Target – Houston, TX

Bettina Forbes from Bestforbabes.org posted yesterday about a mom from Houston feeling harassed in her local Target store for breastfeeding her baby.  This is despite a policy in place that says breastfeeding in welcome, although there is some weird wording here.  You can read Bettina’s story here: Target Employees Bully Breastfeeding Mom Despite Corporate Policy

Michelle Hickman, the mother in the post, has started a Facebook page to rally for a nurse in at all Targets on December 28th at 10 a.m.   Best for Babes also outlines some additional cases involving Target and harassment.

Care to get in touch with Target about this, after reading the whole story, please:

Target Corporation, 1000 Nicollet Mall, Minneapolis, MN  55403

Guest Relations: (800) 440-0680

guest.relations@target.com or Target Corp. Contact Form

Washington D.C.

Another incident involving breastfeeding harassment was in Washington, D.C. Simone Maningo-Truell dos Santos was nursing her 4 month old baby in the hall at the Henry Daly Building.  There is a law that protects her right to breastfeeding, but two different guards told her she would have to stop, including telling her it was public indecency. (Thanks to @KristenCampbell for sharing this with me!)

What to Do if You’re Harassed for Breastfeeding

These two incidences are both within the last couple of weeks.  This is NOT old news.  So what do you do if you feel like you are being harassed for breastfeeding?

• Know what the law says about breastfeeding in your state or situation.
• Ask to speak to a manager or someone in charge.  Be firm but polite.
• Go above their heads when needed.
• Always document names, times, titles – any info you can get.
• Ask for help!

Have you ever experienced breastfeeding harassment?

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.

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.

ACOG Releases 2009 Medical Liability Survey

Results Paint Dismal Reality for Ob-Gyns and Their Patients

While this is a group that usually likes to stick their heads in the sand when it comes to the women that they care for, I was surprised at the honesty about the OB-GYNs that they serve. ?I know ACOG has been concerned about the number of doctors who are leaving obstetrics, but this actually breaks it down and shows you the drop in doctors offering VBACs, how many are being sued, etc. ?The most startling tale? ?They admit that it harms the patients…

And why are they not doing VBACs, seeing high risk patients and providing better care? ?I think they say it best:

“Of the survey respondents who reported making changes to their obstetric practice as a result of the risk or fear of professional liability claims or litigation, 30% decreased the number of high-risk obstetric patients that they accepted. In addition, 29% reported performing more cesarean deliveries, and 25.9% stopped offering/performing vaginal births after cesarean (VBACs). An additional 13.9% decreased the number of total deliveries.”

Litigation. ?Perhaps the power cry from the women shouldn’t be “Keep your scalpels off my body!” but rather, “I’ll promise not to sue if you practice evidenced based medicine.”

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.

She is arrested for drunken breastfeeding. The officers did NOT do a blood alcohol test at the scene or ever. The Chief of Police said that his officers deal with a lot of alcohol related problems and therefore, know drunks when they see them.

I am so baffled. This stand of knowing drunks when you see them would certainly not fly had this mother been driving. Could her behavior not have been caused by anything other than alcohol? Perhaps the sleep deprivation of being a new parent? The stress from having just been beaten? Again, in any other case other causes of a medical origin would have at least been ruled out.

One thing from the article that really startled me was the fact that they couldn’t believe that the mother was breastfeeding while they questioned her. She was in her home to the best of my knowledge, so why would breastfeeding a needy newborn not be normal? Breastfeeding is not a crime.

You’re going to read words, I never thought I would write, I agree with Dr. Amy on this one.

All this said, I think that if you choose to drink to the point of being intoxicated while you are breastfeeding, you need to have someone with you to care for the baby. But was this woman at this point or otherwise having issues? I’m interested in how this unfolds. Please share your thoughts.

It seems that some doctors are quite upset over being rated online.? One doctor received this comment from one of his patients: ?Very unhelpful, arrogant, did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people.”? Dr. Segal, who has started a business to help doctors fight these online reviews states: “such postings say nothing about what should really matter to patients ? a doctor?s medical skills ? and privacy laws and medical ethics prevent doctors from fighting back.”? I think this statement is very telling.? It seems many doctors feel that the only thing that should matter to a patient is the doctor’s medical skills.? These sites are showing doctors that something else does matter to patients: bedside manner.? Patients today don’t place unquestioned trust in their doctors like they did in generations past.? They want to be involved in their health care decisions, and feel respected and cared about.? I think that most patients would desire a balance between medical skills and a good bedside manner, as well as feel like they have decision making power over their own health care.? I think what is happening with these websites is that patients are using their consumer power and really showing doctors what is important to them and how they need to be treated.? Medical skills are not the only thing that matters to patients anymore.

Segal’s company is providing wavers for doctors to ask patients to sign.? These wavers will ensure that a patient can not fill out an online review, or post about a doctor online in any other way.? The article states: “Doctors are notified when a negative rating appears on a Web site, and, if the author?s name is known, physicians can use the signed waivers to get the sites to remove offending opinion.”? Of course, these wavers only have power if the name of the person who wrote the review is named, which is not the case on many of these sites.? The article states: “RateMd?s postings are anonymous, and the site?s operators say they do not know their users? identities. The operators also won?t remove negative comments.”? Hopefully if this happens on any site that hosts ratings of doctors with anonymous sources, they will follow the example of RateMD.com: “John Swapceinski, co-founder of RateMDs.com, said that in recent months, six doctors have asked him to remove negative online comments based on patients? signed waivers. He has refused.”

I wonder why a doctor would even present wavers to a site that rates anonymously?? Perhaps they feel if they make every one of their patients sign a waver, then of course one of those patients broke that agreement?? However, it seems to me that the doctor would need to take this up with the patient, not with the site hosting the comment.? The site did not sign anything forbidding them from hosting ratings of doctors, the patient signed something forbidding them from giving that rating.? Therefore the agreement is with the doctor and the patient, and the website does not have to honor that agreement.? I think as long as the site is anonymous, then there is nothing a doctor can legally do to prevent this from occurring.? The article states: “Segal, of Medical Justice, said the waivers are aimed more at giving doctors ammunition against Web sites than against patients. Still, the company?s suggested wording warns that breaching the agreement could result in legal action against patients.”? It seems to me that the only function of the wavers would be to scare a patient into silence, making them feel as though they may get sued if they rate their doctor on one of these sites.? It is odd that Segal states this will give doctors ammunition against the sites, when they have no legal agreements with the sites.

I am sure it is distressing for a good doctor to stumble upon a bad review made about them, however, your typical consumer is savvy enough to be able to discern that one bad review does not mean much.? Many bad reviews on the other hand could be really telling.? If a doctor is getting so many bad reviews online that they would consider asking their patients to sign a waver, perhaps they should think about changing the way they practice.? If a doctor asked me to sign a waver like this, I would run, not walk, out of their office.? I would never want to see a doctor who would attempt to stifle my freedom of speech.? I would be afraid that signing this waver would leave me open to bad treatment, and I would be left with little recourse if I signed my rights away.

In the birth world, we now have The Birth Survey which will soon be putting their national results online (currently only NYC’s resluts are up).? The Birth Survey differs from these other sites in that it focuses solely on doctors or midwives who assist with childbirth, and it asks comprehensive questions about the entire birthing experience, from prenatal to postpartum.? This is not a flippant rating given on a whim, but a thought out recounting of an actual experience.? The survey is anonymous and takes about 20 to 30 minutes to complete.? If you have given birth in the last three years and have not taken The Birth Survey yet, please do.? Hopefully doctors and other care providers will begin to learn from the feedback given on sites like these and adapt their practice style in a way that will serve their patient’s needs.

http://groups.yahoo.com/group/VAMUM/

HB 2163, is a bill to amend ? 54.1-2957.9 (the CPM statute).

What is wrong with it:

• The proposed legislation would add an amendment requiring midwives to give informed disclosure to their clients about the risks associated with home deliveries and with some specific pregnancy conditions. This legislation is redundant to the existing statute that already requires that licensed midwives in Virginia hold the designation of Certified Professional Midwife (CPM) and practice according to the standards of the National Association of Certified Professional Midwives.

• CPMs are required by their certification to give a written informed disclosure regarding their experience, training, and the risks and benefits of home birth to every client at the beginning of care.

• The NARM Job Analysis (cited in the VA statute) specifies the principles of informed consent and the conditions that may require additional education and informed decision making. The conditions cited in HB 2163 are included in this list.

• The NACPM standards of practice (also cited in the VA statute) refer to informed consent and requirements for education and information of CPM clients.

• The Virginia Licensed Midwife regulations already require that informed consent be obtained before any invasive procedure is performed.

HB 2167 is a bill to require the Board of Medicine and the Department of Medical Assistance Services to review regulations and policies to ensure that no reimbursement is made to certified professional midwives providing services in high-risk situations, including high-risk home deliveries.

What is wrong with it:

• This legislation is discriminatory to low-income women. Any woman who qualifies for Medicaid is designated “high-risk” based on her socio-economic status. Midwifery care, by way of its hallmarks of increased education, support, and respect, has been proven to benefit women who are at risk for pregnancy complications. Evidenced-Based Care does not support restricting access to home birth to women based on perceived risk. This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in some Virginia communities.

Submitted by Birth Activist Pam Pilch

Catherine Skol was the victim of abuse and harsh mistreatment.? Unfortunately others have also endured this type of treatment when giving birth.? Her case is particularly horrific, and I am sure she is suffering from the effects of this trauma in her life.? I personally am thrilled that she has brought a lawsuit in order to try to bring this doctor to justice.

The fact that Catherine Skol secured a lawyer and was able to actually sue her abusive doctor is perplexing.? I have heard many stories of trauma over the last few years, and there are many other women who have had similar experiences.? I have only ever heard of one other woman being able to bring a legal case over this type of treatment at a birth, and there were unique extenuating circumstances that made retaining a lawyer and getting a settlement possible for her.? I have never heard of any other woman being able to get a lawyer to even talk with them about a birth experience where they were abused or mistreated.? As an example, I myself called several lawyers about my birth experience and was unable to even get past the receptionist.? This is quite common, no matter the severity of the experience, if there are no physical damages it is pretty much unheard of that you will be able to retain a lawyer to file a suit.

I speculate that there are three reasons that Catherine Skol was able to retain a lawyer and file a civil suit.? First and foremost, she is a former police officer.? If there is one job where people (particularly men) will take what you say seriously, it is probably this one.? People would feel that surely a police officer wouldn?t be lying, or blowing things out of proportion, or not have been tough enough to handle the situation.? They would reason that surely a police officer deserves to be listened to.? Second, she was a seasoned mother and this was her fifth baby.? I?m sure it was thought that of course she knew what to expect, and how things should go, and was able to decipher that things were not going as they should because she had been through this experience four times already.? Third, she was denied pain medication.? There is a difference between not wanting pain medications or other standard treatments and being mistreated for your choices, and wanting pain medication or other standard treatments and not being allowed to have them.? I think either situation can induce trauma for a woman, but a lawyer would be much more sympathetic to a woman who wanted the standard pain medications and was denied it.? Both acts can be a form of mistreatment or abuse, but being denied what is considered to be standard medical care in that situation garners much more sympathy from most people.

No matter how Catherine Skol was able to retain a lawyer, I feel that this is an important case that could possibly set a precedence for other women who are abused while giving birth.? If Catherine Skol wins her case, women who have had similar experiences would then have a leg to stand on legally.? There would be a case they could show a potential lawyer in order to persuade him to take their case.? I am glad that she has gone public with this case so that providers and institutions as well as other women who have been mistreated are made aware of it.

I have read of some people expressing concern over why this woman would sue.? Many are very concerned about lawsuits being brought up in any form concerning maternity care.? Some say that lawsuits have caused the current atmosphere in the maternity ward, and how can more lawsuits possibly help the situation?? What will Catherine Skol, or women like her gain from a lawsuit?

There are a few things that can be gained from lawsuits of this type.? First, there are monetary damages.? Being traumatized is quite expensive.? Severe trauma may take years of various types of treatment to overcome.? Many people are not adequately covered by health insurance when it comes to mental health treatment.? Most people are either not covered or their coverage is limited in some way.? This means there will be extensive out of pocket expenses for months or years, which can add up to thousands of dollars.? Second, when a person is mistreated, in order to protect others from the same type of mistreatment, that person will desire to take some type of action.? They will also be looking for some type of closure for themselves.? In the hospital system that fears litigation, there is no room for debriefing sessions with staff members or providers who participated in the event, and there can never be an apology or an admittance of making a mistake.? Some women will never have the opportunity to see their providers again, and others will see them once at six weeks postpartum, but will generally not be given the time they need to even begin to process the experience with their providers.? This situation is bad for both the women and the providers.? If this scenario was possible, the woman could possibly gain some kind of healing knowing she has made her grievances known and that she has been heard, and a provider could possibly gain some understanding and compassion, and use the situation as a learning experience.? If there were adequate health care coverage in this country, and not such fear of litigation that provisions were made to allow a patient?s grievances to be heard and acknowledged, then there would be no reason to sue.? Since women who have been mistreated during their birth experiences do not have that, then they must sue to be heard by the provider, and to gain monetary damages.

The other reason it is important to file a lawsuit over abusive treatment is to try to change the type of maternity care that women routinely receive.? If it is possible for a care provider to be sued over this type of treatment, then care providers will begin to take notice when women complain over it.? It gives women power to be given the opportunity to voice their grievances, and since this is the working system in the country to do so, it is high time that women were able to use this system in this regard.? Not being able to even get a lawyer to consult with on a case like this leaves women damaged and powerless.? Powerless to get compensation for her own suffering, and powerless to prevent it from happening to anyone else.

Thank you Catherine Skol for having the courage to take advantage of your unique position and filing a precedent setting civil suit.? I hope you pave the way for women after you to also have the power to file a lawsuit, and I know that your even filing one has made a difference to this doctor and other care providers who have undoubtedly read about the case.

Some notable quotes from the article:

Both the law and respect for women’s humanity require that every pregnant woman be fully informed of the risks of all forms of labor and delivery in a language she can understand; that she be supported in her decisions about how to bring her children into the world, whether it be in a hospital, a birthing center or at home; and that she not be penalized for those decisions either medically or legally.

A pregnant woman must either submit to a subsequent C-section, whether she thinks it is a wise medical decision or not, or deliver her baby outside the hospital. For those women who do not want a home birth, or who cannot have one because of lack of health insurance coverage or lack of available midwives within a safe distance of home, this is coercion, not consent.

Policies and practices that force pregnant women to submit to unnecessary surgery cannot be justified. We would never countenance that practice for any other patient. Pointing to potential risk to the baby does not justify ignoring the mother’s decisions about her medical care.

Such reasoning inappropriately views a pregnant woman’s decision about her and her baby’s needs as suspect, and it ignores her legal rights as a patient. All pregnant women, whether they view birth as a natural event only rarely needing medical intervention, or whether they willingly accept medical assistance with the birth process, have the legal right to informed consent and to direct the experience of bringing their children into the world.

Cesarean’s are just one of many procedures that many birthing women are not allowed to give informed consent to. This is the first article or statement I have ever seen by someone in the legal field that says that this is legally wrong to do to women. I personally have contacted several lawyers and not one would talk to me, or allow me to pay them for an hour of their time while I presented my case to them. I am thrilled to see some acknowledgment by a legal organization that ignoring a pregnant woman’s rights is illegal and cannot be justified.