Birthrape And The Doula

Apr 29, 2016 by

The (1)“At many births, while I have my hand on a woman’s arm reminding her to breathe, someone has their hand in her vagina digging around, her eyes are wide, she’s trying to get away, screaming STOP… What do I do? What do I say? How do I help make it right? I hate it. I hate it. I hate it. It seems so wrong.” [excerpt from one email among many I’ve received over the years]

Dear Doula,

I wish I could tell you that these kinds of things only happen to you, that they aren’t worldwide, that people aren’t suffering, that how one is treated during birth doesn’t traumatize a person, and that I don’t have multiple examples of this in my doula interview files. But that wouldn’t be true.

I wish I could explain what the medical careprovider is thinking or understand more deeply the processes that lead this person to conclude that what they are doing is right or that it doesn’t matter to the person in the body that they are touching. But that compassion is hard for me to come by.

What I can tell you is that the careprovider has somehow forgotten they are treating a person, not just a body. The medical detachment they learned to protect themselves has gone haywire, and so much so that they’ve forgotten that a real person is inside the body, and it is the person, not simply a medical situation they are treating. There is no detachment for the patient – and everything is experienced wholistically, meaning it affects their psyche and their spirit as well as their physical selves. Maybe the medical careprovider never learned this or maybe this knowledge has gotten buried.

But our focus needs to be on our client, on the person in the body. We are their amplifier, their voice, their conduit, when others who are caring for them aren’t listening. We are the one reminding that there is a person in the body, and that person has value. So what do you do?

  1. Be the voice. State what is happening in clear language.

“Dr. X, I hear [client’s name] saying “Stop” and “No”. Do you hear them?”

“[Client’s name], do you want Dr. X to stop?”

“Dr. X, is this an emergency or can you stop for a moment and let us all catch up with one another?”

Christine Morton and Elayne Clift, in their book Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, discuss the “interactional wedge” when doulas ask physicians to stop doing what they are doing and talk about it. It’s one of the main reasons doulas are often disliked by medical careproviders. (My opinion is this an asset for informed consent, which I discuss here). When we interrupt a physician or midwife, we are vying for power, so it must be very clear that we are doing it on behalf of our clients whose voice is not being heard even though they are expressing themselves.

  1. If the medical careprovider does not stop, appeal to the nurse.

“Nurse Y, I hear [client’s name] saying “stop” and “no”. Do you hear her too?”

“[Client’s name], do you want Nurse Y to ask Dr. X to stop?”

“Nurse Y, if this is an emergency, can you explain quickly to [client’s name] why Dr. X cannot stop? She needs to know this for her own well-being.”

Sometimes careproviders don’t stop because they think that whatever they are doing will be over quickly and just want to finish. Unless there is a medical imperative, this is selfish behavior because they are putting their own desire to be done quickly over the patient’s need for understanding and caring from them. Unfortunately, this is their prerogative as careproviders. As doulas we will experience a wide variety of responses to our clients’ needs for compassion and kindness from their physicians and midwives. Often the lack of it within a system is why we are hired as birth doulas.

  1. If the medical careprovider stops, facilitate the communication. Start with gratitude – really. Then help your client to gain information, preview what they can expect especially with bodily sensations, and encourage eye contact and affirming touch (if possible) between careprovider and client and nurse and client.

Your goals are:

  • To assist your client not to feel they are being treated like an object, and for the careprovider not to fall into the trap of treating the body as separate from the person inside of it (objectifying).
  • To assist in obtaining the information they need about what is happening and why.
  • To forecast what is going to happen and what sensations they might experience.
  • To re-establish a positive relationship with the physician or midwife and the client, and the nurse and the client, if possible.

“Thank you, Dr. X. I think [client’s name] needs a breather from all that intensity. Can you explain what is going on?”

“What sensations can [client’s name] expect?”

“What other procedures or people might we expect?”

“[Client’s name], what do you want Dr. X or Midwife Z to understand about what you were feeling or why you were feeling it?”

If the doctor or midwife seems disinterested, show it matters to you:

“[Client’s name], do you want to tell me more about what you were feeling or why you were feeling it?”

  1. What if it really is an emergency and there isn’t time for the physician or midwife to stop?

If the physician or midwife is really concentrating, we don’t want to interrupt them. So appeal to the nurse.

“Nurse Y, I can hear that [client’s name] is becoming really frightened/terrified (make sure you include an emotion) by what is happening and the pain they are in. Can you please get their attention and explain briefly why the doctor or midwife can’t stop?”

Use the Take Charge Routine from The Birth Partner to get through the painful procedure.

If the nurse is unavailable or busy, it’s up to us.

  1. What if the physician or midwife doesn’t stop, the nurse can’t help, and the situation is continuing? What do I do then?

You go further into what I call “trauma prevention mode”. You want to affirm that they are not alone in what they are experiencing, that you heard what they said, that what they wanted is not what is happening, and that you know how to help them get through it. If you can forecast any sensations or what might happen next, do so.

Get your client’s attention and look them in the eye. Grasp their hand, arm, shoulder, or side of their face firmly. Say:

“I’m right here with you and I’m not going anywhere.”

“Dr. X isn’t stopping but I hear your request and your pain.”

“Right now, let’s just get through this together.”

“This might get crampy or sharp before it goes away, but I’m right here.”

In the immediate aftermath, most careproviders and nurses will make some acknowledgement. “Sorry I couldn’t stop right then”, and then just go on to the next thing. For them, it isn’t any big deal. This is what I find the most frustrating – it’s as if they ignore the situation it doesn’t exist. I imagine that in their mind, that’s true, even if it isn’t our client’s reality. Whether to pursue a conversation at that point is up to your client, the situation, and how they like to handle conflict. We have to take our cues from them.

If you are a direct person, who is used to privilege and of having choices in your medical care, this might be very frustrating to not pursue the situation. But your client may feel that any confrontation may make things worse, or that they have to take what they get. Clients may be afraid of the consequences to them and their baby. These consequences may be very real, especially for people of color, immigrants, and those living below the poverty line. If you are white, or otherwise privileged it may be hard to believe but consequences for not being compliant exist.[i][ii][iii] This is hard because you are emotional too, but you have to keep in check what you would want to do. You will be leaving this client and their baby in a few hours, and they will have to deal with any aftermath.

In some cases where the doula is concerned about being asked or made to leave, it may be appropriate to go directly to option #5.  The doula who is in the room can offer more effective support than the one who has been restricted to the waiting area.  Use your skills to assess the situation.

Sometimes I find that clients are not interested in pursuing a conversation at any time. They just want to put the unpleasantness behind them. They may also have a different memory of what occurred, minimizing their experience. Don’t mess with this! The brain works to protect the psyche, and defense mechanisms are called that for a reason. They are defending against the negative impact of an experience. Often how a person thinks about what happened to them (cognitive appraisal) influences whether a situation is coded as traumatic or not. So, in the moment, they may make minimizing statements to try to soothe the chaos of their thinking – but whether that works in the long run remains to be seen. Increasing oxytocin flow by positive touch, eye contact, laughter, holding the baby skin to skin, etc, should be encouraged if it feels appropriate and congruent with your client’s feelings and experience of the moment. Oxytocin lowers stress hormones, which contribute to encoding memories as traumatic. After all, it’s still a birth! If the event really does become a source of anxiety and trauma, we can validate our client’s feelings at that time. Once again, we take our cues from them.

But what about us? As doulas we are often the ones left feeling raw and as if we witnessed a rape. I say that if you feel that was what you saw, then that was what you saw and you should seek counseling with that in mind. Your experience was valid even though it doesn’t jibe with what the medical careprovider, nurse, or client experienced.

If you have a positive rapport with your client’s nurse, you may want to discuss what you witnessed if you have some private and unhurried moments together. “It was really difficult for me when [client’s name] was crying out for Midwife Z to stop. My client sounded terrified, and then the midwife didn’t stop and it just continued. Can you help me to make better sense of this? What was that like for you?”

Hopefully you will get a good dose of understanding and some insight on the nurse’s perspective of these situations. You will get a snapshot of the nurse’s mindset if they feel free enough to share with you. I have found that some nurses feel exactly the same way the doula does, but they don’t know what to do either. Sometimes the discussion with the doula, who is an outsider, is the impetus for them to talk with the director of nursing about it.

Other times, the doula will hear a minimizing statement, “Oh, I knew it would be over in another minute and the mom sounded like she was overreacting.” Or, “Most patients wish Midwife Z would be gentler during that procedure but that’s just the way she does it.” If that’s the case, just thank the nurse for their insight and know that you’ve learned how they rationalize their way through these situations.

Note:  All my suggestions are based on my research, discussions with expert doulas, and conversations with medical careproviders.  I am steeped in white culture, the privileges of education, and being white. Please interpret my suggestions with that in mind – your culture and life experience may lead you to conclude that other actions are more appropriate or better than what I have written.  My goal is give doulas actions that are within their standards of practices as most define them – a beginning point to have a conversation, not to provide the last word for every doula.  

Is it rape? Aren’t you exaggerating?

Some people feel that by using the term ‘rape’, I’m overdramatizing these situations or minimizing the experience of people who have been sexually violated. But I don’t think so. The patient has given over their trust, their body, their life, to a medical careprovider who has a sacred covenant to treat that person and honor them. When they act in a manner that is dismissive, painful or coercive, they violate that trust. The careprovider is touching the most intimate parts of the body – places that may only have been touched by one or two other people besides the careprovider! They have power over the patient and are treating their body like an object. The patient is often lying down and is unable to move or get away. When the patient says, “No” and “Stop”, to me, they are voluntarily retracting their consent.

As a qualitative researcher, our ethics state that the person who is having the experience is the one who defines it. They choose their language and share with us their emotions and mindset. In recent Facebook queries with over forty responses from mothers and professionals, all of the people who felt they had experienced an assault during their labor used the term “rape” or “birthrape”.  Many had also experienced sexual assault or rape, and these people felt many links between the two experiences. The term “rape” has a visceral emotional component that grabs one’s attention in a way that “assault during labor” does not. That is what the victim or survivor wants – for us to acknowledge and see their experience as best we can through their eyes. These people didn’t feel assaulted, they felt raped.[iv]

Rape is defined as “unlawful sexual intercourse or any other sexual penetration of the vagina, sex organ, other body part, or foreign object, without the consent of the victim. An act of plunder, violent seizure or abuse; despoliation; violation. The act of seizing and carrying off by force.”[v]

If the person who had the experience describes it in terms of feeling their body was violated, that is an assault. If they say, “I feel like I was raped”, that counts. They may have signed a legal consent for treatment for a vaginal birth form upon entering the hospital. But that in no way gives medical careproviders, or anyone for that matter, consent to violate their person when they clearly state their wish for that person to stop.

The medical and nursing literature is full of research on traumatic birth and the role of physicians and nurses in creating that trauma. It is also full of the pain that medical careproviders experience when they feel they have been complicit with or damaged by the coercive tactics of their coworkers and colleagues. For more information, I would urge you to read chapter 17 in “Traumatic Childbirth” by Cheryl Tatano Beck, Jeanne Watson Driscoll, and Sue Watson, or access Beck, C.T., & Gable, R.K. (2012) Secondary Traumatic Stress In Labor and Delivery Nurses: A mixed methods study. JOGNN, 41, 747-760.

 

 

[i] Bridges, Khiara, (2013) Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. UC Press

[ii] Oparah, Julia, & Bonaparte, Alicia (2015) Birthing Justice. Routledge.

[iii] The American Dream of Birth (2016) Video (Free and a good watch!)

[iv] If I was working with a group of medical care providers desiring to change their care practices, I probably would use the word “assault” repeatedly in discussion – it’s no good triggering their own histories of being assaulted or demeaned when the goal is lasting behavioral change. The majority of physicians have experienced bullying behaviors and mistreatment from professors and supervisors. The idea that physicians are perpetuating what they experienced as students and residents to their patients is a valid one. https://portalcontent.johnshopkins.edu/Housestaff/Uploaded%20Files/Medical_Student_Mistreatment_at_Hopkins_BRIEF.pdf

[v] http://www.dictionary.com/browse/rape

There are several good books about trauma and recovery but these are a good place to start:

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms by Mary Beth Williams PhD LCSW CTSSoili Poijula PhD

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter A. Levine

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others by Laura Van Dernoot Lipsky and Connie Burk

19 Comments

  1. I am so grateful to read this, and be given some sample dialogue ideas. I have seen this a few times already in my short(ish) doula career. I am a survivor of rape and seeing these moments of trauma have been incredibly intense for me personally. It is difficult to separate my own triggers and not place that trauma on my families. The last birth I attended, I felt paralyzed by my Scope of Practice, I felt I couldn’t stand up for my client.

    Thank you for your exhaustive writing on this subject. You truly are “doula-ing the doula”.

  2. I am glad to read your article, it is a tough subject to address, and truthfully I had to work my way up to reading it. Not because I think it’s unimportant but because it is So important and when you have seen women disrespected, when they try to speak out and you see them ignored, when scare tactics are used to coerce co-operation, well it certainly has effected me. I kind of dreaded reading it because I didn’t want to just get upset. Getting upset is only good if you can do something about it.

    So I was especially glad to see you offered some tools for the doula to implement with both care providers and mothers. I think I do a good job helping the mom on her side of things, and over the years I think I’ve gotten pretty good establishing a rapport with the careproviders and have always been pretty good at just coming out with questions that help both myself and my client understand things without making it seem like I am questioning them (I’m not… just seeking info). But the part about helping the mom be heard, interrupting the doc, THAT I needed some words for. “Use your words” that common expression moms today say to their tots and young children applies to this situation but what if you don’t actually have those words? Dialog examples help a lot and lends itself well to role play for cementing new skills. So, thank you for that.

    There is much to think about in this article, One thing struck me particularly:
    “The patient has given over their trust, their body, their life, to a medical careprovider who has a sacred covenant to treat that person and honor them.”

    Oh, yes, patients in every area of medicine give their trust, sometimes too much trust in my opinion, to their care provider. Trust is probably the most important factor in the relationship with the doc/midwife as well as with us. I don’t know if doctors know this about the patient- or if they understand they they need to earn it to keep it, that it is not something they are owed just because they have MD after their name. Do they understand that the trust can be broken?

    Patients have turned their body over to them, particularly in situations where they will be unconscious (such as surgery), but also sometimes in other ones where they will be conscious. I sometimes see mothers turn themselves over completely to their care provider. They abdicate all their power to that person, almost like the doctor is a god or like a tiny child is with a parent. Truthfully, I don’t understand this, but I see it become a mistake just about every time… the care provider has too much power and they are too vulnerable.

    In childbirth or situations where the patient will be in pain or will undergo an awake procedure they will be vulnerable- in procedures they have turned their body over but in childbirth I don’t think they have to do it completely. (really mothers are doing the work- the birth is theirs not the care provider’s). The complication with birth is the pain, which makes us vulnerable because we will be less able to care for ourselves. Our level of vulnerability will be more or less, depending on many factors such as education (both extended general, as well as birth (or prodedural), related to our racial status, our socio-economic level, insurance status, the area of the country we live in, how we have been socialized, if we have been victimized (or traumatized) in the past,and also our choice of care provider. (Some do not have much choice or are held back due to other factors). As doulas I hope we can help them become less vulnerable.

    I certainly hope mothers are not consciously turning their lives over to the doctor or midwife. In some medical situations our very lives ARE turned over to the doctor. However, as I see it, in birth we need the CP in case of disaster, but generally I don’t see birth as life or death, though some mothers do. For that matter some doctors do. This is a fundamental problem.

    But the sticky wicket is that part about a “sacred covenant” and that bit about honoring the patient. Doctors do not “have” this covenant nor this attitude. And doctors do not do this. Oh no, no, no. Should they? yes Do they? no (though I think maybe they used to many many generations ago) Will they? I do not think so- not HONOR (respect, I hope is attainable for everyone regardless of age, station, race, intelligence, etc), And a sacred covenant- I don’t care what they say in that Hippocratic oath, those are just words, people can say anything, and many doctors do not get into medicine for let’s just say altruistic reasons and the desire to care for others. So a sacred covenant is too much to ask for. Do patients think this is what they are getting? – maybe they do?

    This was a new idea for me. But maybe I learned my lesson a long time ago and wised up in my own life. I was coming of age just when there was a change starting in the public’s attitude about doctors which used to be complete trust and acting if their words came straight from God and people gave utter obedience to them even when it didn’t make sense. So I have never felt that way. Plus, I was disrespected by several care providers while I was a young adult and as a result I do not “honor” their profession- I do respect it- but individuals earn my respect. I see myself as a consumer and them as a service provider- if I don’t like their service I fire them and hire someone else. That’s it- if they cannot meet my needs as a whole person I won’t give them my hard earned money and high cost insurance dollars. I see my relationship with the doctor as a partnership with him/her in my health and life-wellness nothing more. Sometimes less if I don’t respect him or her. I think that makes me less vulnerable as a patient.

    I know I am long winded so thank you for reading. I had a big point to make about mothers’ vulnerability in a system and society not set up to respect her or give her power of voice. The sooner we take back our power, grab it for the first time, and assert it, the sooner we stop expecting doctors and midwives to fulfill a sacred covenant and honor us, when we can know and respect our own needs, when we demand respect by giving our dollars to the best providers the sooner things can change. As a doula part of my empowering of women starts way before the birth room in helping her to re-evaluate. I encourage her to listen to her guts about red flags, to change providers as needed, to give her “her words” so she can self-advocate before birth and during birth. Oh what a big big probelm we have and it takes tackling it from many angles to make and live the change we want to see.

    • Well, I wrote all that and then I kept on thinking… well, Amy, you were successful on that one!!! *smile*
      I have some thoughts to work out and thought I would share them:
      I have a problem with the use of the word rape in the birth arena and the coined term “birthrape”. This is why:
      The definition of rape is correct as stated but what is not included but rather implied is that the act of rape in INTENDED as a sexual one, either for the sexual satisfaction of the perpetrator with blind disregard to the woman OR with the intention to harm the woman.

      Assault in birth, violation in birth, is done in the sexual areas of the body but NOT with intention of anything sexual (usually) and without the intention to harm (usually).

      The word Rape in the context of birth makes me squirm. It makes me very uncomfortable, however it is not from unwillingness to acknowledge violation or assault. I think using this word in relation to what happens to women in birth DOES dismiss, demean, and de-emphasize the acts of true rape that occur to women every single day.

      I feel it’s ok, fine, appropriate if the mother defines it that way because we don’t have a good word for what has happened to her, SHE is defining it. But I don’t think WE should use those words- I don’t think we should put the words rape or birthrape in her mouth.

      I spent some time really thinking about my discomfort with the word in the context of birth. Why? Why did I feel that way? It seemed wrong. It isn’t because I don’t recognize the assault. But is it true that women are being purposefully SEXUALLY violated? No. I truly hope they are not. I do not believe that most CP’s have that intention. The CP’s are medically violating women in their female part, their reproductive parts, their sexual parts, Unfortunately these are all the same parts. It is hard to have an accurate word for what these women have experienced.

      Maybe they have been sexually violated- if it did feel sexual to them. ( and it could have been!) But as a general use of the term that still doesn’t seem quite right. I still don’t think it’s rape. Violation- yes, absolutely. Assault, yes, especially if she is saying “No” “Stop”. Her patient’s rights are being violated, her body is being violated, her psyche is being harmed…. some or all of these. But rape, Really? We need a new word that does not take away from women who are actually being sexually violated outside the context of birth, outside of medical treatment.

      I had this observation: I think the continuous, epidemic, over-use of epidural has impacted medical practice. Doctors can become very used the the fact that women with an epidural cannot feel their hands, their prodding and poking and since it doesn’t hurt the mother they can get the wrong idea that what they are doing has no impact on her. Then when they have an undrugged mother they forget, and keep on with what they are doing because they are used to just doing it, and “getting it over quick”. I was amazed at what a doctor would do to my client’s vagina while she was numb that he would never and could never do if she wasn’t! She’s be screaming bloody murder if she wasn’t numb!

      So no, they are not off the hook! No way! Things do need to change. But rape, I think, is the wrong word. Here is what I worry about. What if this word- birthrape- gets out into the public lexicon? Can it do more harm than good? The truth is that a lot of women are scared of birth, they hear it hurts pretty bad (why do you think the use of epidural got to be epidemic?) , and then they are supposed to nurse the baby which they may hear just about tears off your nipple, or keeps you tied to the baby. Now, what if we add to that fear that they might be raped while giving birth???? How could we ever undo that? How could they ever trust that they would be safe? OMG, I swear to you I would be terrified. (that’s my personal truth) A woman could be too terrified get the care she needs!

      Plus, what about those women who really ARE sexually assaulted by doctors, midwives, or nurses while under gynecological care, pregnancy, or birth? If we dilute the power of this word “rape” by using it in situations that are not rape how will we ever get people to face the fact that rape can and does happen in the medical setting? What would we call that?

      We really need to think about this some more.

      • Amy Gilliland

        I’ve wrestled with the concept of intent on the part of the perpetrator in another context. As a certified sexuality educator one of the difficult discussions we have is about date rape, especially when both people are under the influence of alcohol. Judgment is impaired and there is may be little intent on the part of the perpetrator to violate the other – they imagine they have consent. The person who feels violated may have felt powerless to stop the other person or that their quiet ‘no’ or stillness of their body signaled ‘no’. That’s where the problem occurs – what is consent? Was their intention to rape? No, but that was the impact of their behavior – that was the outcome.
        So I do not feel that a lack of intention to commit an act absolves the perpetrator from the consequences of that behavior. That applies to both the date rape context and the birth rape or birth assault one as well.

        • I see the point you make about intention to harm….I also hesitate to make the distinction about intention to rape or violate because it has the potential to absolve the perpetrator….

          I am making a distinction on the intention of a sexual expression. Do you see that what is happening in the birth room is not sexual ,intended as sexual? That rape (date or otherwise) is an intended sexual act. A vaginal exam is not.

          It’s fine to disagree but I still remain wary of diluting the word, and inciting more fear in pregnant women. I do not mean this to belittle the birthing woman’s experience in any way.

          If you truly believe that these acts of violation are indeed rape then are you comfortable with the idea that these women should be filing a crime report with the police? That physicians and midwives and nurses need to be held accountable as criminals in a court of law as well as their medical board? That the definition of rape be changed to include medical rape on any patient, man woman or child? To bring every person in the room with the mother who does not stop the CP as complicit to the act, including her own husband, mother, doula, and subject to criminal charges?

          I’m really not trying to be mean. I’m trying to see exactly where you stand on the word rape in this context. Because if you want birthing professionals and the medical profession to adopt this word “birth rape” then it needs to be clear what it is and what should be done when it happens.

          • Amy Gilliland

            I’m not advocating that anyone adopt or avoid this terminology – as I said in the blog, these are the words that people who have had this experience use. Language is often context dependent.

  3. satc_fan

    I am not a doula but I happened across this on a link from facebook and I thunk it is a really important message which we often forget that although consent is given for procedures it can be withdrawn at any point. Using the term rape whilst initially very jarring comes to make sense as you read through. Definitely thought provoking.

  4. Amy Gilliland

    On Sunday, Cristen Pascucci interviewed me about this blog post. I thought you might enjoy hearing our conversation about the culture surrounding birth and careproviders that makes these actions possible, why birthrape is the right term, and whether what I’ve written will lead to lasting change. The half hour just sped by, so grab some tea or water and have a sit down with us.
    https://youtu.be/TXRoui4HRcEhttps://youtu.be/TXRoui4HRcE

  5. Spot on about using the term “rape”. I feel that preventing the trauma in the woman’s life is so important. But giving voice to the experience (birth rape) is also important. Once it is identified as such, rape,….validating the conflicting feelings our mom’s have is also a step in healing. It gives them a voice to share their experience and come out of the shadows. It gives them a voice to report, educate and heal. It is also a big step in informing and educating and changing the medical culture in which it occurs. As a former doula, and now a mother of an adult child who is a student in the medical field, I can tell you how you are correct that “how” these students are taught plays a huge role in them losing their compassion for the individuals they provide care for. Your research and the collective voices of women,that experience this and the doulas that understand this can bring about a change that is desperately needed! Thank you for your opening a frank discussion that needs to occur and providing training that is vital in preventing and healing trauma!

  6. Michelle Burdis

    I have had two births – One in Hospital – Totally controlled by the medical staff at Royal Free in Hampstead – The midwives didn’t listen to anything that I said and didn’t even want to believe that I was in Labour until I demanded to be examined – I was too quiet according to them !! – When they realised that I was 9 cm – they tied me down by strapping me to various machines – half of which, didn’t work properly and half were unnecessary as I was progressing gradually – – – But they said that they needed to know what was going on. – When my son was born they made me have an Episiotomy, even though I was stretching nicely and it wasn’t taking a long time – and they put a monitor on his head for their benefit – even though he was ok! – I asked for a different midwife to sew me up because she was horrible – but was told that she was the only one available and she was the best – – – – My Scar gave me months and years of trouble – finally healing and then constantly itching – causing tightening on that side which made for an uncomfortable lovelife.
    The other birth was at home – with two midwives (one arriving 25 minutes before the birth and the other arriving 10 minutes before the birth.) – I used the Gas and Air and was in control and felt respected – Being told what was going on and being given options, even when I was puffing in contractions. – No Cut – No hands on – No Brutality.
    My husband was there with both births – He also felt like he was ‘in the way’ in the hospital but at home, he was actively involved and useful, as well as listened to and respected, knowing everything that was going on.
    We both went to NCT classes and felt well informed but I didn’t feel like I was an ‘Earth’ mother or wanting anything that was ultra modern or demanding in my birth – I was well informed as a Maternity Nurse, but didn’t feel that I was being dictatorial at my births – they were both too quick to say that I was demanding –
    I feel that it is a shame that we have to have Home Births – to get the birth that we want.
    – We should have the facility of a ‘Home Style ‘ Birth – in Hospital, where we can be listened to and respected, but still where we are near to medical intervention in a dire emergency.
    The work of a Doula is very important – we are the voice of the mother and the hands of a partner while being invisible when necessary.

    • Amy Gilliland

      Thank you for sharing your story, Michelle – it adds to the conversation.

  7. emma

    While reading this it made me think of when I had a coil put in. It was really traumatic and afterwards I did feel violated. The nurse didn’t explain to me what was going on when she was talking to her colleague in medical terminology. I agreed to try it, but feel it wasn’t handled well. I will never have it done again :/ also as someone who wants a family i am really wanting that whole person approach in my birth experience……and feel the world is back to front. X

  8. I love this article. Thank you so much for writing it. I find that this message and topic is often not discussed in a way that is productive for doulas to truly examine both their own role and what they can do to shift this. There is so much a doula can do. Doulas do not need to be a fly on the wall witnessing abuse over and over again. DTI has been creating methods for doulas to use in just this very scenario called the Slow Doula Method. This method discusses these very issues and gives actionable steps for the doula to first ground themself, build rapport (and team dynamics) in the room and step up to a dialogue with the birth team that puts the birthing individual front and center. Amy, I would love for you to see our materials and hear your thoughts. If we all collaborate on this together I believe we can shift this culture of silence and abuse. You may see a link to more about SDM here and if interested in talking more about this please contact me so we can have a chat. http://learn.doulatrainingsinternational.com/courses/slow-doula-method

    • Amy Gilliland

      I like the fact that I’m not the only one who considers teaching communication skills a HUGE part of a doula training. We facilitate relationships – that’s our job. Between people, between careprovider and laboring person, and between the laboring person and how they relate to themselves. To me, its one of our major responsibilities – as much as understanding maternal positioning.

      • Yes, I agree. I appreciate very much the active tool of “sample dialogue”. It’s very important, at least for me. I’ve been a doula quite a while and a lactation counselor a few years longer and still there are times when it’s nice to hear new ways to phrase things, and as a new doula it helps a lot to have examples of what to say. Not just in the birth room but also in interviews and prenatals, etc. Some families are great talkers- very articulate and thoughtful in what they say to one another and a person can learn from childhood, but other people come from families or lives where very little talking went on, or respect in when spoken to, perhaps little was explained to them… Knowing how to speak to others so they hear us and we are understood, so we don’t insult them or turn them off is very important. (it is the reverse side of active listening… both invaluable skills as a doula). Plus, it’s helpful to have alternative example of how to express your thought as people, even speaking English natively, sometimes speak a “different language” they use words differently, so when you say something they hear another meaning… rephrasing with other words helps.

  9. Amy this is a fabulous article in every way. Sharing everywhere!

  10. This is an excellent article and I wish I had read it before this happened to one of my clients! I am a white birth doula and I was hired by a young, black, Muslim client awhile back. All was going well until the midwife thought that the client had retained membrane and called the ob in for her opinions. Although the ob did explain my clients options, Nd the client agreed to have the ob try to manually remove the membranes, my client clearly asked the ob to stop after she started, and the ob did not stop right away. I was really taken aback by this. Doulas are told not to speak to the providers, so the best I could do for my client was to hold her hand, get her attention, and encourage her to breath through this. This really upset me, but if our certifying organization tells us not to mention all to providers, what other option do we have?

    • I think it is–there’s no other way to say this–absolutely ridiculous that anyone would tell doulas not to speak to providers. Doulas are members of the care team; they are integral to what is going on with the mother; they are human beings who deserve respect and professional treatment from their colleagues in the medical field. How does a doula establish a rapport/trust/relationship with the other people in the room without communicating with them? The idea of a doula not speaking to providers feels disempowering and even a little sexist to me.

      • Amy Gilliland

        I have heard this from a few people over the years. I think it goes back to a time when doulas were in a precarious position and might get thrown out. I’ve also heard it said so that all communication about her needs would come from the laboring person, and not from the doula. Then the doula can’t be accused of speaking on behalf of the client. There are few “first wave” doulas who are still like this – they just do their doula thing in a bubble. Shows how we all have different ideas about what a doula “should” do in her support role.

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