"Birth rape" is a viscerally shocking term that has made its debut online within the last few decades, and has been discussed by parenting bloggers and journalists in quite a lot of detail but remained controversial. If you have never heard the term before, it's probably not what you think it is. The term "birth rape" is, after all, not used to describe coerced sexual intercourse during labor.
What Is Birth Rape?
To understand what birth rape means, we'd first have to look at the meaning of the word "rape" without the modifier "birth". While rape most often refers to coerced sexual intercourse, rape is a crime that is usually motivated by the perpetrator's quest to have total control over the victim. It is more about power than about sex, and we'd generally agree that a crime can still be termed "rape" if the perpetrator used a bottle or some other instrument, rather than his penis, to violate the victim.
Birth rape can be defined as coerced genital contact during the process of labor and birth that makes the laboring woman feel violated. As medical professionals are those who assist the laboring woman, birth rape is usually said to be perpetrated by doctors, nurses, and sometimes midwives.
As far as I can see, the term first appeared online in 2005. Since then, it has become a hot-button issue that has been discussed over and over again by journalists, bloggers including medical professionals, and women participating on online message boards where pregnant women and new mothers congregate. The experiences of those who apply the term to an event they personally underwent vary widely, but all were treated disrespectfully by a healthcare provider.
Women who feel the term "birth rape" applies to them may have had their membranes stripped, their water broken, their cervical dilation checked, an episiotomy (vaginal cut) carried out, or have had their placentae recovered from the uterus manually after giving birth, without their consent or despite their adament refusal and cries to make it stop. Sometimes, they are physically restrained while this happens and sometimes, they beg their healthcare provider to stop. Is it rape, though?
The idea that rape is more about power than about sex is widely accepted as true, yet rape does have a sexual component. Is that component missing in these situations?
One Face Of Birth Rape
Dana is a highly educated professional who spent the last months of her pregnancy reading everything she could about birth. By the time she got to hospital, she knew she didn't want to have an episiotomy unless a very specific situation in which it would truly be warranted arose. She told her OBGYN she would prefer to tear naturally, and got a sneering reply — "And you're a doctor, are you?"
As her labor progressed, she started to do what most women in labor do: scream. That's when her nightmare really kicked off.
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He kept his word. Dana required surgery to fix the scarring afterwards, but before that she went through a year of pain. She could not sit without pain, had no sexual intercourse because trying hurt too much, and suffered from urinary incontinence. Terrible, yes?
Dana happens to live in a developing country where patient rights are not a priority. The doctor still practices. You'll have to agree that what happened to her is a crime, but also that it has a sexual component and that the doctor wanted total control over her. The situation really isn't that different to rape, both in terms of how Dana felt, and in the fact that the doctor who did it violated her most intimate parts.
Birth Rape And Informed Consent
Is "Rape" Really The Right Word?
Dana's story illustrates birth rape perfectly. The act the doctor committed damaged her genitals, and his words show he was motivated by a desire to hold power over his victim. The promise she would not be able to have sexual intercourse afterwards also shows a sexual component.
Other cases are less clear-cut. What about medical procedures the healthcare provider genuinely believes to be necessary in order to save the baby, but to which the patient will not consent? What about being bullied or forced into unwanted epidurals or the augmentation of labor with Pitocin, or a c-section? These acts do not involve the woman's genitals, yet some describe exactly these things as "birth rape".
Perhaps the problem with birth rape is that it's not a legally recognized term, and there is no clear definition as to what constitutes birth rape.
There are certainly other words that might apply in some cases. Medical malpractice and assault or battery come to mind. There is no doubt in my mind that birth rape is an appropriate term in certain situations, but I also think we need a clear definition.
Some argue that the very term "birth rape" belittles what "actual rape" victims go through. As an actual rape victim, I can say that I believe the term is perfectly acceptable in cases where the victim is sexually violated during labor and birth and calling it something else would belittle the birth rape victim's experience.
Looking at Dana's story, we can be almost certain that the perpetrator would be in prison if he had committed the crime on the street. Why should the fact that the woman was in labor at the time and the perp wore a lab coat exempt him from punishment?
Cases in which a healthcare provider carries out medical procedures that involve a pregnant woman's genitals against her will also show something disturbing.
We should remember that the healthcare provider has two patients — the mother and the baby — but also that pregnant women don't suddenly lose their minds when they conceive.
They have the same right to informed consent as any other patient. Acting without consent outside of an immediate emergency violates those rights, and it might be sexist even if it's not sexual. It should not be acceptable.
Informed Consent And Choosing Your Healthcare Provider
Patient rights vary from jurisdiction to jurisdiction. In many places, women who are admitted to a hospital in labor will be asked to sign a general consent form. Informed consent means that patients have a right to information about medical procedures they will undergo, and that they should give their permission before the procedures are carried out.
During a routine labor and birth, there will be numerous small medical interventions like blood pressure checks, electronic fetal monitoring, cervical checks, and perhaps the administration of IV medications or epidural anesthesia.
There will not be a separate consent form for every little procedure, but and everything your healthcare team does will generally be covered by the consent form you signed at the beginning.
That does not mean you can't say you want more information about a certain procedure or that you do not consent to an intervention. You generally have the right to do so, unless there is an immediate, life-threatening emergency that does not allow time for these things. How will your healthcare provider or the staff of your hospital react to your requests? Much of the time, that depends on the hospital's policy as well as the attitude of individual providers.
Pregnant women and their partners will have the chance to look into both of these things before labor starts, though they may not be seen by the OBGYN they saw for their prenatal care when they give birth.
Touring your hospital prior to labor and birth, meeting any person who might attend your labor in advance, and figuring out how open a hospital is to the active participation of patients in their own care can give you valuable information.
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Most healthcare providers will be respectful of their patients, though bound by hospital policy and liability concerns. Those patients who encounter acts they believe to be criminal usually have the possibility to take action against a doctor, midwife, or nurse either through the hospital or the court system.
Finally, it might be time for healthcare providers to remember that women in labor are at their most vulnerable and that this is at least in part due to the fact that giving birth involves sex organs. Perhaps doctors, nurses and midwives working in obstetrics need additional training to help them understand how intimate and sensitive labor and birth is to women. This could, maybe, prevent some of the situations in which women feel so violated they use the term "birth rape".
- Photo courtesy of Mamma Loves by Flickr : www.flickr.com/photos/mammaloves/4153340169/
- Photo courtesy of Bradley Gordon by Flickr : www.flickr.com/photos/icanchangethisright/6019730837/