When I say No....

**warning, sexual abuse triggers throughout**

NavelGazing Midwife has written a very insightful post on birth trauma and birth rape and, because of my previous post, I wanted to share my thoughts on this touchy subject.

Something Barbara notes is that, as a woman who has experienced rape, it was hard for her to hear women using this terminology when talking about birth practices.
an... "old post I wrote in 2004 right after I learned what birthrape was. I’d been quite angered by the women who used the term because, as a woman who has been raped, it was offensive. How could anything in birth be equated with the horrific experience women around the world experience? I could have closed my mind and left myself in anger, but I probed and really pressed the women to explain it so I could understand what they meant."
When you consider what rape truly is, though, and get to the bottom of  the physical and emotional implications of the actions behind the term, as Barbara ended up doing, it is exactly that.. rape.

Rape is (emphasis mine):
1 : an act or instance of robbing or despoiling or carrying away a person by force
2: unlawful sexual activity and usually sexual intercourse carried out forcibly or under threat of injury against the will usually of a female or with a person who is beneath a certain age or incapable of valid consent — 
3: an outrageous violation - Merriam Webster Dictionary
Some might say 'see, it says sexual activity - and they aren't doing anything sexual to you'... Let's break that down...

Sexual means:
1. Of, relating to, involving, or characteristic of sex, sexuality, the sexes, or the sex organs and their functions.
2. Implying or symbolizing erotic desires or activity.
3. Relating to, produced by, or involving reproduction characterized by the union of male and female gametes
Activity means:
To be in action, movement, or a specific pursuit.
My vagina/perineum/etc... is not just for intercourse.. So, by definition, we can ascertain that something done to my sexual organs against my will by someone in specific pursuit or action against those sexual organs would constitute as rape.

Barbara goes on to talk about the terms "assault", "battery, and "rape" from a legal code book:
"Legalese regarding the definition of assault includes (emphasis mine and my comments in parenthesis):

“… the essential elements of assault consist of an act intended to cause an apprehension of harmful or offensive contact that causes apprehension of such contact in the victim. (“You need to have a cesarean or I will get a court order to make you have one.”)

The act required for an assault must be overt. Although words alone are insufficient, they might create an assault when coupled with some action that indicates the ability to carry out the threat. (“Open your legs. I’m going to do a vaginal exam.” And the woman tells the practitioner that she doesn’t want an exam or tries to close her legs before the exam begins.)

Intent is an essential element of assault. … the intent element is satisfied if it is substantially certain, to a reasonable person, that the act will cause the result. In all cases, intent to kill or harm is irrelevant. (I’m going to give you an episiotomy.” “No!”)

There can be no assault if the act does not produce a true apprehension of harm in the victim. There must be a reasonable fear of injury. The usual test applied is whether the act would induce such apprehension in the mind of a reasonable person. The status of the victim is taken into account. A threat made to a child might be sufficient to constitute an assault, while an identical threat made to an adult might not.

Batterydefinitions include: “The act must result in one of two forms of contact. Causing any physical harm or injury to the victim—such as a cut, a burn, or a bullet wound (episiotomy, cesarean, IV, internal monitors, IV antibiotics, etc.) —could constitute battery, but actual injury is not required. Even though there is no apparent bruise following harmful contact, the defendant can still be guilty of battery; occurrence of a physical illness subsequent to the contact may also be actionable (a post-cesarean infection, systemic yeast after IV antibiotics, etc.). The second type of contact that may constitute battery causes no actual physical harm but is, instead, offensive or insulting to the victim. Examples include spitting in someone's face or offensively touching someone against his or her will.

Intent: Although the contact must be intended, there is no requirement that the defendant intend to harm or injure the victim. (This allows for the belief of doctors and nurses that the procedure/intervention is helpful, but the woman sees it in a completely different light.)

Intent is not negated if the aim of the contact was a joke. As with all torts, however, consent is a defense.

Under certain circumstances consent to a battery is assumed. A person who walks in a crowded area impliedly consents to a degree of contact that is inevitable and reasonable. Consent may also be assumed if the parties had a prior relationship unless the victim gave the defendant a previous warning.”"
** go read the rest of her post, it is a great read.

The gray area lies within the term 'rape'.. in many legal code books, as Barbara mentions, there is the specific outline that it must be intercourse or genital to genital contact. But that is not the original definition of the term rape.

Is it the result of one of many cultural disparages? Only 50 years ago, 'fingering' would be considered sexual deflowering. But, because of the culture we live in, we have changed the term to fit our cultural leanings... If we considered it  being a child instead of a full grown woman being touched inappropriately, would we consider it rape or only battery? IMHO, rape is rape. If it is done to my sexual body (genitals), regardless under what situation or with what instruments, and it is done without consent, it is rape.

I love how Rixa puts it:
Pain (or suffering) is like a gas: it fills the available space, no matter how small or big. That's why it doesn't mattter if someone else's suffering was worse--and there will always be something worse if you look hard enough.
I am glad that this is getting more understanding and thoughtful exposure, beyond the blogsphere. Although some still haven't gotten the 'aha' moment that it deserves. Tracy Clark-Flory writes:
"How awful to feel so violated while giving birth.... It is unbelievably horrific -- but it isn't rape, and the suggestion that it is seems like a violation in its own right...." "We have a special word for forced sexual intercourse, because it deserves a special word. Rape is used as a tool of terror, torture, intimidation and war (as we're seeing right now in Congo). Sometimes it is about violence, sometimes it is about sex, and sometimes it is about both. It is a special kind of crime not only because of what it is, but also because of what it does to the victim (in her own mind and others')."
I have to disagree on many points. As shown earlier, rape is not ONLY about sexual intercourse or genital to genital contact. By definition, it is sexual activity as well, and can even mean an outrageous violation, which she herself says it is.

Another thing that bothers me is her 'definition' saying that rape is about violence, sex, as a tool of terror, torture, intimidation, and war... It is.. but it is a little more specific most times as well... it is also about power. The more powerful subduing and violating the less powerful.

The man who has pedophilic fantasies, the college student who wants to be with a gal he can't have, the Grecian ruler who knows he can have any male or female slave in his household and takes advantage of that... intercourse rape is often about power.

And so, often, is birth rape. You would not believe the countless stories I have heard:
  • women who were sewn with no anesthesia while a doctor berated her for crying, and she has no doubt it was in retribution for telling him he could not give her an episiotomy or some other reason.
  • women whose knees are forced apart for a digital (finger) vaginal (sexual organ) exam to be performed against her will.. even sometimes nurses helping hold her knees open. And oftentimes, these vaginal exams are found to be more painful, heavy bleeding occuring, and sometimes the water being broken because of the aggressiveness of the exam.
  • Women who are bullied into getting an epidural because the nurses are tired of spending time and energy on one patient/tired of hearing her (want to shut her up and make her easier to handle).
  • Women who were given HUGE episiotomies even though baby was not near crowning right after the mother dared remind him that she didn't want an episiotomy (something she discussed with him prior after he stated he always does them for first time moms*). He followed this up with a growl, 'now THAT'S how we do things around here'.
  • Women who have been refused epidurals because they were told 'you wanted a natural birth, you're going to get one' after transporting to the hospital (from a planned home birth) out of exhaustion from prolonged labor.
And more.. You don't hear these stories from the women who are complacent and accepting of whatever their doctor/midwife tells them, you hear these demonstrations of power from women who question their doctor's authorities and then are 'taught a lesson' for their insubordination.

Other times, it is coercion, whether by threat or not, to be able to perform a sexual activity on her body against her will:
  • "if you don't let me do xyz, your baby will die" (even if the baby won't)
  • "Just a little peek, it won't hurt a bit"
  • "If you won't let us, we will get a court order"
  • "You might not want to, but I/we always get what we want because we know what's best for you"
  • "We can do this the hard way or the easy way, it's up to you"
Turning the Page

Thankfully, like I said earlier, we are coming to the point in our culture where we are understanding what is NOT OK in the birthing arena. We are coming to the place where we, as a culture, understand that, regardless what we call it, it needs to be addressed and women need to be given a safe place to heal.

Barbara notes:
Is Postpartum Post-Traumatic Stress Disorder (PPPTSD) an illness of luxury? If we were huddled in a migrant camp, would we really be concerned that the doctor pushed our legs apart to do a vaginal exam? Or would the multi-rape experiences overshadow the minimal intrusion the roaming doctor or midwife does.

Is PPPTSD judged by societal norms?

When I was in sexual assault self-help groups (almost always led by therapists), there was a tendency among the women to rate the abuse, almost always minimizing their own. “Well, I was just sexually abused at twelve from the guy next door. She was six and it was her brother. She had it much worse than I did.” Over and over, we had to remind each other (and be reminded) that rating the abuse discounted our own.
Kathy, from Woman to Woman CBE, adds:
But should we compare ourselves with ourselves? That’s not wise. If we compare ourselves and our situations with how good they could be, we can always find something lacking. If we compare ourselves and our situations with how bad they could be, we can always see that it could be worse. But does the fact that we are not the lowest of the low mitigate the fact that we are in some way suffering and/or in pain? Why should we compare the level of violation we feel to what someone else “must feel” from having been violated in a different way? Is that helpful? If it is, then perhaps we should; but I don’t think that it really is helpful.

In one way, it is this “comparative way of thinking” that may embolden some people to continue acting in a hurtful way. “Well, sure, I did X, but at least it wasn’t as bad as what this guy over here did!” Using that criteria and logic (or illogic), a mass murderer could justify himself by saying, “At least I didn’t murder millions of people, like Hitler and Stalin did — I only raped and murdered 50 women!” ?!?!?!? “Well I may have raped 10 women, but at least I didn’t molest any children!” ?!?!?!? Are comparisons really even valid, when you’re comparing a rotten apple to a rotten orange? They’re both rotten fruit! — why try to make it sound like either one is acceptable?!
Thankfully, also, there are women and organizations out there that are ready and waiting to help women to heal from these traumas. A few of the organiations are listed in my sidebar (and below):
Additionally, there are other things women can do. Namely, she can report the care giver who caused the trauma... not to the hospital board, but to the police. As another poster said,

Why is it birthRAPE?
The focus is on the vagina, the urethra, and the anus.
There is penetration.
The woman has said no, or would say no if she was given the chance for informed refusal.
The action has not been taken for emergency medical treatment, as in lifesaving.
The woman has suffered psychological injury as a result of the rape.
There is damage to the vagina, anus, urethra, or uterus as a result of the rape.
The woman is harassed or shunned because of the rape.
The practitioners who were involved refuse to bear responsibility for their actions, and other practitioners refuse to consider the fact that these type of actions are sexual violations.
Other women are encouraged to harass or shun the woman because of her rape because it is too much to wrap their prejudices around.
Police will mount an investigation into these type of allegations if they are reported, and practitioners found guilty will be prosecuted - if women come forward and report.
To HEAL, she can find a counselor, she can attend groups that deal with sexual trauma, she can journal, talk with a trusted friend, find a creative outlet (like pottery, painting, or poetry) that can act cathartically, or even attend a birth healing workshop.

She can contact a doula or midwife who is familiar with birth trauma and who might have symbolic practices to help women to release these emotions in a positive and safe way. There are people out there willing to help and women need to know that (fortunately and unfortunately) they are not alone.

If you encounter a woman who states she has been a victim of birth rape, she needs some things from you, the person with whom she has entrusted with this information:
  • resources, if you have access to them (like here and other blogs/websites) give them to her. 
  • knowledge, if it is more recent, she can report it
  • understanding, she needs a listening ear, not someone who will argue semantics or dismiss her emotions/experiences
  • compassion, someone who will validate her feelings, not someone to give her empty platitudes
In Closing

If a woman says no, she means no. And, whether you agree and call it birth rape, you refuse to call it birth rape and call it birth trauma or birth battery.. the bottom line is that it is not ok. Our care providers need to remember this truth and our women need to be given the safe space to heal from their experiences. Only when we see women through the eyes of compassion and understanding, and hold care givers accountable for their actions, can we hope to turn the page on this ugly truth in the childbearing.

* this was a client I worked with personally for her second birth and info shared with permission.
^ this was a client I worked with personally for her third birth after prior experience.


Anonymous said...

Great job on a sensitive subject that MUST be addressed. This and "pit to distress" have to be brought to light and discussed so they can be stopped.

Kathy Petersen said...

Just like the atrocities committed against our mothers and grandmothers that were only discussed and stopped after Ladies Home Journal (?) published the article/letter by the L&D nurse who could no longer keep silent about the abuse and inhuman and inhumane treatment she witnessed on a day-to-day basis, even so we have to bring to light the treatment birthing women are subjected to even today.

Mia said...

Wow, thanks for this article. I am planning a birth center birth a few weeks from now. I've heard some of these horror stories from friends. I also plan on being an L&D nurse, and then pursuing my nurse practitioner/CNM. One of my goals would be to tell women about their options. I was able to hand out our birth center's phone number to several pregnant soldiers in our reserve unit the other day (one of which, was pushed into consenting for an epidural with her first pregnancy). They had heard of birth centers, but not that we had one. I really want people to know what options are out there.

Anonymous said...

What is the best way to find out if your doctor, hospital, birthing center etc. makes a practice of the atrocities you mention?

Nicole D said...

Anon - the best thing you can do is pick a birth place and care provider that you trust COMPLETELY... and consider having a non-biased support advocate (like a doula, mom, MIL, or partner/friend) there for you.


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