My response to Free Advice Legal Forums: Childbirth issues

Once in a while I stumble on the mother lode of all blood pressure triggers: in this case, it wasn't The sOB but the legal forums on freeadvice.com. "Outstanding advice, unbeatable price" is their motto. Let me tell you: you get what you pay for.

There are no shortage of odd, extremely sad cases floating around over there, and this was one of them: in short, a mother was 38 weeks pregnant with a breech presentation, and requested an ECV to turn the baby. The doctor was hesitant - probably taking the "Well, it might not work and you'll end up with a cesarean anyway!" approach that is so typical. Basically, the mother was given a VE-turned-membrane sweep and began labor three hours later. *sigh*

It's clear that the doctor was hesitant to do the ECV because she was afraid it would work, not because it wouldn't. The patient was obviously somewhat, at least, informed that she had options, and when she tried to exercise her rights, was thwarted. A cesarean ensued, and the patient had other problems as a result. While this was three years ago (so her child would be about six now), she still had lingering thoughts and bitterness over it, which was understandable and completely justified.

Boy, did the idiot comments fly after that. Of course the "You have a healthy baby, get over it!" was among them. I had been reading this forum for a few days prior, and saw the nastiest comments come up from the same woman every time - but this time I could not keep my big mouth shut. I had to say something before my brain exploded.

Here is my response:

While I know this is an old thread, hopefully someone might return to it to gain some perspective and help. 

There are some major philosophical issues that first must be addressed here - namely, the rights of the pregnant patient. People seem to have a lot of trouble understanding those areas and that, even though you are pregnant, you are still entitled to be treated like a person. Some of the comments here are so hateful and almost misogynistic - and I think that is indicative of our legal culture when it comes to childbirth issues and injuries/malpractice that might occur - that basically say, "You wanted a baby - you should therefore subject yourself to anything that might happen to you in order to deliver that child." That is not true, but because it's the predominant theme among most people, they'd lead to believe that the things happening to you were somehow normal and justified, and you should just "get over it." Too bad!

Unfortunately, I can't say their answers would be the same if this were a male patient; or someone receiving cardiac care, for example. There is such a double standard that exists when discussing childbirth issues and most of it, I think, is from ignorance. Yet, ironically, those very same people come back and tell YOU that YOU are uneducated. Very sad. 

You have every right to be bothered by this, but unfortunately because of the time frame, you probably don't have much recourse legally. Unless there are multiple complaints filed against the physician or hospital, they probably wouldn't do much to entertain your complaint. Even if there were multiple complaints filed, they probably wouldn't do much more than issue a perfunctory slap on the wrist. I say this not as a legal or medical professional, but as a childbirth advocate who has talked to many (MANY) women who have gone through similar scenarios, and as a mother of three young children. 

Reading between the lines here, I think it was obviously very unwise of your doctor to purposely strip your membranes without your permission. While some people think you can't really "prove" that this is what happened, you will know that a typical vaginal exam does NOT feel the same as when your membranes are stripped - that is your first clue. Not only that, but the obvious admission from your nurse friend says that she knew in advance that a stretch and sweep was going to be performed; I'd be curious to know what it says in your chart about that. Why would they do this when the baby was in an unfavorable position? Because they wanted you to go into labor and hence deliver the child by cesarean. I think your doctor hesitated about the external cephalic version because she was afraid it *would* work, not because she feared it wouldn't. A portion of them ARE successful, and while painful, that is why they admit you to the hospital and administer an epidural - most of the people who commented here either overlooked that or didn't know that is usually standard procedure. Unfortunately, what they also don't know (or don't want to admit) is that sometimes, babies will turn up until the last minute, even while in labor, into a vertex position. While some people will tell you this is rare, I think it's probably because the baby was never given a chance to turn because mother was sectioned before labor even began. 

A healthy baby DOES matter, but so does a healthy mother. Many people are too quick to completely dismiss any emotional or psychological aspects of birth, especially those that are traumatic. What many of those same people - including mothers - don't realize is that often times the very procedures we're subjected to cause more problems than if they had just been left alone; in other words, they treat birth like an accident waiting to happen, instead of treating things as they happen, IF they happen. Preventative, defensive healthcare in pregnancy and childbirth often causes more harm than good. 

It is the lack of compassion and utter venom that people like these forum members spew that makes women afraid to file complaints against their doctors, and the idea that unless you've lost your uterus, your baby or your life, there is no harm done. Bull----. And if you do complain, someone steps up and gets into a virtual pi***** match to compare birth stories and just how more terrible theirs was than yours, so you just better sit down and shut up. The truth is, few people know what normal is anymore, and are actually normalizing the abnormal. Unfortunately, it's rampant in obstetrics, and very difficult to just up and switch care providers, especially at the last minute. While it sounds like a good idea to just tell the OP to change doctors - at 38 weeks? Are you kidding me? No one would have taken her on, I'm sure. 

Consider your rights and options should you have another child (maybe you've already had one) and at least know that you have them. I'm glad someone mentioned ICAN; they are a good resource for support. Your lack of trust in doctors is not uncommon and you should not be made to feel like a freak because of it - you were violated and had things done to you without your permission. If this had been a sexual rape, would those same people tell you to just "get over it?" Is it simply okay because this was a physician, someone we should trust and respect, who did it instead? It's still a violation of your body and your rights and has changed the course of the way you birth future children FOREVER.

Sally, who thinks your birth was the worst ever and you didn't sue, no! This one's for you.

I'll anxiously await a response. *eyeroll*

The Obstetrical BS Series: "He's the doctor ... you have to listen to him."

When I was 22, I visited the Dreaded Gynecologist for the first time. I was young, naive, and totally stupid when it came to seeing the OBGYN. My doctor proceeded to tell me two things: That doctors should always put gloves on before examining you, and that they should always tell you - or ask - before they did something to you.

For some reason, people would never tolerate having someone aggressively approach their genitalia in any situation - but because you're at the OB's office, whatever he does to you is suddenly okay.  It's like your care provider has free reign over your body parts, and it's just too bad if you don't like it.

While we should be able to trust our physicians, I'm no longer under the delusion that I necessarily can. As a result, I've become increasingly skeptical when hearing "emergency" birth stories and in dealing with my own OB.

Many people are under the impression - especially when it comes to labor - that doctors are always well-meaning, know what they're doing, and are doing whatever it is to you because it's necessary. I'd like to say that were always true. Unfortunately, largely because a lot of people are totally uninformed about birth, they don't know what's truly necessary and what isn't. Sometimes even when you are informed, it doesn't make a difference and you get railroaded into something terrible. I hate to say it, but that aspect of birth advocacy really depresses me.

Because of that lack of information, and the blind trust in the physician to be overseer in all aspects of our care, some people think that mothers who consider their experience 'less than perfect' are going to extremes when making claims of birth rape or assault. They think you're exaggerating, that you are being dramatic, that you care more about the "experience" (gah - I hate that description) than a "healthy baby!" Fervent anti-natural birth advocates like Dr. Schizo often make those claims, as do those diehard women who run in her circles. To say that a healthy baby doesn't matter to any pregnant woman is utter BS. But to some of us, the process of getting there means more than to others, and can greatly shape our definition of "health" both for mother and child. I hate how those "anti" people tend to completely disregard the emotional and physical well-being of the mother in favor of the baby, as if it means nothing. How can we even consider for a moment that mom's overall emotional and physical health don't play a role in how she cares for her newborn?

Many times I've run across comments like, "Just listen to your doctor, he knows what he's doing," or "You are not a doctor and you can't possibly know anything." Totally downplaying mom's (completely relevant) fears and concerns as if she's some kind of idiot. When she dares to question the doctor, suddenly she's treated with disdain, as if to say, "How could you" One mom, when confronted with the comments of a knowledgeable labor and delivery nurse, basically said, "You're not a doctor, and I won't listen to you." That degree and white coat mean so much to some people that they're totally willing to overlook huge red flags, like My doctor treats me like sh!t, belittles me, makes me feel like my concerns are meaningless, and doesn't treat me like a human being.


Our often well-meaning, completely birth-stupid culture devalues mom and her individual labor and birth needs, essentially seeing her as nothing but a vessel - an incubator who holds that baby in for 10 lunar months and suddenly ejects it in any way possible, whether she likes it or not. Then they either turn around and accuse you of being uninformed, or being selfish - even though your baby is no doubt just fine.

OB:  “If I’d known the baby was so big, I would have done a cesarean section.”

Mother:  (holding her just birthed baby) “I wouldn’t have let you!”

OB:  “It wouldn’t have been up to you.”  (Courtesy My OB Said What?!?)

So, mom is perceived as selfish and superior because she would have had the audacity to question her doctor. And her doctor is basically implying that he would have done a cesarean without her permission. Many women called it as they saw it, except this one:

"u ladies need to be a little less sensetive, hes an OB.. part of their job description is to come into contact with female genetalia.. birth rape? give me a break.. i have had 5 kids, and have suffered some pretty traumatic birth experiences ((ie. heamorraging and having the OB use her hand to mannually remove the clots from my uterus))… but thats birth, its dirty, its hard, and its not pretty… if ur not ready for that, then adopt, or buy a puppy…get over yourselves…."

So in other words, even if your vagina was forcefully entered into with a hand, fingers or other tool, or even the mere suggestion was made of doing something without your consent, you're just supposed to get over it. Because he's the doctor.

Yes, an OB's job is to come into contact with vaginas and whatnot. But it's the contact part we need to examine: did he ask first? Did he tell her what he was planning on doing before he did it? Did he preface it with a comment that suggests her rights were completely irrelevant to him, as the above post suggests? (As a side note, I bet you ten bucks that the second commenter's "traumatic birth" was likely due all or in part to her overzealous physician. What say you?)

Further down in the comments section, another poster mentions how yes, it's assault; but it would be awfully hard to prove in court. Of course it would, because we have a whole generation of sheeple who think the doctor is always right and only does what's good for you.

Awhile back I read the comments of a mom who was nervous about her doctor inducing her with Cytotec. She was planning on standing her ground if the doctor insisted on using it, but "didn't want to make him mad." I nearly swallowed my teeth.

As usual, the old "He knows what he's doing" crap came out. And while I was happy that she had done some reading on Cytotec and the concerns surrounding it (more than likely because she's used to hearing about Pitocin and this sounded different, thus prompting her research), I'm sure she had no reservations whatsoever about Pit and didn't question that one iota.

Your OB is not the boss of you. He is not God. He is not your dad. He is a medical advisor, and you are free to seek another opinion regardless of what he says. Yes, sometimes unpleasant and painful things must be done to us for the safety of ourselves and our babies, but he or she should do so with compassion, dignity and respect. And if he's not giving it to you, then you need to demand it, because it's your right.

Do not let anyone tell you to disregard or ignore your feelings of inadequacy, spiritual, emotional and physical pain, and other complications that might be hard to concretely identify but you know they're there. You are not just a holding tank for this child; you are a human being with feelings, emotions, and rights.

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.