Keavy's Story - Royal Alexandra Hospital, Edmonton, Alberta

May 20, 2014 - When my home birth resulted in a retained placenta, I was transferred by ambulance to the Royal Alexandra Hospital in Edmonton. No sirens were used, and I was alert and conversing with the paramedic and midwife the whole time. When I arrived at the hospital, the attending physician entered the room but never addressed me, speaking only to the other medical staff. Without warning or explanation, he began roughly pressing on my abdomen and then thrust his hand into my vagina. It was excruciating, and he stopped when I screamed. The nursing progress notes later recorded, "It was impossible to remove her placenta without anesthetic as she could not tolerate it." At that point, I was asked to give consent for a manual removal of the placenta under sedation and was taken to the operating room.

I told very few people--not even my husband--about what the physician had done. It was only three years later that I finally was able to face what had happened and to begin to do some research about consent in medical settings. What I learned was that although there are some situations in which consent is implied, exams or procedures that are a) invasive, b) intimate, c) painful, or d) risky require explicit consent. I realized that since I had not been informed about what the doctor was doing and was never given the opportunity to consent to it, what had happened to me was assault.

More than three years after my child's birth, I finally submitted a complaint to the College of Physicians and Surgeons of Alberta (CPSA). I had the support of my midwife in doing so (and am extremely grateful to her for validating my decision to take this forward). 

I waited 18 long months before finally receiving the results of the review: my complaint was being dismissed. The decision was based on the fact that consent for vaginal exams is "not routinely documented"; therefore, they said, there was no proof that consent was not given. Perhaps I had forgotten, they suggested. The letter, written by a male physician, also explained to me that procedures performed during childbirth are often painful. It reasoned further that I was dealt with swiftly and effectively and that my care had therefore been adequate. The attending physician, meanwhile, claimed that he had only been doing a vaginal exam, not a manual removal of the placenta (despite the written record provided by the nursing progress notes and the resident's operative report). The CPSA did concede that there had been an "unfortunate lapse" in communication and that the doctor would be given "directed advice regarding the consent process."

It was very difficult to receive this decision. Many parts of it seemed to be contradictory or illogical: how was a "lapse in communication" about a vaginal procedure anything but a failure to obtain informed consent? Furthermore, there seemed to be a bizarre logical flaw: if the nurse and the obstetrics resident who were present had both misunderstood what the doctor was doing, how could I have been informed about what was happening? The inconsistency between their reports and the physician's account suggested that no explanation had been given--and therefore that no consent had been obtained. For these reasons, I decided to appeal the decision. This time, I was successful, and my case was sent before the Hearings Director.

I want to acknowledge here that as a cisgendered PhD-holding white woman in her 30s, I am among the most privileged of people giving birth. I know that this went a long way toward enabling me to make a complaint--and to appeal that complaint when it was dismissed. 

Five months later (now five years since my child's birth), I received the final decision of the Complaint Review Committee: again, my case was being dismissed. This time, the report claimed that because I was tachycardic and had lost around 1000mL of blood when I arrived at the hospital, my case had been an emergency, and consent could therefore "be implied." While the letter did concede that my case could "serve as an important example for a change in practice," there were insufficient grounds to refer the physician to a hearing. This was the final decision, and it could not be appealed. 

Documents from the College of Physicians and Surgeons of Alberta - Submitted by Keavy Martin

To this day, I have questions about the complaints process that I went through and whether it was worthwhile. There was nothing patient centered or trauma informed about it; in some ways, it was even more stressful than the hospital transfer itself. Every time I wrote to or received a letter from the CPSA, I had to re-live what had happened. I began to dread looking in the mailbox every day as I waited for the latest decision. I would try to explain what it feels like to have your claims downplayed, or to not be believed, but unfortunately, this is something that anyone who has experienced assault will already know.

Today, I continue to wonder about the process whereby my birthing body allegedly relinquished its right to consent. What is the heart rate, the percentage of blood volume lost, when a person surrenders their autonomy? Again, I was conscious and alert when the physician entered the room, and it would have taken ten seconds, tops, for him tell me what he was about to do. I question whether we did not have those ten seconds to spare. I can't believe that what happened to me was justifiable; it terrifies me that the CPSA does.

At times, I do wonder whether the fact that I was transferred from a home birth had anything to do with the care that I received. When I woke up from sedation, one nurse told me that I would have to quit shaking or I would not be allowed to hold my baby. She then asked if I was going to come to the hospital the next time I gave birth. Was a bias against home birth a factor at the hospital? Did the doctor believe me incapable of making good decisions--and therefore not worth consulting about my own body?

Sometimes, I also wonder why the numerous other medical professionals (nurse, midwife, obstetrics resident) who were in the room when this took place did not say anything. All of them were women, and all of them--except the midwife--were outranked by the attending physician. It was not their fault that he violated the consent process. However, I wish I'd had an outspoken ally in the room. I wish someone had said something. This makes me wonder about the need for much wider education--indeed, for a major culture shift--in reproductive medicine. 

Although the complaints process did not protect me, the experience has given me first-hand knowledge of what complainants too often go through--and why many choose not to report at all. The most useful thing that anyone said to me, especially after my complaint was dismissed for the final time, was, "Well, it DID happen, and I believe you." So to the others out there who were harmed during childbirth, whether you complained or whether you chose not to, I want to say: I believe you. It should not have happened, but it did happen, and I believe you.

Thank you for the opportunity to tell my story.

Submitted by Keavy Martin