2020-2021-2022
I hadn't heard of the term 'obstetric violence' until my therapist used it after I had described what had happened to me during the birth of my third child. Wanting to learn and understand what it meant, I began Googling. At some point I found this website and felt that it could possibly hold a place for my words when I was ready. Maybe someone else would happen upon my story and find a strange comfort in being able relate to my experience. Maybe someone considering a birth at the Sault Area Hospital would see this as a cautionary tale and know they will need to advocate for their autonomy. Maybe the staff involved would stumble across their names and learn about the active role they had in perpetuating obstetric violence. Or maybe my words could just rest in this corner of the internet and that would be okay because I'll have got them out.
The first incident took place during labour with my eldest. I had expressed to my nurse, Robin, that I preferred to not use an epidural and that I wanted to use IV fentanyl as my first choice if I needed pain management. After close to 20 hours of contractions I got my first dose of fentanyl. Another dose was supposed to be offered to me after 30 minutes and I naively trusted Robin to do this. I suspect she had some hesitations with the use of fentanyl based on how I overheard her answering the nursing student's questions about it. Time stops making sense in labour and I didn't ask for my next dose because I believed that she was watching the clock and would let me know when she could administer it. Instead, I laboured for three more hours before she opted to offer me an epidural, which I accepted because I needed relief, believing that not enough time had passed to be able to use fentanyl again. I trusted Robin to respect my choice to use IV fentanyl and support the plan that was in place but I feel that she judged it and made the decision for me on how she preferred my pain to be managed. I would never have consented to the epidural if I had known that fentanyl was still available to me. This was not informed consent. It was this experience that triggered an anxiety. If Robin could betray my trust, then any other stranger to my care had the potential to do it again should I give birth to another baby here. Would my decisions really be my decisions? Or would they first have to pass the scrutiny of someone else before being deemed acceptable enough to be acted upon? Would I be given all the information that I would want to give truly informed consent? Or worse, would I not even be given the opportunity to consent?
A little over a year and a half later, I was back at the Sault Area Hospital labouring with my second child. My pregnancy had been filled with anxiety as I constantly worried about how a nurse's disregard of autonomy could manifest. I had come prepared with a written birth plan and had discussed my preferences and how I'd like to be asked for consent with my provider. I am grateful for the first nurse I encountered who read my birth plan and respected my wishes during my labour. I delivered at shift change and a new nurse, Riley-Jo, had taken over. Following a quick shower, she asked to perform a fundal check and I consented. Then, without offering any explanation or obtaining consent, Riley-Jo began a fundal massage. I was not hemorrhaging. So caught off guard, I squirmed in pain, grabbed her arm, and said, 'No, I don't like this'. She removed my hand and pressed into my belly again. I repeated myself but she didn't stop. More than once I had said 'no'. If she thought she had my consent, 'no' should have been heard as withdrawing it, yet she continued with it. Riley had read my birth plan, she ought to have known how important consent was to me. After this, I swore that I could never have another pregnancy if it meant that I would have to give birth at a hospital again.
For my third pregnancy I was under the care of a midwife and had prepared for a home birth. I felt so at ease knowing who would attend my birth and I had full trust in them. At my 38 week appointment I was provided a list of dates where there wasn't enough midwifery coverage to support a home birth and I would need to present to the hospital if I were to go into labour. It was half the remaining days leading up to my due date and I instantly felt anxious. I believe this caused the blood pressure reading that was taken immediately afterwards to be high. Throughout pregnancy I had been checking my BP twice daily and, while creeping closer to the threshold of gestational hypertension, it had never exceeded it. It had never been this high before and I was sent to the hospital for a workup. I did not have preeclampsia but on a second reading at the hospital, feeling incredibly anxious to be back in the labour and delivery department, it was high again which meant that my midwife would need to transfer care or I could agree to an induction with her. I was crushed. I hated the idea of an induction because I valued a low intervention birth and inductions can lead to a cascade of interventions. I also knew that if I transferred care and went into labour spontaneously that I could see myself reaching active labour and choosing to remain at home unassisted. In hindsight, I wish that's what I had done to spare myself the trauma that ensued but I chose to move forward with the induction so that I could keep the provider I trusted. I convinced myself that things would move quickly and smoothly as I'd already had two spontaneous vaginal deliveries but I couldn't have been more wrong. A day and a half later when I had maxed out on pitocin, waters broken, and hadn't progressed beyond 4cm my midwife had to transfer care to a physician. The plan was to attempt a therapeutic break and resume pitocin in a couple hours. I was exhausted at this point and knew that if there was any hope of making it through this induction I would need to rest so I chose to have an epidural placed prior to resuming pitocin. A couple hours after the epidural had been placed the nurse who had now been assigned to me, Julia, told me that I would need to empty my bladder and that I could have an in and out catheter or an indwelling catheter. With this epidural I couldn't feel the contractions but I could feel and move my legs normally. I had the sensation that my bladder was full and that I would have control over it. If I could pee on my own, then a catheter was an unnecessary medical procedure and I did not want to increase my risk of a UTI nor did I want another device connected to me. I told Julia that I'd first like to try using the bathroom and was met with resistance.
Julia told me that I was not allowed to use the bathroom because it was against hospital policy. I told her that there was no actual policy barring patients with an epidural from using the bathroom and that no policy would ever supersede a patient's choice or allow them to perform a procedure without a patient's consent. I told Julia that she could document that she explained to me that I was at risk of having a fall by standing with an epidural, that I verbalized my acceptance of this risk, and that I would be using the bathroom. I had presented the plan of using a wheelchair where I could stand and pivot from the bed to the chair to the toilet and back. I am aware of how to do safe patient transfers and the limitations that staff have in offering their physical support. I explained that my husband would assist if I needed it but that I felt very capable and wouldn't be making the request if I didn't believe it was possible. She insisted that I was not allowed to, so I asked her if she was going to document that she inserted a catheter without my consent or if I would be left to pee myself in the bed. She deflected, telling me that in her 17 year career she has never had an epiduralized patient use the bathroom. I told her that it is possible for people to void by themselves with an epidural. I explained that as a healthcare worker in this hospital I have patients who are at a significantly greater risk of falls than myself choose to walk into my department or independently transfer and that I cannot invalidate their choice by forcing them into a wheelchair or mechanical lift. We may not personally agree with their choice, but we do have to respect it. I told her I can make decisions for myself about my own safety and assess and assume my own risk. She continued to refuse my request for a wheelchair as our conversation went in circles. Julia eventually left the room and I thought she had gone to retrieve a wheelchair, except she returned to tell me that she consulted with her supervisor who said that I cannot get out of bed to use the toilet. I told her that her supervisor doesn't get to make decisions for me. She left again and again I thought she was getting a wheelchair. This time when she came back she said that she needs to ask the anesthesiologist if I can get up to pee to which I said the anesthesiologist does not get input on my decisions. Then she asked me if I wanted a patient advocate and I told her that I was already advocating for myself and that this was getting drawn out and more difficult than it needed to be. Julia left the room again and came back with another nurse, Erin. Now there were two nurses in the room bullying me.
'If you fall, it is going to be a lot of paperwork for me.' It is not my responsibility to make decisions about my healthcare based on anyone else's convenience.
'If you fall and get injured then I won't be able to sleep well at night because I would feel responsible.' Whatever potential for physical harm they sought to prevent was being made at the certain expense of psychological harm yet they still expected me to make a decision that was sensitive to their feelings.
'If you fall, we won't be able to help you back up' I would not proceed if I felt unsafe self-transferring. My husband would be available to physically support me if I needed it. In the event of any patient fall mobile mechanical lifts are available in the hospital.
'If you fall you'll need a c-section.' When as a pregnant woman did I lose the ability to assume my own risk? I can walk across an icy hospital parking lot without someone threatening a c-section if I fall. I can agree to an induction which I'd argue carries the greater risk of a c-section, but that's not viewed as problematic of a choice.
'You realize that your epidural is not a walking epidural?' That doesn't matter because I still have normal sensation and control in my legs and bladder. At one point, I stood up beside the bed to prove that I could ambulate and Erin immediately, without seeking permission to touch me, grabbed my shoulders to sit me back down.
'We will have to call your doctor in to talk to you.' The power dynamic shifted to three against one. The infantilizing dialogue continued. I told them I was being bullied. I told them I was being backed into a corner. I told them that this is not how to obtain my consent. I was in tears as I told them that not being heard is why I was anxious to have a hospital birth. Nobody was listening to me. Nobody was letting me choose what I wanted for my body.
Nearly two hours had gone by and I really needed to pee. I begged for someone to get me a wheelchair. I'd have walked myself to the bathroom but my epidural pump was locked to the bed's IV pole. Erin pointed this out, telling me that I wouldn't be able to use the toilet because of this. They claimed they weren't able to remove it from the bed. I told them that it just needs to be transferred to the mobile IV pole, but they insisted this couldn't be done. It was a lie. There is a key. Patients travel the halls with narcotic pumps locked to mobile poles all the time. It was an excuse to get me to submit to catheterization. It worked. That hill that I was trying so hard to climb suddenly became insurmountable. How could I get to the bathroom if I was tethered and locked to the bed? I hadn't been able to convince them to bring me a wheelchair, how could I possibly convince them to bring the key? I cried as I said 'I give up, I don't care anymore'. The catheter went in. I cannot comprehend how the three healthcare professionals in the room could hear those words and believe that they had obtained clear, enthusiastic, freely given, informed consent. In a setting outside of a hospital where a woman repeatedly denies persistent pressure and coercion to have something inserted beyond her labia, is physically restrained to her bed by a lock, only submitting because escaping the situation is an impossibility, we would be calling it rape. What I experienced was obstetric rape.
I wish that was where the traumatic experience ended, but it wasn't. Ultimately, the induction was a failure and I agreed to a c-section. In the operating room, numbed, drapes up, exposed, I could feel my skin being cleaned with the antiseptic solution. I heard the voice of the OB give an order to someone to 'clean inside her vagina too'. His voice then directed to me, 'we need to clean your vagina'. It wasn't a question. I murmured 'mmhmm' expecting to hear more. All of a sudden I felt something being forcefully shoved inside me. The person doing it never said a single word to me. That person had not explained anything. That person had not sought my consent. I don't even know who it was that was penetrating me. I winced and felt the object withdraw. Then I felt it inserted again and I winced again. I counted it happen five times, wishing each time was the last. Once the surgery was done, I was being cleaned up and felt something pushed into my rectum followed by a new voice telling me that they'd just given me an indocid suppository. I remember feeling like this was another violation. Where was the opportunity to consent to something being inserted into my body? I wish I could have said something in those moments to call them out but I just froze. It's not that I would have declined any of it. It's that I needed to be in control of giving permission. I needed to know that they were respectful of my body and the person to whom it belonged. The whole experience has left me with this gross, icky feeling that is hard to describe-like my body isn't entirely mine. Like someone else, multiple people, got to make decisions about what happened to it and never returned all of the control to me. It has shattered my sense of safety and I now need to fiercely protect what remains of it.
I had debated filing a complaint with the hospital or the CNO, but ultimately decided against it. I didn't want to be retraumatized by sharing my story, my medical records, with strangers whose sole purpose would be to judge it to determine whether or not it would be valid to take action. What would be the result anyway? Worst case, nothing? An exercise in futility? Best case, a disciplinary suspension? Financial compensation? Neither of those take back what had happened to me nor would they have a meaningful impact on addressing the root of the problem which is a culture within the Sault Area Hospital labour and delivery department that is either blind to or tolerant of obstetric violence. In my three experiences there was always another person present who could have spoken up in the moment to say 'this isn't right', but nobody did. Even the supervisor on shift that day couldn't recognize the problem with upholding Julia's invalidation of my choice. If leadership was this oblivious, then I couldn't envision them enacting change. There does need to be change though. A meaningful effort to change. It needs to extend beyond education to where implementation happens and practice actually evolves. It needs to be genuine trauma informed care. Perhaps this can be achieved by allowing the shame to permanently exist on a public platform. Let it motivate accountability so that when someone references this webpage and asks what's been done to address obstetric violence at the Sault Area Hospital, there'll be an answer.
Before my discharge from the hospital I had at least three different providers warn me that I'm at a greater risk for postpartum mood disorders because of my traumatic birth experience. It's odd to hear someone else label your birth as traumatic, especially before you realize it for yourself. Where do they think the trauma comes from? The loss of my home birth plan? The prolonged, high intervention induction? The unplanned c-section? The complicated repair with significant blood loss? While not the outcomes I'd wanted, I can make peace with those events because I had the opportunity to make the informed choices that brought me there. Surely they didn't recognize that the greatest source of trauma were the moments where I was stripped of my autonomy, otherwise they should have seized the opportunity to prevent it. In the weeks following the birth, the grief of losing the home birth I had planned for began to subside and was replaced with a panicked feeling. Something small could trigger a reminder of some part of the birth. It's almost like I would fall down a staircase of memories and end up on the same landing each time where flashbacks of the bullying, the assault, would play over and over. My chest would feel tight, my spine and sternum would ache, my heart would race, my insides would burn, my hands would get cold and shaky, my eyes would fill with tears, nausea would start, and I'd lose the ability to concentrate on my surroundings. I'd have trouble falling asleep. I didn't want to be touched. I avoided things that might trigger this response. I suspected this was PTSD and I began seeing a therapist. Since doing talk therapy and EMDR some of the symptoms have improved. Unfortunately, I've exhausted my benefits coverage and had to pause these sessions. Trauma is expensive. I acknowledge how privileged I am to have been able to access therapy at all. I know I'll need more. Birth trauma still has such a hold on my career, my family, my relationships, and I need it to let go. I dread returning to work at the same hospital following my maternity leave. I doubt I could honour my long-standing offer to be a gestational carrier for my brother and his partner. I struggle with feelings of resentment towards those in whom I trusted to support me and advocate for me during the birth but instead remained silent while watching me plead for my autonomy. This is an awful place to feel stuck at.
I often remember my midwife telling me during my prenatal appointments how much I'll love a home birth. Sometimes I let my mind wander into the fantasy of what it would have felt like to labour and deliver in the safety and comfort of my own home, to have felt supported and respected, to have felt happiness and fulfillment. But when I snap out of the fantasy, the grief and the trauma are still there. The feelings of regret, sadness, frustration, betrayal, squeeze out any room for joyful memories of the birth. I do not get to go back and change it. This will forever be my experience.
Submitted by V
