the exam of my cervix, which was not yet dialated, almost 1cm. she said, "I am going to strip your membranes" and all of a sudden I could feel several fingers inside of me, moving in a circular motion. It felt like scrapping the pulp and strings off of the inside of a carved pumpkin and the stringy stuff was my nerves. She tells me, "You will have a 75% chance of going into labor within the next 72 hours". Ummm, okay? I was not due yet, why were we inducing labor early? When I did finally go into labor, close to my projected due date, she wasn't available and I got a fantastic male OBGYN instead, I would say my due date did not fit in her schedule. But why not ask if I was okay with inducing it early? I am not actually, I prefer nature takes it's course and babe comes when babe's ready. Even if that means swapping patients around again, if they are recieving better care because of it, that's what should be done, that's what matters. Looking back I am just so sad/ angry that people made choices with my body, without full informed consent. That they saw someone weak and scared, and thought that they better new what was best, or could take advantage of me. Maybe even hoped something would happen so I wouldn't be a mother. People may think I am just being emotional and jumping to conclusions, but since I have been diagnosed with endometriosis and told to see a GYNO. I went back to the only one I knew- as the male doc who brought my son into the world was booked for 6 months in advance, and I was in too much pain to wait. She told me I could not afford any treatments, the best thing would be a hysterectomy or depolupron (puts body into fake menopause) and to come back when I had money. In the meantime take around the clock Ibu and Tylenol. I got a second opinion, luckily, after she stood there during the appointment looking at herself in the mirror and telling me I shouldn't bother finding treatment without money. This new GYNO had me try a $4 perscription, and it has helped tremendously. I don't know if there is a whole lot wrong here, technically, but I feel taken advantage of and indignified. I just don't want this to happen to any other women there again, and would like to see justice made instead of worrying about what other young women are going through. Pregnancy, sexual health, parenthood... are all sensitive topics and leave you subject to vulnerability, a support system is what a women really needs to have a happy pregnancy thus happy baby. Ideas? Thoughts? Any feedback welcome.

Jespren said...

In comment to the question about blanket consent forms, I've heard from several lawyers, and even a doctor or two, that they 'arent worth the paper they're written on', but they are used because the average person doesn't know that, so when they complain, tthe hospital can wave the waiver in their faces and scare them out of any actions because the patient thinks it's legit. They are ultimately pointless because, to be legal, a person must give informed consent, so unless the blanket form includes full information on the benefits of any and all procedures you come across during you labor and delivery they still, legally, need direct and specific consent before each procedure.

Lauren said...
This comment has been removed by the author.
The Deranged Housewife said...

T_winterholler: Have you gone back over your hospital records? Who knows if that would reveal anything interesting. What are the chances of developing endometriosis AFTER a pregnancy? I've often heard of women developing it BEFORE and thus they can't get pregnant without much difficulty or assistance. What you went through sounds absolutely horrible.

Elizabeth said...

This happened to me. I just had to share your piece here with my readers at my Facebook page. I still never said anything to confront the people responsible (more than one professional was involved, from my perspective). I explain it away as she thought I understood what was happening. Does this sound like over-rationalizing to you? If you aren't certain the patient understands what you are about to do, is that alone a reason to not proceed? That isn't exactly "informed consent", correct?

Carolyn Hastie said...

So good to see this post and women writing their experiences for other women to see. Sharing stories is how we learn what's acceptable and what isn't. Your stories are so important. Sadly the truth is there are rogues who deliberately hurt and others who are insensitive to the vulnerability that women have around their pregnancies and it is vital that women know that, so that when they feel uncomfortable, they can say so and stop whatever it is they feel uncomfortable about. Thanks again for sharing. All midwives, doctors and students need to read your stories so they learn from you.

Anonymous said...

I had a client recently who described to me a very painful exam that her midwife gave her about a week before her due date. She told me all about it, described it as "the most painful thing" she had ever experienced, and asked me if exams in labor would be that painful. I assured her that while they would be uncomfortable during contractions, they would not be that painful. My client didn't know what had been going on, but it was very obvious to me that the midwife had done a stretch and sweep without my clients knowledge.

Anonymous said...

Thank you for writing this. When I was 39 weeks pregnant my female doctor did a stretch and sweep without telling me what she was doing or asking permission. I yelped in this day it was the most painful experience I have ever had. It hurt much more than the actual labour and delivery for me. I still feel traumatized and it was a long time ago. I still cry about it sometimes. My husband says I need to 'get over it'. He doesn't understand how I feel violated by someone I respected and trusted.

Anonymous said...

I suffered from ptsd after my inicial visit from the clinic and hospital, u was planning on refusing every swab, bishop score, catheter, and violating or demeaning prosedure....ya I do believe one day our future generations will look at us as we did the past: WHAT no washing hands after taking out a baby then getting the next one?! WHAT they did that to women?! I know its all done in the name of health for the baby but theyre practice is in vain because the law doesnt concider a fetus alive till it is out of the body so why do they have to use guilt trips, fear mongering, and harrassment to get concent? Because it doesnt make sense to concent. I had to agree to swabing for the baby after being guilt tripped and even though the nurse and doctor knew I was forcing myself they could care less what effects an invasive procedure could do to the brain, it was no big deal as ut turns out....untill they LOST my culture so a repeat had to occure then without warning a bishop score was performed this made me thriw out my birth plan I felt wronged and may as swell agree to everything else conflicting my ethics and morality I may be hyperbolic but I felt PLAYED. The culture was inconclusive because cirvical cells arnt around till 21 I was 20, then the doc says I have half a fistula so I need a catheter adjusted thus I agreed to an epidural for needing a catheter anyhow the doc calls him up and say no you dont need it adjusted! I felt like an anumal tied up for two days with no food or water...even a sip under alit of distress from all the nessesary...suppossibly...examinations, which if your a student SAY it, they tell me oh we`re doctors then they dont find the cervix and wow you build your reputation as a trusted profecional through lies and deciet. I told the staff no more students and then they send another to stitch me up....what the hell do we have rights if there is no ONE in the clinics or hospitals to enforce them obviously the checks and balances of nurses and dics was compromised long ago I call for a notary available at all times for all clics and hospitsls to help make birth plans, refusal to concent forms, affidavits and ect because NO does not mean NO it means ask me in 2 mins, remind me of family deaths, include your own personal stories to entice your stance of my poor decision making, say its all for the baby like if saying no is you agreeing to being a bad mother....emotional extorsion anyone??? The lucifer effect exists so dont leave the most vulverable to continue being it pregnant women and newborns, I was told if I didnt concent to a catheter on my daughter she would die....death is always possible and I wouldnt risk it but do you get PATIENT DOCTOR EDIQUACY CLASSES IN MED SCHOOL??? Seriously take some! Thats all you need to be the best health proffecionals a notary and manners.

Sabrina Craig said...

Thanks for helping spread the word about this. It can be very frustrating that there are still those doctors who do such degrading practices to their patients. I hope this post could encourage everyone, especially women, to be brave and let their voices be heard. They should never let anyone change their body in any way, especially without their consent.

Sabrina Craig @ Medical Attorney