Obstetric violence - legs forced open against my will

[NibliaBiblia]

When I was in labour with my daughter, the midwives spent twenty minutes trying to force my legs open to get me flat on my back with my legs up. There was no emergency. It was so they could get a better CTG reading. I physically resisted for as long as I could and verbally told them to stop. They didn't stop until I gave up. After that they did other things without my consent, but I did not they to stop them again.
I complained to the hospital and they have done nothing. I complained to the police and they told me there must have been an emergency. I've complained to the NMC and the CQC. I hope they will do something but it's a long process so I won't know for a long time.
The police used to say that domestic violence was a private matter. They used to say that if you got in the car/went into the apartment/were drinking then you must have agreed to it. I think this is exactly the same type of justification, applied to equally criminal behaviour.
I don't think my experience is abnormal. I think this is fairly routine. They thought that when I gave up that meant I consented.

I hadn’t realised the Dutch medical system had rolled back from home births so much. That’s really interesting.

So much of this seems to be ideological eg the institutional /cultural focus in some maternity teams on the “natural birth” at the expense of medical indicators or maternal preference (as mentioned in the Ockenden Report).

I don't think either "side" has a monopoly on coercion tbh. On the one hand women are not listened to when they say something is wrong and they need intervention, on the other they are railroaded into interventions they wouldn't have consented to.
Be honest about the risks/benefits, give as much information as time allows (which is almost always a lot more than is given) and when a woman makes a decision, accept it!
Even when they don't resort physical force, many times they will just tell you what's happening instead of asking, or use minimising language (just hop up, just have a check, just put a little clip), or just keep "explaining the risks" until they "gain consent", or just ignore your requests. Verbal coercion is also coercion.

At no point have I suggested removing consent.

Are you that patronising and superior in real life? Must be great being so perfect you can dish out that kind of criticism! Or are you not in fact perfect? Something for you to reflect on, perhaps.

I think a lot of people got confused when you said "choices that result in the death of her child".
You meant "you can't neglect your child/not feed them/withhold blood transfusions from then for religious reasons etc". But because of the context it read as "pregnant women should be stopped from doing things that endanger their babies while in the womb i.e. refuse C-sections, not get on their back when told to etc".

OP I’m so sorry for your experiences. Women have been suffering violence at the hands of the medical profession for as long as it’s existed.

I think it’s fantastic that you’ve gone to such lengths to get recognition of your experience, to prevent it happening to other women. I hope you get some closure somehow.

I’ve found this thread very interesting. It’s indicative of really systematic problems that so much of this “care” is carried out by women, who don’t always listen to the women they’re caring for.

Yes, I was querying the point when made more broadly, ie outside the context of birthing, as it clearly doesn’t extend that far.

Your situation and poor treatment is pretty black and white OP, and I didn’t mean to suggest otherwise.

I suppose I got drawn into the theoretical side of the debate, towards thinking about what informed consent or refusal really looks like when women have so many different discourses & ideas acting on them, none of them 100% correct at all times. I suppose I was wary of people celebrating the refusal of treatment as though it was the only type of freedom, when real freedom would be a holistic, non patriarchal medical system that allows for informed choices to be made.

Thank you. It has been helpful, if difficult at times. It was very upsetting when the police wrote back refusing to even record a crime but successfully challenging that, having the crime recorded and classified, and finding out about the section 20 ill treatment offence was very encouraging.
Truthfully even getting the trust's "investigation" where they investigated something completely irrelevant and wouldn't even name my allegation was weirdly validating. It just made it so clear that there's no way they can justify it, because they not only felt they had to pretend it hadn't happened but went so far as to pretend I'd never even said it happened.
For everyone else who has experienced similar i do recommend going to the trust but don't stop there because they'll never stop of their own accord. Go to the police, the CQC, the NMC, the PHSO. Just brace yourself because you will very likely be dismissed, ignored, belittled, blamed.

100% with you on this. Some women choose elective C-section and free birth for the same reason, because they do not feel safe in maternity care. Neither one is a free choice in that instance.
It reminds me of people saying that women should be free to be stay at home mums and not feel pressured to work full time. Yes they should, but choosing between spending very little time during the week with small children or near total lack of financial independence is not a great choice either way.

I think female judgementalism is built into us by patriarchy. We trained to police each other fiercely, keep each other in line. It works brilliantly as a tool to keep us obeisant to men because we're weaker when we're competing and scratching at each other than if we unify.

I personally have always had a strong allegiance with women because I could see how they were routinely humiliated and contained and suffered at the hands of men, and I also experienced that. But even I had to retrain myself, to recognise my kneejerk responses to something a woman did might be internalised misogyny. I've caught myself many times in moments like this.

So unfortunately, I don't think female judgementalism is a rare thing. But I DO think that we can get over it, retrain ourselves out of it. Lewis is right that we should work together to create a welcoming empathetic kind environment for each other and ourselves.

I gave birth in Spain where a lot of hospitals still practise the hideous and antiquated technique of pushing hard on a woman’s stomach when she is in the final stages of labour, supposedly to help get the baby out. I’d been assured the hospital I chose wouldn’t do this and it was written explicitly in my birth plan that it was not to happen.

To my shock the nurse asked me if I wanted her to do it but I was in the middle of a contraction and couldn’t speak. Fortunately (my panicking) DH saw my eyes trying to get his attention wildly and spoke up for me. If he’d not been able to advocate I’m almost sure it would have happened as the labour was really long and the nurses seemed quite impatient.

"Be honest about the risks/benefits, give as much information as time allows (which is almost always a lot more than is given) and when a woman makes a decision, accept it!"

Yes, this is the absolute crux.

And I agree about the minimising language. I had my second two - again by elective CS - in Australia (no argument from my ob because I'd already had a CS). Everyone was simply lovely there and the CSs went as well as the first in Germany. But I REALLY did not enjoy the nurses and staff calling me "Mum".

eg "I'll give him to you now, Mum"

I have a name!

Nor did I like the lactation consultant trying to force a discussion about breastfeeding on me (I intended to pump for a few months and then FF, since this worked well for us with our first). Consultant wanted me to EBF for at least a year. She came to my room twice (i.e. ambushing me lying in my bed). The first time she was really pushy. Then she kept leaving information booklets in my room. ie she must have come in when I was sleeping on 2 other occasions. The second time she came around when I was awake, my H told her to take all her booklets and that we didn't need her help, and she got a really angry face and made a loud comment to a nurse in the hallway about "Some women think they know it all".

There is coercion and disrespect for women built into the entire system of pregnancy, birth, and feeding, it's everywhere (like patriarchy), it's often promulgated by women, and it needs to stop.

Enraging.
"Built in" is exactly right.

It can be hard to strike a balance with giving information while not coercing someone.

I remember being in a room with a labouring woman and the fetail heart was dropping, midwife wanted to do a vaginal examination to see how low the baby was (I was a student). Woman was distressed and said no so midwife rightly didn't do it but said to the woman that she really needed her to consent as she was worried the baby might die.

The woman agreed and then ended up being an emergency section as baby was still high up and heartrate didn't recover.

I went to see the woman on the postnatal ward the next day and she said that she was really cross that the midwife had said that. Which I understand. But the midwife wasn't wrong, it was a possibility at that point. If the midwife had just documented "declined VE" and done nothing else and the baby had died the woman would quite rightly have turned round and said she didn't realise how serious the situation was, etc and that she should have been told.

This thread has made me reframe my birth experience with my DD, only child, 23 years ago. I was 42, got pregnant twice after 40 (I miscarried the first pregnancy), had a trouble-free pregnancy, and a 14-hour induced labour that ended in an episiotomy, ventouse attempt, and successful forceps delivery. Breast-feeding was easy for DD and me, and I recovered quickly from the birth.

The less than good parts of the whole experience were not at all terrible, my DH was a great advocate for me on two occasions (the first when I was on the ward in the bath having contractions and throwing up and he negotiated hard for me to go to the labour ward, the second when they wanted to send me home the day after the birth when the community midwife had said I should stay in hospital for three days to get breastfeeding established as I had no family around me).

I am quite assertive myself so had no difficulty responding firmly when my first epidural didn't work and the (female) anaesthetist patronised me (anaesthetist: 'Well we do find that some women like to have every method of pain relief available' me: 'you are an anaesthetist, I am a patient; you have administered an epidural and I am still in pain so I have asked you, via the midwife, to come back; this is not about me being some kind of hysteric desparate for any attention I can get'), or when I was offered a second and third Anti D injection (see previous post up thread), or when a wheelchair arrived to take me to the labour ward (I was perfectly capable of walking).

Now, I can see that while none of this was traumatic in the least, it was sub optimal. I didn't want to be induced because it makes Labour more difficult and there were signs on the morning of my induction that labour was very close to starting, but induction was presented as a fait accompli by the consultant. There was certainly no discussion. On the ward, I was left to my own devices. Had my DH not been there, would I have had to drag my vomiting self, wrapped in a towel, from the bathroom to the nurse's station to say I was having contractions? I was not asked if I wanted to go to the labour ward in a wheel chair. That too was presented as a fair accompli.

In summary, my choices were not always discussed, I was not always listened to respectfully, and there were some process errors that could have led to harm. What all this shows is that our expectations as women are quite low, and that far more needs to be done, in my opinion, to help women understand before they give birth in a hospital what good care looks like, what they should expect and how to advocate for themselves.

There definitely are situations where there's some nuance and women might be cross about a midwife doing her best. But I bet that woman didn't make a formal complaint.
Out of all the women who have shared horrific experiences on this thread, how many so you think have formally complained? Even fewer will have escalated beyond PALS/the trust.
I think this is massively under-reported, not over-reported.

Were they doing it in the best interests of the baby.

why would you not comply with the midwife who is trained to facilitate a safe birth?

It doesn’t matter

Even if you think a particular course of action is inadvisable women in labour have agency and bodily autonomy and the right to refuse consent to any medical treatment or procedure, same as anyone else.

Information can be coercive I suppose! I had a high-intervention birth when I wanted low-intervention, and I still think about everything that happened sometimes.

I was sent to hospital at 41 weeks with a bleed, and they recommended staying in and being induced. I declined.

They raised their eyebrows and brought a couple more people in, who explained that they didn’t know the reason for the bleed, and if I went home they may not be able to save the baby if something happened.

I was so upset. I had imagined labouring at home to begin with, in relative comfort. I was free to leave the hospital, but who could calmly go home when you’d be taking a risk with your baby’s life?

Like the case you describe, I was upset at the time, but afterwards I was grateful for the straight talking.

I had a failed induction, and ended up with an emergency c section 48 hours later after I got an infection and baby was in distress. It was the opposite of what I wanted! But the staff were attentive and kind to me, and I came away with a healthy baby. Every procedure was explained to me fully; all my questions were answered.

I think the NHS is high intervention, low risk: they like very much to be in control, and if there’s the slightest sniff of anything potentially risky, they are all about getting the baby out with everything they have at their disposal. That power and control in the wrong hands, or even just the hands of staff who are having a bad day, can be pretty devastating for some women.

Nobody in that room has better interests in the baby than the mother. We really need to stop minimising poor care with this statement.

Obstetrics is one of the most litigious areas of medicine. Sadly that means that there are often very heavy handed responses to any risks.

Even if it was an emergency, @Keepgettingolder81, there was still no justification for the midwives forcing @NibliaBiblia onto her back and into stirrups. Instead of wrestling with her for 20+ minutes, they could have calmed down, allowed her to relax for a moment, then explained why they needed her to lie on her back. Gaining informed consent is infinitely preferable to using violence on a patient.

And if you have read all of her posts, you’ll see that there was no emergency - the ctg trace wasn’t showing any issues, it was simply not maintaining contact with the baby. When they got the trace, there was no problem with what it showed - so there was no emergency to ‘justify’ what was done to her.

I can understand that. I feel under pressure to get the right results at work, and my job isn’t a matter of life or death!

The medical profession is all about “care”, but I feel you could also only survive in those jobs if you become desensitised to it all, to some degree. And while birth is a unique experience for most women, it’s totally run of the mill to the staff.

Practical considerations must impact things sometimes too. I looked around the empty ward on the day I was encouraged to stay in and thought, yeah no wonder you want one out of the way during the lull! :D

The thing is it only goes one way.
There's a saying in the States that you never get sued for the C-section you perform, only for the one you don't perform.
If there are consequences for not cutting women open when you've missed a problem, but no consequences for cutting them open unnecessarily, there will be a lot of women who have had unnecessary surgery.

Well that's a silly saying because you most certainly do. At the moment, there is major controversy because they took a woman to court to force a c section while she was in labour.

You have to be able to justify your recommendation with evidence based practice.