It happened 37 years ago, but I never forgot.
I was on my medical school obstetrics rotation and had just watched the birth of a baby. The mother had sustained a large second degree tear and the obstetrician was repairing it … without anesthetic. It would have been easy to give the mother local anesthesia but the doctor didn’t do it. The mother was screaming in pain yet the doctor was telling her she was “doing great.” There was no reason for the doctor to forgo the anesthetic beyond the fact that he couldn’t be bothered to administer it and wait for it to take effect.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?[/pullquote]
The doctor’s behavior was inexcusable.
That ugly incident came to mind as I read Assault during childbirth increasingly common in Australia says International human rights lawyer:
International human rights lawyer Bashi Hazard says an increasing number of devastated Australian women are likening their experience of childbirth to assault.
For example:
Brisbane mum Hayley Hackenberg, 34, was diagnosed with post-traumatic stress syndrome three months after giving birth to her second child Tobin.
“I was assaulted,” she says, tears filling her eyes. “It made me feel vulnerable and violated.” …
Hackenberg recalls a doctor coming into the room and telling her she was going to do a vaginal examination – in between talking to a midwife about what she was going to have for dinner.
“It really, really hurt, sending pain deep into my stomach. I asked her to stop, I screamed for her to stop, I whispered for her to stop, but she didn’t,” Hackenberg says. “She was looking at the midwife.”
At this point Hackenberg says she told the midwife: “I can’t do this anymore, I want a caesarean”.
She thought about suing the doctor:
She also spoke with a lawyer who said she could press criminal charges for assault but she decided not to.
Lawyer Hazard considers this situation, a patient in serious pain and a provider doing nothing to mitigate or relieve it, to be assault.
Hazard says the numbers affected are significantly higher and increasing but legal action for mental health issues and nervous shock cannot be brought without physical injury and women are often told there is no real injury.
Which raises the question:
What’s the difference between a doctor who performs a painful vaginal exam over a woman’s protests, all the while insisting she is “doing fine” and a midwife who delays or denies an epidural over a woman’s protests, all the while insisting that she is “doing fine.”?
There is no difference.
The practice is shockingly common:
A forum post that asked mothers “anyone else tricked out of epidural?” attracted 1,000 replies in under two weeks…
For example:
When Murphy entered the maternity ward to give birth to her daughter in February 2016, she was told that she couldn’t have an epidural until she was in active labor. When she entered labor, she requested one repeatedly. She never received it…
Months later, she questioned her care at a meeting with the Head of Midwifery at her ward. She was told that the staff had made a clinical decision not to give her the pain relief she requested. They thought she was going to deliver before it took effect.
And:
Danielle … planned to have an epidural. She even included it in her birth plan. Instead, she was refused all pain relief—including gas and air (a.k.a. nitrous oxide, which is widely used in the UK for pain relief during labor).
“Firstly because they told me I wasn’t in labor and to go home half an hour away,” [she] tells Broadly. “Then I was continually told over the phone I still wasn’t in labor [even though] I was in horrendous pain.” When she was finally examined, midwives told her it was too late for an epidural—or even gas and air.
If painful exams and failure to respond to patient entreaties is assault, midwives who delay or deny requested epidurals have also committed assault.
Human rights lawyer Bashi Hazard is correct that assault of women in labor is unacceptable.
Hazard claims hospital staff suffer excessive fear of liability and disciplinary action, so their response is to be more coercive to a mums-to-be as they deliver their babies.
“They no longer perceive the woman as their priority,” Hazard insists. “It is a really toxic workplace environment with everyone ready to point the finger at everyone else.”
In the case from my medical school rotation, the doctor denied the mother local anesthesia for a laceration repair because he didn’t want to be bothered and he believed the woman “didn’t need” pain relief.
When midwives delay or deny epidurals it’s because they don’t want to be bothered and because they believe women “don’t need” pain relief.
If Hazard and other birth activists truly believe that ignoring women’s entreaties about pain is assault, they should call out and even prosecute the midwives who do exactly the same thing.
