It takes a lot for me to be able to control myself sometimes. I bite my tongue on a daily basis when I talk to my friends, or acquaintances, about birth. Many of them are pregnant, are trying to conceive, or have children already. I have friends that choose unassisted birth and friends that choose elective cesareans. I’m somewhere in the middle: I wanted a homebirth badly for my second child. My husband was very against the idea, so we ended up going to the hospital. It was a terrible experience, complete with birth trauma and physical abuse. It has, in turn, made me want to become a doula and childbirth educator so I can reach more families and debunk the myths of childbirth. I’m slowly reading through one of the certifying groups’ book list, giving myself time (my kids are still little!) and letting it all sink in.

The hardest part of taking this path (for me) is learning to curb myself. My best birth isn’t Sally’s best birth. While it may drive me crazy that my friend is tethered to a bed after expressing an interest in being mobile or break my heart after I hear that yet another person has had a cesarean due to being on the clock (impatience), that’s not my birth. While I will never understand the woman that chooses an elective cesarean without fighting for a VBAC, that’s not my place. My place is to encourage, support, be kind, allow them talk about their birth as I talk about my own.

A very dear friend of mine is facing her third (and final) cesarean within the next month. Whenever we talk, she always makes sure to remind me that she cannot attempt a VBAC (a life-long medical condition keeps her from having a vaginal birth). I’ve never discounted the severity of her medical condition and support the decision for her to have a repeat cesarean. It makes me wonder how I come off to people: am I pushy? Rude? Do I really act like natural, vaginal birth is the only way to birth? I know others that do, women that call themselves ‘birth advocates’ and then put down women that choose a different birthing method than them. I’ve been told that I got what I deserved (re: my second birth) because I went to the hospital and that it was my fault that my birth ended up the way it did. I’ve never seen myself as one of these people: I adhere to the ‘different strokes for different folks’ rule.

My friend’s actions have made me re-evaluate the things that come out of my mouth when I discuss childbirth. While I would love for every woman to experience the excitement of unmedicated birth, it’s not everyone’s cup of tea. I want women to come to me knowing that I will give them accurate information, not push an agenda down their throats. So here it is: as of today, I support EVERY woman, EVERYWHERE, to get the birth that SHE wants. If that means birthing at home or scheduling a cesarean, then so be it. I’m not here to pass judgment, I’m here to educate.

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.

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Thanks to Sharon Storton and Jenne Alderks who contributed to this article.

                My sister-in-law ended up having a cesarean, due to high blood pressure towards the end of her pregnancy. My nephew’s birth weight was 9lbs 6 oz. After the delivery when her OB came to see her the next day she said to my sister-in-law “There is no way you would have been able to push that baby out.” This is just so irritating to me. Doctors have no confidence in women and their bodies, and if they make statements like the one said to my sister-in-law, they are making women feel like they are not capable. They are taking away their confidence of themselves and their bodies. And for the most part the woman will believe their doctor, because they’re the doctor, not you.

                As a nursing student, I have seen two c-sections. The first one I saw, I had to walk out before the baby was “born” because I the smell of the skin being cauterized made me feel so sick to my stomach and like I was going to pass out.  The second one I saw I was able to stay in the OR the whole time. I could not believe how barbaric the procedure was. Cutting, cauterizing, pulling, shoving, it was really hard to watch. As the doctor prepares to reach in and grab the baby, he has the nurse or assistant use what looks like a big shoe horn to hold/pull back on the incision to make as much room as possible for the doctor to get inside and remove the baby.  No wonder the woman is in so much pain afterwards, they push and pull and shove her insides around and deliver a baby that apparently was in distress (which is, most of the time, actually healthy at birth). If doctors weren’t so busy looking at the printouts of the electronic fetal monitor there would not be so many c-sections. They see a few decelerations and get all panicky, well what do you think that baby has been doing in there for 40 weeks? It probably has decelerations every day of gestation, only now that it is visible on monitor the doctors can use it to back up their advice that the woman should have a cesarean.

                With my own experiences and in reading both Cassidy’s Birth and Goers A Thinking Woman’s Guide to a Better Birth, I don’t know how a woman could want or be okay with having an (unnessary) cesarean.

While working on a mural I am painting for my daughter’s room this week, I was thinking about how I am in the “nesting” phase of pregnancy. I am actually preparing a new space for my older daughter and the new baby will move into the current nursery after a period of co-sleeping with my husband and I.

This got me thinking about how women prepare for birth. Do many pregnant women feel they are prepared for labor? Do women enter labor in a calm state of mind and feel confident that they know what to do, their partner knows what to do, and they have full trust in their care providers?

We prepare everything else for a new baby. We buy mass amounts of baby gear after doing hours upon hours of research about the “safest” and the most functional brands. We gather tons of baby clothes and blankets and wash them before hand. We buy an infant seat and put it in our car weeks before our due dates AND we prepare the baby’s nursery.

But do many American women feel prepared for labor? How about the ability to labor naturally, without intervention?

The answer is no. American women are scared of birth. Fear has been set into us at an early age. Pitocin, epidurals, and C-sections are part of our culture. Why would we try to birth naturally when we don’t have to be prepared? We go to the hospital and they take care of things for us. The job is out of our hands once the heavy contractions start. And we aren’t allowed to make decisions when we are “in that state” anyway.

What if we made child birthing classes mandatory? What if we showed all those wonderful natural birthing videos that birthing advocate mommas and caregivers have seen? What if women left feeling empowered to have the strength and courage to labor naturally? There may be less medical interventions and c-sections! There may be less premature babies and babies may be born in a less traumatic way! Breastfeeding may be easier! Why, it may just turn the healthcare industry upside down!!

Fear and helplessness is running our birthing community. Shout it from the rooftops, and educate women that they are strong, birth is empowering, and most importantly, that they have a choice. Tell them it is a good idea to prepare your mind and body for birth, just like you prepare the baby clothing and a place for the baby to sleep.

Preparedness refers to the state of being prepared for specific or unpredictable events or situations. Preparedness is an important quality in achieving goals and in avoiding and mitigating negative outcomes.

My daughter's mural

She had started blogging, as many women do, around her wedding.  She had countless posts with paragraph after paragraph about the intricate details of which flower for which bridal party member and why.  She talked for hours about the flavors of the cakes.  And let’s not forget the wedding dress – that needed the be exactly what she wanted.  It had to be perfect.

To be fair this mom was an event planner.  This was what she did for a living.  She took one day and turned it into something really special for her clients.  She said that a marriage should start out on a perfect note, that it set the stage for the marriage.

So when I heard her talking about how birth was only a day and that it didn’t really matter, I knew she was wrong.  And more than that, her own statements about marriage, when applied to her thoughts about birth were incongruent.  How could she say that how you gave birth didn’t matter?  That it didn’t deserve the same amount of planning that her wedding did.  All she wanted to do was to get it over with…

My heart broke for her.  She is certainly entitled to her opinion and I said nothing to her.  But what I wanted to say was that you could get an amazing sense of empowerment through birth.  That giving birth to your baby was every bit as important and empowering as stepping into the limelight in a beautiful dress as you walked down the aisle towards your husband-to-be. And please note, I’m not saying that you can only achieve this through one type of birth, because that’s not what I believe.

So, if in her world, a marriage that was not carefully planned could start your marriage out on the wrong foot – why couldn’t a birth that wasn’t prepared for also cause similar issues?

In the end her baby turned, much to her dismay.  She decided to “try” a vaginal birth via scheduled induction.  She had an early epidural and what sounds like (via Twitter) a violent instrumental delivery.  She had a really rough recovery and gave up breastfeeding early so that she could rest and heal.  She intends to breastfeed her next baby after her scheduled c-section with baby number two.  I can’t help but thinking if a bit of planning for her birth, like a childbirth class might have helped her a bit.  I think it would have helped her achieve her breastfeeding goals at the least. Her birth certainly impacted her beginning into parenting.

So what I had wanted to say to her before her baby was born, but never posted, was that just because you elope and don’t plan for your wedding, doesn’t mean that your marriage is doomed.  It means you missed out on a beautiful experience, the support, the thrill of planning and the joy of walking down the aisle…

The different types of healing to be considered are in the hospital, long term, when you return home with your new baby, and also things you should be aware of such as when to call your health care provider post cesarean. (I also want to thank ICAN and their Recovering from a Cesarean White Paper in aiding to my post today)

While in the hospital :

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal.  It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.)
• Get up and walk around.  It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

The first couple days in the hospital may feel like you are dying, I know because I have been there, but in most cases, you will only get better. When you get home, there are some more great tips for healing, although your housework may suffer for the first couple weeks, I am sure no one will mind too much.

When you get home :

• Focus on yourself, and your baby. You just had major surgery and your baby needs you.
• Have your partner help/do the household chores. Laundry, dishes, cooking, or anything else that needs to be done. Don’t worry, you can put off the dusting, cleaning the bathroom, mopping, and all the big chores for a couple weeks, your house won’t be mad at you!
• Do not lift anything that is heavier than your baby for at least 4-6 weeks. Those infant carriers/carseats are tempting to pick up, especially when going to an appointment for you or your baby, but stay away from it. You do not want to hurt yourself, or have an extended recovery.
• Ask others for help. If you have older children it may be helpful for your partner to take some time off from work, or have an available family member come over to help you. During the first weeks after my second cesarean section my toddler not only got the flu, but I was the only person he wanted making it difficult on me because I could not pick him up.
• Take it slow!  Get back into your normal household routine over a long period of time. You do not want to over do it because you will certainly pay for it later on.
• Have access to baby stuff such as diapers, bottles, burp cloths, wipes, or whatever you and your baby need for a couple hours in several places around the house. If your bed is the only place you are comfortable, make sure you can set yourself up to be able to hang out with baby, change diapers, and everything else you need right there.
• Co-Sleep!  Room in with your baby, so when it comes time for midnight feedings, you do not need to get up or go far to take care of your little one.
• If you have school age children, have others help to prepare their lunches, lay out clothes for the next day and anything else that needs to be done. To spend quality time, sit on the couch, or someplace comfortable and assist them with their home work, or read a book. Find ways to spend time other than anything that may put a physical strain on you.
• Considering hiring a post partum doula. They can really be heaven sent in a post cesarean situation!
• Don’t push yourself. If you want to take a shower and get dressed for the day, make that your only goal for the day.
• Pajamas are your best friend. They are comfortable, and help to remind others you are still recovering from major surgery.
• Remember how important it is to continue to remain well hydrated, and eating healthy.

Many do not think of the long term or emotional recovery of a cesarean section. I personally did not even encounter the emotional recovery until my cesarean baby was 3 months old. Be gentle on yourself, you aren’t the first to go through this, but many people around you may treat your feelings like nothing because cesarean sections have become so common. I can’t tell you how the phrase “a healthy baby is all that matters” feels to me still today.  Do not let others discount your feelings on your experience.

For your long term recovery…

• Contact your local ICAN (International Cesarean Awareness Network) chapter. These are women who have been there, and done that and know how you feel and what you are going through. They are an excellent support system internationally and are such a huge blessing for many mothers. I know they were to me!
• Write out a birth story, express your feelings on paper, or on a blog, get it out. Keeping your feelings inside may be harder in the long run.
• Keep your baby as close to you as possible for as long as you can.

If you experience any of the following symtoms or problems, you should contact your care provider immediately.

• Any type of bleeding from your incision.
• Leaking, redness, or any type of fluids coming from your incision.
• If your pain does not decrease over time.
• Symptoms of post partum depression such as anxiety, fear, problems sleeping, depression, or anything else you may equate with something more than just the baby blues.
• Cramping or pain in your arms or legs that will not go away.
• Continuous headaches, migraines, or backaches.

Over all, be gentle on yourself.
You just went through major surgery!

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

Solace explains:

We invite you to join us in writing to Lynn Rosenthal and Michelle Obama in an effort to bring awareness to the violence women experience at the hands of some maternity care providers. First Lady Michelle Obama has made recent remarks championing the rights of childbearing women, and may be an ally for this cause. Lynn Rosenthal is a former executive director of the National Network to End Domestic Violence.

We are calling for an official review of perinatal practices to investigate common and flagrant violations of patients? rights; mainly the right to informed consent and refusal. We are asking that enhanced and enforced mechanisms for accountability follow the investigation.

What can be considered violent maternity care? Solace states,

The World Health Organization (WHO) defines violence in this way:

“the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

Violence in maternity care is expressed in many different ways. There can be physical violence, such as forcing procedures which women have explicitly refused. There can be emotional violence, such as coercion, manipulation, or verbal abuse. There can be an exertion of power or force over women’s legal rights by individual health care providers and/or by hospital policies such as threatening to call child protective services if a woman does not agree to a procedure or threatening to withhold care in labor if a woman does not agree to the provider?s suggested intervention. ?Informed consent? refers to the legal right of all patients to have the risks, benefits and alternatives clearly explained prior to any procedure. All patients ? including laboring women – have the right to accept or refuse any suggested treatment. Withholding informed consent through the use of physical force, coercion or manipulation is an act of violence and is illegal.

Provider-perpetrated violence during childbirth can result in the birthing woman suffering traumatic stress, anxiety disorders such as posttraumatic stress, postpartum depression and other disabling mood disorders.

For more direction, please click here to visit the Solace for Mothers webpage about the campaign.

To read the letter sent to Lynn Rosenthal and First Lady Michell Obama from Solace for Mothers, Click Here.

Please write letters and spread the word to anyone who may have experienced or witnessed violent maternity care.

I will start with the pregnancy of my first child, Camden. When I got pregnant, I was not all that educated about natural birth in general. I had worked as a doula, but through a crappy agency which I separated from rather quickly. So when I found out I was pregnant, I figured seeing a female Obstetrician would be like seeing a midwife. WRONG!!!!!!! But, I was pleased with my provider for the most part. I was considered a “high risk” patient because of surgery which I had on my cervix in my teen years, so of course like so many other women, I blindly followed what my Doctor told me, because of course, Doctors are never wrong…. right?
As my pregnancy went on I started seeing another female Obstetrician in this practice I proceeded to dub “The Wicked Witch” she was mean, old, cold, and simply rushes me without ever answering any of my questions or concerns. Then it seemed as though, every time I would schedule an appointment with MY OB/GYN I would always end up seeing this other Doctor. It was driving me crazy! Same went for if I had to call the “on call” for the evening, something felt wrong or something was off, and this same Doctor would always insist I went to L&D and be checked. By the time my son was finally born, I am sure they were all glad they wouldn’t be seeing me again!
Then in early November, our family was struck by a tragedy. My husband’s brother died suddenly at the age of 23, which sent our whole family into a tail spin, this was 4 weeks before my due date. From that time on, I proceeded to get sick daily, sometimes several times a day, I started losing weight despite eating like I regularly did before. At my last visit at 39 weeks and change, the Wicked Witch expressed concern that I was losing weight (15 pounds by this point) and that we should go ahead and schedule an induction before it has an impact on my son. Of course like any mother would, I freaked out and agreed. I didn’t want to have something happen to him, and in a way, I was happy because I was uncomfortable like EVERY pregnant woman was in the end.
I went in that Tuesday to get induced. It was December 11th 2007, and we showed up at 6:00am, and they escorted us up to my L&D room, and looking back on it, I wish I knew what I was getting myself into.

My L&D Nurse came in for my little questionnaire/intake and when I said I did not have a desire for an epidural, she and the Wicked Witch OB laughed at me, and told me I would change my mind shortly. From then it just proceeded to get worse!? By 9:30 I was hooked up to pitocin, which in my opinion is PURE EVIL!? Like they had said, after 2 hours of pitocin, 3cm dialated, I was begging for an epidural. I got the epidural but it didn’t seem to do much for me. The OB came back around at noon time, checked me and said I made no progress. I was still at 3cm, -1 station, 80% effaced. Which was a total blow to me because I was hurting and I thought I would have progresses SOME! She told me she was going to go have lunch, see a couple patients and she would be back around 2pm.? My husband and my mother went to get something to eat, I tried to rest a little bit, and eventually she came back. At 2pm, there was again no progress. And this is when she said, well, I am going to come back at 3, and if there is no progress then we are going to have to book an OR. I knew then my worst nightmare was coming true. This cascade of interventions was directing me straight to a cesarean section. From the start of my pregnancy, when I was told about placenta previa (which corrected itself) via ultrasound, I cried at the thought of a cesarean.
She came back at 3pm, and there was no progress, or at least that is what she told me, and they started preping me for surgery. The OR was cold, and bright, and without my husband, it would have been even more terrifying.? In the back of my head I was happy I was about to meet my son, but I was scared to death.
He was born at 4:37pm screaming, 7pounds and 7oz. Which then one of the OB/GYN’s commented, someone of my size (petite frame and short stature) would have never been able to birth that baby. Ya ok!? My mother, my size, gave birth to an over 10 pound baby, HER FIRST CHILD!

My recovery sucked, and during that time, I reached out to ICAN and learned there was no chapter in my area. So, I started one.
In September 2008, we learned we were expecting our second child, and even before I got pregnant, I knew I never wanted to go through another cesarean, nor would I willingly go through it.
My pregnancy was? uneventful, NOT HIGH RISK, attended by amazing Midwives, and so much different from my first.
On May 16th, I was doing a baby fair at our local hospital for our ICAN chapter, talking with mothers all day, giving out information, and around noon time, I started to feel… off. Something just wasn’t right.? Thankfully for me, my Chiropractor was at the booth right next to me at the baby fair so I made my way to him and got adjusted. Once I got adjusted it all clicked. I was going into labor at a baby fair. Were we in a movie?

Next thing you know, the women doing the booth with me said I looked white as a ghost, like I was ready to pass out, so they made me have some water, and eat candy. Lovely combo, but it helped! I wrapped up the fair and headed home. I called my doula and let her know what was going on, but I wasn’t certain I was in labor yet.
I laid down when I got home and tried to take a nap, but I couldn’t get any rest at all. My contractions kept getting closer and stronger. It seemed as though my labor was progressing fast, and I wasn’t sure what real natural labor was like because of my induction the first time around. I called my doula back up and she decided to head on over, and off to the bath tub I went to relax and try to work through the contractions.? Back labor, all the pain was in my back, and later on I found out my little guy was posterior.? By the time my doula got to my house, and things really started to rock n roll, it was around 8pm.? I watched the season finale of Brothers & Sisters which I had DVR’ed, listened to music, and spent a ton of time on the birth ball. Hours seemed like minutes, and next thing I knew it was midnight and I called my midwife. I told her I had been laboring for a while, and things were getting more intense, contractions were about 90 seconds apart, and we still had a 45 minute drive to the hospital I picked, which was one of the most VBAC friendly in the area. So around 12:30am we headed off to the hospital in a 3 car caravan. Myself? laying in my doula’s backseat trying to sleep in torrential rain on the highway. My best friend in her car, and my husband in our car.? We arrived at the hospital between 1 and 1:30am.
We got all checked in, and my midwife greeted us, and gave me a little check. I was 2-3cm which made all of our jaws drop. My labor was so intense we all swore I would be further along!? I decided to get on my hands and knees with the birth ball for a while, then take a shower, I thought about getting in the tub, but it was nearing 4-5am and we all wanted sleep. I couldn’t rest for the life of me.
At this point I asked for an epidural so I could sleep. I knew no matter how much I planned that I would not have one, things change when you are in the actual situation.
I got the epidural around 6am.
I was able to sleep until at 8, when my midwife came back and checked me again 3cm at most.? What was going on?? Why was I not dialating? What was wrong with my body?? Contractions started to slow, then get back to being a minute apart, then slow, then get quicker. Something was just not right, and on top of it all, I am sure the epidural was not helping either.
Around noon time my midwife popped back in and checked my cervix one last time.

Still 3cm and now my cervix was starting to swell, and we were having complications.
I was devastated, my VBAC was crashing and burning in front of my eyes.
My body was defective, I could not birth my baby, my own plan had blown up in my face.
My epidural to sleep, selfishly kicked me right in the ass!

My Midwife consulted the on call OB/GYN who came in to talk to me, along with the Resident who was on call. They were both amazingly warm, friendly, and comforting, and at that point I knew that a cesarean would be how my son was born. But I was not as bothered by it this time around, because after nearly 26 hours of labor, something was wrong, seriously wrong. My mothers intuition turned on and my son was in trouble.

At 1:59pm Benjamin Emil Elwood was born, bruised and looked like he had been through a war! When they opened me up, he was jammed behind my pelvic bone, which his forehead was pressed up against it all that time. He wasn’t coming down, his head wasn’t applying pressure to my cervix for it to dialate. At that moment I knew I made the right choice consenting to the cesarean.? I knew in the long term, it helped my son, and that was simply the way he needed to be born. During the days after my midwife would come see me every morning, sit, chat, and just helped me get through it all. I still today, cannot write about this without crying because the scars from his birth are still fresh. Nearing 6 months old, the pain of the failure is not any lighter. It seems like it was yesterday.

The story I tell is a story of a completely unnecessary cesarean section with my first child, and a life saving cesarean with my second.
The story I tell is a story of pain, and hurt, and betrayal by the one person I trusted the most, my Doctor.
The story I tell is a story of hope for other mothers to learn and become educated from my words.
The story I tell is the story of my sons, the loves of my life, and the ones who have made me the mom, advocate, and woman I am today.

All in all, I am now the North East Regional Coordinator for ICAN, a chapter leader, and the head of a maternity care campaign in my state of Connecticut. My experiences, my children, and my battle has made me become so active that I have been honored to support other women who have been where I have, and I have helped others to prevent unnecessary cesareans.

I love what I do.
I love the birth community.
I love ICAN.
I love being a Birth Activist!

There are several alarming factors in this case. It is legal for a woman in labor to refuse care. Every person has a legal right to informed consent and refusal. Informed consent means that the person will be given the risks, benefits and alternatives of a procedure. Informed consent includes the right to refuse care. But people always say, what if it is an emergency and the baby will die without treatment? The fetus is not legally a person, and therefore a pregnant woman has the legal right to make decisions for her own body, regardless of how those decisions affect the fetus. Furthermore, a parent of a living child has the right to choose or refuse medical treatments for their child. The only legal way that any person can be forced into medical care is if a court order is obtained that deems them incapable of making that decision. I am assuming that the psych evaluation during this woman’s labor was the first step in them trying to obtain a court order. This did not work however, because the first person to examine the woman deemed her mentally capable of refusing care. The second person to examine this woman was unable to complete his examination before her healthy baby was born.

I had no idea that it was legal to have a psych evaluation done while a woman is in labor. I am guessing that this is the only way to obtain a court order, but it seems that it should only be allowable for that purpose. It is unclear to me whether or not these evaluations had any bearing on the decision to remove her child. I find it very unsettling that a woman’s mental health can be evaluated for any purpose while in labor since women enter a different state of mind in order to accomplish the monumental task of giving birth. Is this natural alternate state of being understood by the evaluators? Do they realize that what they are seeing is not mental illness but just a woman in “labor land”? Are they able to decipher the natural affects of being in labor from true mental illness? It seems that any findings from a woman in labor would be in question, so the fact that this was even done with seemingly no understanding that they may not get accurate results is just extremely alarming.

Many people are quick to point out that the c-section refusal was not the final reason given for the removal of her child, but it was her mental illness and her and her husbands unwillingness to work with the system in having their child returned to them. As for her mental illness, she had been treated in the past for PTSD. She had completed her treatment. Many women have a history of being treated for a mental illness. If a woman has ever been to therapy, chances are there is a diagnosis of some kind in her records somewhere. Many women have been on medication at one time or another. Lots of women have been treated for postpartum mood disorders. Will these things now be held against us when we have children? Is it legal to remove a child from a home just because a woman has been treated for a mental illness in the past and they feel that she is therefore at greater risk of abusing or neglecting her child? The irony is that the very system who caused my PTSD can now remove any future children I have because of it? And this is all perfectly legal in this country? As for their unwillingness to work with the system, I can understand that. In those first weeks after being traumatized and devastated, and seeing things through this lens of overwhelming emotions, I am not too sure that they would be capable at that point of seeing the benefits of cooperating with the people who just did this to them.

So, does a laboring woman have any rights? Do the laws of informed consent and refusal apply to her? Why is it that a woman is stripped of all her legal and civil rights during the window of time that she is giving birth, yet she has personal and parental rights at any other time in her life? The laws of informed consent are on the books, but they can’t be upheld legally. If she is violated and damaged, she can not sue for compensation simply because no lawyers will take a case like that. I was just told last week by a lawyer that I had no legal right to refuse any unwanted physical contact or medical procedure during my labor since I had signed a blanket consent form upon arriving to the hospital. Apparently, according to him, a woman can scream “no” and “stop” all she wants to, but she has no legal rights do so, since once she signs that consent form she is allowing the hospital and it’s staff to do whatever they deem necessary from that point on. I disagreed with him, but he holds the beliefs and opinions of most of the lawyers and judges and health care providers in this country. In order for a woman to have any rights, it has to be able to be upheld legally in court. Otherwise, it is just a useless law written in a book somewhere and has no power or bearing on women’s lives. Therefore, I would say that no, women have no legal rights while in labor or giving birth. I think this is the singular problem with our maternity care system. If a woman has no legal rights to refusal in an emergency, then everything becomes an emergency, and she suddenly has no legal rights over anything that happens to her from vaginal exams, to IV’s, to fetal monitoring, to episiotomies and c-sections. In order to change the system, women must be granted their legal rights. Education can only go so far. We can all be highly educated victims, or we can change the system and insist that we have a right to informed consent and refusal in maternity care.