The treatment received by laboring women from care providers during childbirth can sometimes be so abusive, degrading, and violating that many survivors of these childbirth experiences are now terming it “birth rape”. Recently, there have been blog articles about whether or not women have the right to use the term “birth rape” to describe their traumatic birth experience where they felt assaulted by their care providers. In many of these articles there is acknowledgment that women have a right to feel upset or traumatized by their birth experience, but they do not have the right to label their feelings and experience as “rape”. The writers believe the word rape should be reserved for sexual assault only.
It seems apparent that many feminist bloggers bristle at the suggestion that the experience of childbirth can, for some women, feel like being raped. Some of these women may term their experience “birth rape”, and have subsequently suffered a backlash from the feminist movement of which many of them felt they were a part. Many childbirth and mothering issues do not get the attention they deserve from feminists, which is quite odd since most women will become mothers. This disconnect has never been quite so obvious as when these blog posts and the comments made to them appeared across the internet.
In her article “Bad Birth Experiences Need a New Name” Sierra of Babble writes, “The word rape is, for better or worse, taken. It refers to a non-consensual sexual encounter. Women who’ve been through a traumatic birth deserve their own language, not a term that suggests they’re a subset of rape survivors.” In her article “The Push to Recognize Birth Rape” Tracy Clark-Flory of Salon’s Broadsheet blog writes, “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’).” Though these statements are trying to make the case that women should not be using the term “birth rape”, their arguments are actually describing some aspects of birth rape quite well.
In her article “When Giving Birth is a Traumatic Violation is it Rape?” Brittany Shoot of Change.org’s Women’s Rights blog highlights one aspect of this issue when she states, “But I do wonder why women wouldn’t consider using terms like ‘labor assault’ or ‘maternal abuse’ or even ‘birth trauma’, which is already widely used, to describe their horrific experience.” A big problem with this issue is that there are no words for the experience of being traumatized for any reason around the events of childbirth. Women who have been traumatized by their birth experiences have literally had no language to express it. The term “birth trauma” is only beginning to sometimes refer to the mothers emotional reaction to events around childbirth, though mainstream society still thinks of the term as referring to the baby’s physical experience. Therefore, a woman can’t simply say she has birth trauma, she must clarify that her experience of giving birth was emotionally traumatic for her and she suffered from a postpartum mood disorder afterward. That’s quite a mouthful, and it is not very comfortable to say. Many women can’t find the words, and others find themselves misunderstood and being asked to justify why they would feel traumatized when they have a healthy baby.
There are even more issues with the matter of “birth trauma” and “birth rape” though. Mainly, they are not one and the same. A woman can experience birth trauma without having been birth raped. This seems to be a major misunderstanding with many people. Women do not term just any birth intervention “rape”. “Birth rape” is a term used to describe a situation where a care provider fails to provide informed consent and uses their position of power to pressure or force the woman, who is in a vulnerable position, to submit to the proposed procedure. The provider likely used manipulation, coercion, or force to get the birthing woman to do what the provider wished her to do. Often times, in the moment the woman feels her or her baby’s life is at risk, but later discovers that the medical necessity of the procedure is questionable. Even in cases where the procedure was clearly needed, the woman often feels that if she had been allowed to consent to it she would not have felt violated or traumatized.
Medical procedures done in childbirth usually do not cause trauma nor are they birth rape when they are done for a medical purpose and the birthing woman makes an informed decision to undergo the proposed treatment. Just like sex is not rape when the woman makes a decision without pressure to engage in sexual relations with a partner. It is only birth rape when a birthing woman is pressured to the point of feeling she has no other choice than to accept the procedure, or when she is actually physically forced to undergo a procedure she did not want or choose. Some women even scream and fight but are physically restrained or otherwise forced to submit. This is very different than being traumatized by an actual emergency that arises during childbirth. Both types of trauma, those caused by an actual emergency and those caused by provider abuse, can be labeled “birth trauma” but only one type can be labeled “birth rape”.
Even after the birth is over and the woman is left to suffer the trauma of the experience, there are still no words for her suffering. Though many women experience symptoms of trauma after childbirth, only a small number of them are labeled as having postpartum PTSD (post-traumatic stress disorder). A woman may experience classic symptoms of trauma such as nightmares, flashbacks and hypervigilance, but since she is a postpartum mother and not a returning soldier she will more often than not be labeled as having PPD (postpartum depression) by her doctor, therapist, or psychiatrist. She will likely be prescribed anti-depressants, told she is just depressed due to fluctuating hormone levels and sent on her way. Not only do these women not have the words to accurately describe the event they endured, they also do not have the words to accurately describe their suffering due to that event. The horrific experience they endured is lost in the PPD label.
It is surprising that the words for these things are only recently being created as the women in our culture have been suffering from birth trauma and birth rape for decades; they have just never had the words to communicate or even recognize this. The closest they have come to sharing their trauma is through swapping horror stories at baby showers, which only served to normalize the experience of being mistreated by care providers. When there is no language or recognition for an experience, the victim is left alone and suffering without the ability to reach out for the proper type of help and support. Nor is she able to advocate for change, as there is no recognition that a problem exists to the point that there aren’t even words in our language to speak about these things to one another. This is why the term “birth rape” is now catching on. These women are ready to express their feelings about what happened to them, and many of them feel as though they have been raped. This is the word they have chosen to talk about their experience and to bring awareness to the issue.
Since only a minority of women are talking about this issue, it might be assumed that only a minority of women are victims of it. Postpartum Support International tells us that only 1 – 6% of women are diagnosed with Postpartum PTSD after childbirth. However, this small percentage is deceiving. Many women are never diagnosed because their experience with medical care providers during birth was so traumatic they are terrified to return to the care of a physician or a mental health provider and never receive a diagnosis. Other women do seek help from their doctor or from a mental health provider, but are not accurately diagnosed. Many doctors are reluctant to implicate themselves or their colleagues in contributing to a patient’s birth trauma, so are more comfortable with the diagnosis of postpartum depression. Many mental health providers do not seem to be aware of or accept all of the research available about trauma following childbirth and oftentimes miss signs of trauma and focus on signs of depression. Add to this the fact that post-traumatic stress disorder is a very specific illness and nine criteria must be met to be diagnosed with it. A woman could have debilitating trauma and meet eight of the nine criteria, but not be considered to have post-traumatic stress disorder.
When women self-report on their symptoms of trauma after childbirth we find higher percentages of affected women. The 2008 Listening to Mothers Survey: New Mothers Speak Out Report states that 18% of women experienced symptoms of post-traumatic stress after childbirth. The American study by Soet, et al. (2003, Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth, Volume 30, Issue 1, pages 36–46) says that 34% of women experienced an obstetrical event in childbirth that was traumatic. The current birthrate in the United States is around 4 million births each year. If we assume that the research holds true, and “18 to 33%” of birthing women will experience trauma following childbirth, approximately 720,000 to 1.3 million women are experiencing birth trauma each year. We do not know at this time if the root cause of their trauma is actual or perceived obstetric emergencies or mistreatment by care providers, but often these two things overlap and we do know that many women who label themselves as having experienced birth trauma will cite some form of mistreatment or difficulties with care providers as a reason why they feel traumatized.
The concern though seems to be that when women use the term ‘birth rape’ they are somehow taking something away from a woman who uses the term rape to refer to sexual assault. Sierra of Babble writes, “My problem is that by conflating a bad birth with sexual violence, we do a disservice to survivors of both experiences.” Brittany Shoot from Change.org’s women’s rights blog writes, “We can all agree that violation of any kind is frightening, traumatizing, and wrong. What these women describe is alarming and terrifying. But doesn’t calling an invasive birthing experience ‘rape’ sort of diminish the experiences of sexual assault survivors?” What women who use the term birth rape are trying to convey though is that birth rape is sexual assault. Just because the intent of the perpetrator was not to enjoy sexual acts with the victim doesn’t mean it is not perceived by the woman as sexual assault. Most sexual assaults are not even about sex, they are about power and control over the victim. In listening to women’s stories over the years, birth rape is also about power and control over the victim. What is wrong with a woman using a term that seems to accurately describe how one feels to be physically assaulted, usually towards one’s sexual organs, by someone who wields power and control over that person? How does this take anything away from someone else who is physically assaulted towards their sexual organs, by someone who wields power and control over them? That’s like saying that grieving for a pet takes away the real and true grief that another person feels at the loss of a human. How does a similar experience with similar feelings associated with it take anything away from each other when similar terms are used to describe those situations?
Despite what some of these blogs indicate, it does seem that the term “birth rape” and the concept of being assaulted while giving birth are beginning to be recognized. At the end of Brittany Shoot’s article on Change.org is a poll asking people if they feel the term “birth rape” is acceptable. 67% of responders felt that “birth rape” was an appropriate term to use. In a recent article in the International Journal of Gynecology and Obstetrics, Dr. Pérez D’Gregorio, the president of the Society of Obstetrics and Gynecology of Venezuela wrote about the introduction of a new legal term called “Obstetric Violence”. The article states, “The term appeared in March 2007 when the ‘Organic Law on the Right of Women to a Life Free of Violence’ entered into force and was published in Venezuela’s ‘Gaceta Oficial’ (Official Gazetta).” Dr. Pérez D’Gregorio quotes from the law when he states,
Chapter III, Article 14, of the law establishes that:”Violence against women referred to in this Act, includes any sexist act that is likely to result in harm or physical, sexual, psychological, emotional, occupational, economic or patrimonial suffering; coercion or arbitrary deprivation of freedom, and the threat of executing such acts, whether occurring in public or private practice.”
The definition of “Obstetric Violence” is then defined which is quite similar to the term “birth rape”,
In Article 15, 19 forms of violence are described, including obstetric violence, which is defined as: “…the appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.”
The article then talks about what acts specifically could be considered to be “Obstetric Violence”,
Chapter VI concerns offences, and Article 51 establishes that: “The following acts implemented by health personnel are considered obstetric violence: (1) Untimely and ineffective attention of obstetric emergencies; (2) Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available; (3) Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breast-feeding immediately after birth; (4) Altering the natural process of low-risk delivery by using acceleration techniques, without obtaining voluntary, expressed and informed consent of the woman; (5) Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman.”
The term “obstetric violence” adds validity to the concept of birth rape. At the same time, it offers an alternative, though more formal term to use. Perhaps now that this term is recognized legally in Venezuela, it might help raise awareness and get some legal recognition for this issue here as well.
One concern about this term seems to be for the perpetrator of the act rather than its victims. In her article “Bad Birth Experiences Aren’t Rape” Amanda Marcotte of Slate’s XXFactor blog writes, “If the social definition of rape is rooted in the trauma to the victim and not in terms of what the actual rapist did and why, we’ve lost our main tool in stopping rape from actually happening. … So our terms have to center around the actors, not the objects of their actions.” Marcotte argues that it is the experience of the rapist that matters more than the experience of the victim in what we call this act. This does not, in any way, seem like a feminist viewpoint. There is such a wide range of sexual assault, from child molestation to date rape to stranger rape. Is the child molester any less of a rapist because he meant no harm to his victim? Shouldn’t we center our terms and our activism around the experience of the victim and not of the perpetrator?
Another concern that has been brought up is that these bloggers feel it is inaccurate to compare sexual assault with assault during childbirth simply because the women involved in both of these experiences subsequently suffer from the same mental illness; post-traumatic stress disorder, or PTSD. Brittany Shoot from Change.org’s women’s rights blog writes, “The same symptoms that one might exhibit after assault of any kind — PTSD, for example — do not necessarily mean that these two experiences — rape and birth trauma — can be compared.” Clark-Flory of Salon’s Broadsheet blog seems unwilling to accept that similar reactions, such as PTSD, indicate similar experiences. She claims that we can not compare traumatic childbirth to war, thus we can not compare traumatic childbirth to sexual assault when she states, “but it would be no more accurate to conflate traumatic childbirth with war than with rape. These are very different experiences that can have very similar results. Similar results do not imply the same experience.” Again, traumatic childbirth and “birth rape” are not one in the same. Birth rape is a specific type of birth trauma, one in which the victim is violated by her care providers. People can develop PTSD from many different types of traumatic experiences. Not everyone who is exposed to these traumatic experiences will get PTSD, so it is useless to try to gain insight on the similarity of experiences based on the diagnosis of PTSD afterward. However, the specific reactions of women who have been sexually assaulted and who have been “birth raped” can be of some use in understanding why women may use the term “birth rape”.
Sharon Storton, a licensed psychotherapist in the California area who works extensively with both birth traumatized women and sexual assault victims created the following table to help us understand how similar the experiences of sexual assault and birth rape are:
A soldier returning from a war may have PTSD, but it will manifest itself in a different way than a rape or birth rape victim. In reading through Wikipedia’s entry on Rape Trauma Syndrome the lists provided of the several stages of trauma are so similar to birth rape that it is difficult to find any differences. One might change “fear of men” or “fear of women” in the phobia section to “fear of doctors/nurses/hospitals/clinics” for a birth rape victim. Other than a few minor adjustments like that, this matches up extremely closely to what a birth rape victim goes through, yet there are many differences here than what a soldier with PTSD might go through. Therefore, it is not that a sexual assault victim and a birth rape victim are diagnosed with the same illness, it is that their specific reactions, symptoms, and cover-up symptoms throughout the entire course of that illness are mostly the same with only a few minor differences.
When childbirth in which the care provider assaults a woman, lies to her, violates her body and removes her baby from her care can not be called rape, then what do we call it? It seems the underlying reason that women are not allowed to use this word is the idea that these women brought this situation upon themselves and therefore don’t deserve to use the term rape to describe it. Consider Brittany Shoot’s comment from Change.org: “I also have to wonder if we wouldn’t have arrived at this grave state of affairs if we hadn’t all complied with the medicalizing of our bodies, giving birth, and women’s health in general.” It is irrelevant why our great grandmothers chose to start giving birth in hospitals, what is relevant is that most women choose to give birth in a hospital setting and a small number at home with a midwife. Even though most women are choosing to invite trained professionals to their births, they still have an expectation of respectful and kind treatment. Despite where women give birth and how many medical procedures they may choose in the process, all women deserve to make their own choices and control their own bodies during childbirth. Every woman has an expectation of kind treatment, of decision making power, and of her legal right to informed consent and refusal. When those expectations are not met and she is assaulted and violated, she has the right to call her experience whatever she thinks describes it accurately.
Instead of arguing what words to use, perhaps feminists should try to understand the abuses that are sometimes occurring against women during childbirth. The patriarchal system that creates an imbalance of power and leads to the suffering and trauma of a potentially large group of women should be embraced as a feminist concern, not dismissed because of the language used to describe this issue. As it stands, the feminists who have argued the point polled and got their answer: the majority of people who responded to the poll believe that birth rape is an appropriate way to define it. If they can accept that, we can move on to preventing it and obtaining redress for those who suffer its effects.
Thanks to Sharon Storton and Jenne Alderks who contributed to this article.