Nurse opinions on "Birth Rape"

[EKUGRAD]

I ran across this writing on a site called, "Birth Trauma Truths" and wonder what my fellow nurses think and/or feel about it. Me: Mother was Army Cadet RN, put me to work on the county hospital L & D when I was 13 years old. I have now been a Registered Nurse in all areas for over 42 years. Even with precips I always made a point to drape Mom and explain everything everybody was doing. I once solo delivered a babe in the floor of the hallway outside ICU, while a code was going on inside! I had never heard of Birth Rape but apparently it has been around on midwife's sites for quite some time. Weigh in and discuss, discuss.

FROM BIRTH TRAUMA TRUTHS -

A vulnerable woman, who is powerless to leave the situation, is at times held down against her will, has strangers looking & touching at private parts of her body, perhaps without appropriate measures being taken to acknowledge her ownership of her body or to preserve her comfort levels. Perhaps she has fingers or instruments inserted without her consent, and sometimes against her consent, invading and crossing decent boundaries. She is fearful of what is happening to her and perhaps for the wellbeing of her baby, and receives no reassurance that either she or her child are ok. That is a violation, no matter how you look at it. Even IF this treatment is given with no malice and the intent of attempting to assist her with birthing her child, there is NEVER a reason to forgo common decencies that will enable her to maintain a role in the birth, some autonomy over her body, to be involved in the decision-making, to be informed about what they want to do BEFORE they do it.

[taracnm]

I'm sorry this was your experience. It should NEVER happen, and we cannot solve a problem we don't identify. Thank you for sharing.

[taracnm]

It is not about the outcome, but the lack of consent

All rapes are assault, but not all assaults are rape. Is a lady partsl sling or abortion with severe complications a rape just because it involves the reproductive system? Is any bad outcome on a woman rape?

[taracnm]

What I've been told is that when patients are irrational, then they no longer fall into this category where they have a right to refuse. "You can't reason with someone who is irrational." A patient who is screaming, "No," when her midwife or doctor goes to cut an episiotomy might be thankful when she finds her frightening and exhasting labor is suddenly over with and she and the baby are safe. Of course there are grey areas even with irrational patients.

Irrational is not the same as unable to give consent. I don't care if you think it is the best thing for her, or if you think she will be "thankful", it is her right to decline. I don't know of a single person who has EVER thanked someone for a forced episiotomy. Even if there is a medical emergency, there is time for consent.

[taracnm]

Perhaps the issue is less about calling it birth rape diminishing women who have been victims of sexual assault, but rather, NOT calling it birth rape diminishes the women who have experienced it, when all they hear is "but what's important is a healthy mom and healthy baby." That attitude suggests that the ends justifies the means, and completely invalidates the very real experience of pain, fear and utter powerlessness of women who have experienced it. And in my experience, the very women who feel traumatized by being physically assaulted during the birth process are women who HAVE been sexually assaulted at some point earlier in their life. For that very reason, being assaulted during labor is incredibly triggering for them.

So I would submit that not allowing them to call it what it feels like, which is rape, is incredibly invalidating.

I was going to say exactly this.

[offlabel]

Yes, this is a real thing. As a CNM and former labor nurse, I can tell you that it goes beyond just "informing" a birthing woman what is going on. You must get informed consent. Think of that in the context of a "traditional" tape scenario...would being "informed" by the rapist make penetration okay? Of course not. The woman must be asked permission and have control over her own body. No one should touch a birthing woman without asking her permission, informing her on the perceived need for the touch or intervention, and the possible risks and benefits. THIS is informed consent, and does not change, simply because a baby is involved.

So you're not making a distinction between an individual that is meaning to do harm (rapist) and one that is obliged to act in the patient's best interest (heath care provider)? What if consent is retracted after the fact because it was under duress? What if there is an injury to the baby as a result of a refusal of an instrument assisted delivery and the provider is held liable?

Is the informed consent that covers all of the possible means of delivery that is signed at the intake/triage desk on admission revokable? Because that is where informed consent is official.

And is there any obligation to the baby? Does the child have no right to a safe delivery if the mother makes a decision that is contrary to one? If there is an injury to the baby, who then is responsible?

[taracnm]

So you're not making a distinction between an individual that is meaning to do harm (rapist) and one that is obliged to act in the patient's best interest (heath care provider)? What if consent is retracted after the fact because it was under duress? What if there is an injury to the baby as a result of a refusal of an instrument assisted delivery and the provider is held liable?

Is the informed consent that covers all of the possible means of delivery that is signed at the intake/triage desk on admission revokable? Because that is where informed consent is official.

And is there any obligation to the baby? Does the child have no right to a safe delivery if the mother makes a decision that is contrary to one? If there is an injury to the baby, who then is responsible?

Logically, there is a distinction, but to the woman who feels violated, I believe the perception of harm is the same. In some respects, I believe that the woman feels that the offense is that much greater because she feels she SHOULD be able to trust and feel safe, but then experiences a betrayal of that trust. Trust is such a huge part of this, and part of the process of informed consent is to ensure that a woman does not feel she is being made to make a decision and give consent under duress. This starts with building a relationship with the woman before the potential emergency. Injury to baby is, unfortunately, one potential outcome, as a woman has the right to decline intervention. We cannot abuse a woman in the name of saving her baby. However, I believe all women really are trying to do what they believe is in the best interest of both themselves and their baby. This, again, is why trust is so important. A woman is more likely to sue a provider they don't trust, or who they feel violated them. If a patient refuses an intervention, it is up to the healthcare team to document the refusal, steps taken to gain consent, etc. to protect themselves from litigation. Although there is a blanket consent signed on admission, it does not explicitly cover all procedures, it is more of a consent to provide care, unless stated otherwise. A patient can revoke consent and decline care at any time. It does not give us license to do whatever we want. If individual procedures are covered in this consent, then it needs to be covered, in full, between the patient and provider. There is, of course, an ethical obligation to the baby, but not a legal one, as most states do not recognize the unborn as people, and the mother is the legal decision maker for the baby unless this is revoked by court order. Again, having the mother's trust allows her to make appropriate decisions based on informed guidance. When a provider betrays this trust, then poor decisions and poor outcomes are even more likely, in my opinion.

[offlabel]

Logically, there is a distinction, but to the woman who feels violated, I believe the perception of harm is the same. In some respects, I believe that the woman feels that the offense is that much greater because she feels she SHOULD be able to trust and feel safe, but then experiences a betrayal of that trust. Trust is such a huge part of this, and part of the process of informed consent is to ensure that a woman does not feel she is being made to make a decision and give consent under duress. This starts with building a relationship with the woman before the potential emergency. Injury to baby is, unfortunately, one potential outcome, as a woman has the right to decline intervention. We cannot abuse a woman in the name of saving her baby. However, I believe all women really are trying to do what they believe is in the best interest of both themselves and their baby. This, again, is why trust is so important. A woman is more likely to sue a provider they don't trust, or who they feel violated them. If a patient refuses an intervention, it is up to the healthcare team to document the refusal, steps taken to gain consent, etc. to protect themselves from litigation. Although there is a blanket consent signed on admission, it does not explicitly cover all procedures, it is more of a consent to provide care, unless stated otherwise. A patient can revoke consent and decline care at any time. It does not give us license to do whatever we want. If individual procedures are covered in this consent, then it needs to be covered, in full, between the patient and provider. There is, of course, an ethical obligation to the baby, but not a legal one, as most states do not recognize the unborn as people, and the mother is the legal decision maker for the baby unless this is revoked by court order. Again, having the mother's trust allows her to make appropriate decisions based on informed guidance. When a provider betrays this trust, then poor decisions and poor outcomes are even more likely, in my opinion.

That was too long to read all of it...so I didn't...but reckless malpractice and criminal negligence isn't made more egregious by re-lableing them "rape". In fact they are reduced because of the more sensational and emotional language of the more inflammatory term. But knock yourself out...not everything has to meet some progressive, outraged narrative...what you describe is beyond the pale (that is, wrong)...but the terms have already been defined and if you insist on hysterical emotion, you'll be dismissed out of hand. Good luck.