An Inside look at Obstetrical Violence

(Derived from a podcast conversation with Tranquility By HeHe team members HeHe Stewart and Caitlin LeBeau in Episode 136 of The Birth Lounge Podcast, find it here!)

Have you ever heard the term “obstetrical violence” and wondered what it meant? Or maybe you envisioned this blatant act of disrespect or an assault of sorts. These are both examples of obstetrical violence, but there is another side to it, too. A sneaky side. We're going to share a few instances of medical manipulation in the birth room. Not always aggressive, not violent. And that is a tactic- they are trying to get you to do what they want. Which is so hard to say because we are conditioned to trust our doctors, we want to trust our doctors.

This isn’t about batting heads- this is about questioning, looking into research/evidence, looking into policies so you know if they are being influenced/pressured. Have that open communication if you can. You can say, 'That's not, evidence-based, I'm really only interested in evidence-based research and policy. If the hospital policy prevents you from giving me like the most current stuff, I would just appreciate you giving me that heads up. I understand you can't suggest that, but I would love if you would just let me know the last year that the policies of the hospital have been revisited.'

This should feel like a two sided convo. You can push back a little. they should be able to give you answers- and if they don’t you need to do that research on your own before game time.

Bait and Switch

But a bait and switch- which basically means, you earned my trust and then you tricked me. So heartbreaking because during the pregnancy, they were amazing. This one that we last had where the mom was overdue and went into an appointment and they basically had told her, 'You know, we're going to have to do an induction because your baby has passed 40 weeks and 2 days'. Which we know average first time mothers deliver most typically between 40-41 weeks.

So they went home, they did the research. They decided to try a natural induction method instead over the weekend first. After the weekend, they gave their doctor provider a call and the doctor said, 'Oh, we don't have any beds until Tuesday in the evening.'

What is that? If I NEEDED an induction four days ago and now I'm comfortable coming in for a medical induction, but your pushing it a day and plus? How does that make sense? I just can't handle being told that you need to have your baby without having gotten out of that window of where we know a first time baby is likely to be born around 40 plus 5. And then you have providers calling it a late baby or an overdue baby. And that is instilling fear in these parents, especially when you're at the end of pregnancy.

'This is a long labor...'

We had a birth recently that was going well at about 16 hours- we had just hit the mark where her provider said the baby could 'come at anytime'. Then shift change at the hospital happened. The nurse we we working with literally said to us, 'Be careful with the doctor coming on call.' How horrifying that a nurse felt compelled to warn us about the doctor that was coming into our space.

The doctor on-call comes in, says, 'Let's get you prep for a C-section.' This was the first time we were seeing the doctors face. They hadn't introduced themselves. Also, and most importantly, this is the first time we're hearing these words. You haven't even checked in with us on what is happening, what our birth goals are, how long, how long we've been in labor. It had been 16 hours. What happened? The fear that that doctor brought in the room and then said, 'Your labor is so long. I don't think this is going to happen for you, kiddo.' I feel nauseous thinking about those words. That is so rude and disrespectful.

16 hours is a long time, but is it a long time in birth? Not really, not at all. It's not even the average amount of time for a first time mother. But then you have a doctor coming in a doctor who sees this every day say, 'This labor has really taken a long time'. And birthing people start to question themselves.

If there isn’t an immediate emergency, you should be able to think things through. Catch that manipulation when it's happening and push back on it. Ask the questions that you should. Your doctors aren't always going to tell you everything unless you ask. It's all in your approach of how you say this. Don't try and catch them tripping up in a lie, simply say something like, Oh, I was thinking X, Y, and Z, because the research I had seen showed X, Y, and Z' or 'I was actually wondering if X, Y, and Z would be an option. I know you didn't mention it. But I was wondering if we could explore that or I have some questions if I might be able to use that or not'. Your approach is not you against them. That's not what this is meant to suggest.

(For more birth stories and examples of medical manipulation, please check out the podcast episode!)

But what can you do?

Your job is to take this preparation, evidence based knowledge, this idea of shared decision making and put it in your toolbox. Make sure it feels aligned with you. Make sure that it's evidence-based and then go for it. Take the time and come up with a couple of questions that you have. Even one question can spiral into a conversation or your doctor giving you more information. This information could shape the path of your birth.

You can go in being the calmest person ever to the hospital, and then you go in and you hear these medical providers talking nonsense around you, or just hyping you up in the wrong ways. You just completely forget about what was happening 10 seconds before that. You're just focused on what your nurses and doctors are doing or saying. Even them using bad language around you and not being mindful of the words they are using. It doesn't have to be intentional. Just be aware of this when you go into the hospital. It can be startling and alarming. 

You can also use this as an opportunity to remind your medical team to take conversations outside or to ask them not to have conversations over/around you. Sometimes all your doctors or nurses need is a reminder that they are negatively impacting the birthing persons space with their words. You can also ask for a new nurse or doctor when you feel like they are negatively impacting your birth.

If a doctor does comes barging in and says, 'Let's go, you know, time for a c-section'. You can say, 'We haven't decided right now if we want a C-section. We would actually like a few minutes'. And you know, if it's an emergency, they will be very upfront with you and let you know that there isn't a few minutes to spare. It's rarely an emergency C-section, but we don't have a word for non-emergency sections. We have scheduled C-sections and then we have emergency C-sections. We don't have any sort of like unplanned terminology. This was just unplanned. We gave it a try and it didn't work.

Birth as a Business

So if we want to look at this as a business, birth is a business. If you haven't seen that documentary, you1000% should. It is called 'The Business of Being Born'. It's will open your eyes to how much birthing people can be cash cows for hospitals. We can go from bringing in like a little bit of income to like being a major source of income depending on choices and pressures put on birthing people.

And you have to think for the typical hospital labor you're looking at less than $10,000. For a C-section, you're looking at $30,000 to $55,000. That's how we go from being a small stream of income to a main source of income for a hospital.

I don't want you to feel fearful of this. I want you to do your own research. There are things that are good for you to know. There are a ton of things that you can read, listen to, or watch to educate yourself on the business side of birth, which is important to know as a consumer, because it actually does impact you. It impacts their bottom line, but it impacts you your body and your life after this. It's not meant to be scary. It actually gives you a lot of power if you'll dive into it in the correct way.

Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!