Things you hear about pregnancy and labour: stretch marks, nausea, weight gain, waters breaking, epidurals, pushing, tearing, episiotomies.
Things you don’t hear about pregnancy and labour, but are the only things I’ll care about if I ever get pregnant again: bedside manner, body autonomy, and INFORMED CONSENT.
If you’re already cringing, this post is not for you. Scroll away. This post is for pre-pregnant me and for every woman reading who can relate.
Jumping right into it: during what I thought was going to be a routine cervix exam, my doctor tried to perform a stretch without my knowledge or consent. If you don’t understand, google “stretch and sweep”. It might take you a minute to realize how incredibly jarring this was. Not to mention painful. I was admitted to the hospital pre-labour because my water “broke”, and according to my first cervix check I was 0.5 cm dilated. I walked around for 7 hours, trying my darnedest to avoid induction. When my OB came to check my cervix, I expected it to feel like the first check. It didn’t. It took longer, and the pain was sharp and unfamiliar. In the middle of the procedure, I reflexively clenched everything I could clench, and I shouted, “ARE YOU JUST CHECKING OR ARE YOU DOING SOMETHING ELSE?” When he finished he said, “I just did a mini stretch. You’re barely 1 cm dilated”.
This was the most vulnerable time in my life and my right to body autonomy was violated. Unfortunately, it wasn’t the only time.
I asked for an epidural after 12 hours on Pitocin – I agreed to being induced because my only priority after the non-consensual stretch was “What is going to get me out of this hospital faster and away from these ‘cervix checks’?” For me, the best thing about the epidural wasn’t numbing the contractions, it was that I couldn’t feel the cervix checks anymore (at this point I had 6 more to go). This is not the mindset one should have on the verge of having a baby, but the stretch left me traumatized. Even though the bottom half of my body was numb, I could still feel pressure. Even though I couldn’t feel pain or discomfort, each check was like repeatedly reliving the trauma of the non-consensual stretch.
There was an issue with the baby that I didn’t fully understand (because it wasn’t explained to me), something to do with the Pitocin and the baby’s heart rate. A new nurse walked in without introducing herself. She told me to change positions a few times without explaining why. I tried to tell her that the baby seemed fine before when I was laying on my side, and she told me, too aggressively, “It’s not up to you any more, it’s up to the baby. We are listening to the baby now.” I wasn’t hysterical. I wasn’t objecting to her instructions. I wasn’t giving her any attitude. I was just trying to understand what was happening, and she treated me like my asking questions was getting in the way of my own birth. She then said, “I have to check inside.” No further explanation. I didn’t even know her name. I said, “Can we wait for the doctor to do it?” (not my OB, the next shift had started) She looked at me like I was stupid and said, “No, have to do it now.” Nobody told me if this was a life or death situation. I tried to decline, but I felt pressured into letting her do it because I didn’t understand what was wrong. I rolled my eyes and said fine. She inserted her fingers and said she had to “tickle the baby’s head”. It appeared to have worked, and she looked at the monitor and said, “There, he’s fine.” Before she was finished, she VIGOROUSLY shook her hand - up and down, up and down - while it was still inside my body and said, “See? Baby is fine. It’s ok.” I was shocked. I looked at my doula to see if any of this made sense to her, but she looked shocked too. I didn’t feel pain because of the epidural (Thank GOODNESS), but I watched and felt my body shake. I watched this obnoxious stranger put her fingers inside me and literally shake me by my vagina.
BONUS: The doctor came in and asked how dilated I was. No-name nurse said “I don’t know, I didn’t check yet.” I looked at my doula again: still shocked. I said, “You don’t KNOW?!” She brushed off my frustration with, “I don’t know I didn’t get a chance to check yet. I check now.” As she gloved up to go another round I held my arm out over my numb body and shouted for one of the other nurses to come do it instead. After this, no-name decides to try to introduce herself, probably sensing that I hated her. She tried to tell me her name, what her role was, what department she was in. I don’t remember any of it, but I don’t think I’ll ever forget her face.
At first, it was difficult to define what happened to me because I didn’t know how I was allowed to feel. I was supposed to trust that my healthcare providers knew best, but I don’t feel like I benefited from their decisions. I know, now, that what I experienced was rape. My right to body autonomy was violated. My right to consent to what happens to me was violated. Of course I’m grateful that I’m okay and my baby is healthy, but I’m still a person. Outside of a pregnant woman’s hospital room, the things that happened to me would qualify as assault.
Originally when I wrote this, I hadn’t filed a complaint. I didn’t bring it up at my 6 week post-partum appointment because for one, I was preoccupied with the stress of being a new mom, and I was scared. I was very, very scared of having that conversation face to face. I was scared of being told that my feelings were invalid, that what was done to me was necessary and beyond my understanding. What was the point of reliving what I went through WITH the person who put me through it, if it wasn’t going to change anything? Well, after writing this I started thinking “What is the point of sharing what happened to me if I didn’t stand up for myself?” Spreading awareness is one thing, but hoping for change without doing anything to make that change doesn’t make sense to me. So I filled out a complaint form on the hospital website.
The complaint was forwarded to my doctor and he called me the next day. The details weren’t sharp for him, which is understandable given how long it’s been. When we started talking about the stretch he said “I don’t think I performed an actual stretch. You weren’t dilated, right? You can’t perform a stretch on an undilated cervix.” I had to remind him that yes, he did mention that it was a “mini” stretch. I had to remind him that I shouted out loud while he was performing the check and I asked if he was doing something else. I had to remind him of what he had said when he finished. To his credit, he did apologize to me. He said he was wrong and that my feelings were valid. He told me that even though those exams are routine for the staff, they are invasive, and no one should ever make me feel like I don’t have a choice in what happens to me.
When I received my doctor’s formal written response, I must admit I skimmed through it. I didn’t really want to read it. I thought that the least I could do for the next woman who finds herself in the position I was in was contribute to the record of obstetric injustices that for some reason, doesn’t reach as many people as it should. After sharing my doctor’s response with my doula and with The Obstetric Justice Project, I realized that the tone and the language of the phone call and letter I received were very different. Over the phone, my doctor literally said the words, “I was wrong. I shouldn’t have done that.” In his letter, he effectively side-stepped any direct admission of guilt:
“I am very sorry you feel this way about your experience.”
“I am sorry if you felt any of these [exams] were done without your consent.”
“We should always ask permission before doing an internal exam, and if this was not done, then again I am very sorry.”
I am aware now that this response was likely edited by a lawyer before being sent to me. This letter does not address the fact that I was raped. It does not describe what I experienced, which was the attempted non-consensual procedure of having my cervix manually opened by my doctor’s fingers. It should have been my right to decide whether I wanted my labour to be induced in this way, but that decision was made for me, by my doctor, without my consent. The genuine remorse I thought I heard over the phone was professionally neutralized in that letter.
As for the nurse, my doctor mentioned in his letter that they would try to find her and “relay my concerns to her”. It has been over 1 month since I filed a complaint with Markham Stouffville Hospital and I’ve heard nothing more from them since receiving the letter from my doctor. It is deeply disturbing to me that patient relations has been made aware of the disrespect I was treated with by a member of their staff and they have chosen to do nothing about it. I am now in the process of filing a complaint with the College of Nurses of Ontario.
In the months that followed my hospital experience, I had never felt less like myself. It was easy to blame my moods and frustration on post-partum depression. You hear about it all the time. The hormonal shifts that come with being pregnant and then not pregnant are expected. People told me it was normal. What I didn't realize right away was that I was also suffering from PTSD. I had been RAPED. I knew that my birth experience was traumatic but I wasn’t able to pinpoint exactly why until I started listening to the stories of other women who went through similar, and often worse, experiences. When I was able to name my trauma for what it was, it was painful, but it triggered a release in me that I am so grateful for. I felt like I had failed at birth, and everything I tried to do in the post-partum period felt like failure too. But knowing exactly what I had suffered through made it easier to forgive myself, because I knew it wasn’t my fault. My dignity had been completely shattered by our obstetric system, and I have been left to put the pieces back together by myself.
I’m sharing this because I wish I had known how much of an impact bedside manner, body autonomy, and informed consent would have on my labour experience. For a first time pregnancy, the list of things to learn and worry about is long enough as it is – “protecting my right to informed consent” shouldn’t have to be on that list. Even with chemical induction, what happened to me was enough to put my body into survival mode and shut down. I was on Pitocin for 20 hours, I was not permitted to sleep due to hourly vitals checks, and I was at the mercy of people who didn’t prioritize my mental health. I don’t blame my body for “failing to progress”. I blame the maternal healthcare system for boxing me into an environment where I felt unsafe.
To all the women reading: know your rights. Ask for the risks and benefits of every procedure that is done to you. You can decline cervix checks, but you won’t hear about this at the hospital. CERVICAL. MANIPULATION. REQUIRES. CONSENT. Without consent, it is rape. If ANYONE on your healthcare team is treating you like a sack of potatoes, tell them to gtfo and find another day-job for your sake, for their sake, and for every mother-to-be who has yet to pass through that hospital. Outside of an explicit medical emergency, being pregnant does not strip you of your right to informed consent. And consent is NOT TRULY CONSENT if it has been coerced out of you.
Submitted by Cielo Almendras
Letter from Markham Stouffville Hospital, submitted by Cielo Almendras