Traumatic Birth and Informed Consent

A friend told me the other day that her son is old enough now that people are asking when she's going to have another baby. And she confided with me that she's not interested in sex anymore. Its a quiet death that many women experience after birth, and can last a few months to a few years or more. To some extent is has much to do with being a stay-at-home-mom who is constantly being touched, puked on, nursed and needed. Which in itself is not how mothering should have to feel. But what she feels is more akin to PTSD because she says sex reminds her too much of her traumatic birth experience.

She said she's seeing a therapist. I suggested finding a birth trauma support group. Did you know where is such an invisible yet pervasive experience of traumatic violence by care providers during birth that there are groups of women who meet to support one another and heal the wounds of this experience?! Did you know that birth trauma and birth violence is so real!? It doesn't need to have been a physically violent experience for a women to have regrets about birth. Often it was just the experience of having no choice, no voice and no control.

I am a real proponent of seeking positive, empowering birth stories because they give us courage to move confidently into our own births. To know that, this is going to be hard, take a lot of work, but I know I can do it. As an empathetic person, I find it difficult to read and hear these traumatic birth stories. But we also need to be prepared for the reality of hospital birth in the US. I'm not talking about the "horror" stories of 3-day labors, or how bad you tore. There will often be difficult and gruesome details in birth, but the overall feeling is important. There is an odd culture of "my birth was worse than yours." Perhaps because we're playing some masculine, toughest gal standing, birth medals of honor. These traumatic birth stories are different. They make me mad as hell at the nurses, doctors and even midwives or doulas (god forbid) who inflict harm by being coercive, disrespectful, demeaning, belittling and physically with or without consent, violent.

Our society has allowed rape culture to pervade the most sacred and feminine of all experiences. But that is not surprising when we consider that grown women in the world's richest country still don't have final say over reproductive rights in general. Part of why we are seeing this is because more and more women are bringing it all to light, to the surface. Literally, shining the light in a dark ugly place. But you should be used to that by now -- we women are getting good at illuminating the parts of our lives we no longer will tolerate. When we see experiences that we've had, presented in the daylight, we are more willing to share our own stories, which in turn amplifies the common experience.

Another reason we see this more is that we are demanding authority of our own bodies again (and again and again). This is MY body and my body alone. No one else gets to decide how I use my body. No one else decides what happens to my body. If you want to have anything to do with this body you have to ASK PERMISSION. Strange how is seems a stretch to take this from the bedroom to the delivery room! My husband needs my consent every time. My doctors need my consent every time. My children are learning about consent. Just because someone has a PhD, doesn't make her exempt from earning the same permission as anyone else. "Expert" does not equal "access."

I want you to know that everything about your birth is your choice. There is nothing that is required. There may be hospital policies, but you can always say "no." Sometimes that may mean you are refused service, and unfortunately that may also mean a fight, a "consequence" and sometimes "no" is what causes the trauma!

I'm not advocating for you to pick fights. I'm also aware of what "no" can and does mean. If you say no to a sexual act requested by a drunk man, there is a risk that he will be violent and you get hurt. But I would not advocate that you just let it happen either. Can you see the parallel? My point is that you can always say "no."

There is a real lack of respect for laboring women. We seem to be just bodies who fill beds and require dosages of drugs and a fetal heart rate. Because you are (rightly and appropriately) in an irrational and emotional state, people think you cannot be trusted to know what you "really want." And if you haven't researched, read and written a birth plan, it can be near impossible to say "no" when we want to because we don't know the consequences.

This is where informed consent is key. And I'm going to put the impetus back on you, that informed consent doesn't begin when the doctor says, "time to start you on Pitocin." It begins now. The amount and kind of information that you'll truly need to make an informed decision goes much deeper than a 5 minute conversation.

Do the necessary work to create a well-researched birth plan and pull together your dream birth team.

This is a once-in-a-lifetime event that you don't get to do over. If women spent half the time preparing, researching and planning for their first birth as they do their wedding, we'd have much better birth experiences. Know all of your care providers and ask them tough questions. Keep asking questions until you get answers. Read, read, read. Talk to other mothers and ask them what they wish they would have known before birth. Make sure that only people who will be positive and supportive of YOU are present in the birth room (or even hospital). Hire a doula (whom you trust)!  Your "no" can be reinforced by the people who know what you've chosen. They should stand by your choices. They can remind you and the birth professionals of what you chose before labor.

When you know all of your options, it can be easier to say "I'd like this instead," rather than just "no." "I'd like to try laboring in this position instead." "I'd like to try this method of pain relief/speeding up labor." "I'd like a different nurse, we are not communicating well." "I'd prefer to risk tearing than an episiotomy." These are all actual options for you.

And despite all efforts to plan, research and choose, unfortunately things can still get out of control. When they do, reach out and get help. You are not alone.