Why is consent still an issue in the birthroom?
I've had three whole sleeps since the birth and finally the tears come. I didn't think there would be any after this one, because it was such a beautiful and gentle experience, with respectful care and support, and I've been riding high ever since, floating on cloud 9. Sleepy and grateful and oh so happy for the couple, but not in the least tearful.
The tears were not triggered by the birth but by a post on instagram. Initially I thought the title shocking. Sensational. I had fingers poised, ready to write "steady on, that's a bit harsh!" It was a post by Kemi Johnson, where she used a phrase I felt was possibly a little dramatic and unfair: Knobstetricians.
And then I read the post properly. The story was of a woman sitting in an obstetricians office, being told by him that he must insert his fingers into her vagina because she was only 1-2cms dilated and believing she could not refuse, he roughly put his fingers into her cervix, and performed a stretch, causing her to bleed afterwards. The comments that followed had more examples of similar stories. I felt sick.
It's not that I haven't read similar stories before, or witnessed the bullying of a client by an obstetrician. One has been under investigation after treating my client and others with impunity. Another clung to her version of events much to the astonishment of a party of four of us who saw how things really went down, and how little regard there was for the mother concerned.
Even as a campaigner for Birthplace Matters, there were stories of obstetricians and midwives not listening to mothers concerns, not being open to hearing their deepest instincts. Yet I still couldn't bring myself to call anyone a knobstetrician.
But this morning, as the sun shines and I sit writing this, I feel that such a word is accurate for at least some of this particular breed of health professional. Adam Kay demonstrated how cavalier jaded professionals can become, while they sleepwalk through shifts and process vast numbers of women like cattle on a conveyor belt. Compassion can wear thin when you're 14 hours into a shift. Kemi is not wrong to use such a term. As uncomfortable as it might make us.
In spite of knowing the work conditions can be terrible within the NHS, it's important we don't let our compassion for that be a carte blanche for work practices that amount to what can only be called birth rape. We must not let people off the hook who commit regular assault in their workplace as a way of life. No matter how exhausted they are. No matter how underpaid and overworked.
Assault of women in the birthroom is not justifiable. Women matter. Their babies matter. Babies are of course precious, innocent, tiny and vulnerable. Their safety and wellbeing matter.
We must get perspective however. Women are not simply packaging for a baby. Obstetricians cannot tear off the wrapper to get to the prize inside.
How have we reached a point where women matter so little to some professionals that they really are sometimes simply seen as packaging? As disposable? As passive? That their thoughts, voice, concerns and experiences are irrelevant?
There's a particular form of patriarchy and matriarchy that are to blame for this phenomenon, where women are viewed as sacrificial to the greater cause of getting at their perfect baby. And woe betide her if SHE is seen as the obstruction to that. We've all heard at least one health professional try to manipulate a mother down a particular pathway with the chilling words " You don't want your baby to die, do you?
Packaged as concern for the baby, abuses occur that demonstrate a fundamental lack of respect for adult human women and their sanctity and rights. It makes me wonder if we are we still seeing babies through the lens of sexism, religious prejudice and the patriarchy of our ancestors. Babies certainly don't have the same baggage as adult women - being more highly prized than corruptible, messy, complicated adult women. They hold the key to our future having yet been untarnished. They are innocent. Blameless. New. But should this mean they trump any and all considerations of respect and value in the motherbaby dynamic? Is this what it all really boils down to? That Eve was a sinner, and like all women after her, corrupt? Tainted? Does her baby subconsciously represent a chance for the human race to start over and get things right? Is that why babies matter more than mothers in the birthroom? Is this why religious people are so angry about abortion?
Why else could women be treated so disdainfully by a few rotten bullies?
The power dynamics in the birthroom could not be spelled out more obviously. MATRON is the very definition of a female boss mother. An authority figure in a position where the arts of persuasion might include intimidation as a tactic to use to get naughty, errant women (treated like girls in some instances) to get them to comply and bend to the will of those that know better and won't (in their eyes) selfishly hijack the babys safety?
Is it not also true that some male obstetricians hold paternalistic ideas about their role? When they ask husbands to talk sense into their wives, are we not seeing a historical reenactment of a power dynamic as old as time? Who were the first male doctors? White, middle/upper class men in an era that reflected their dominion back at them at every turn. In a society built upon values that centred their knowledge as the only authority worth deferring to, and which has continued to push indigenous and female intuitive knowledge to the fringes, trashing it at every turn in favour of a very particular brand of science that just happens to sit nicely within a capitalist model.
Women's knowledge doesn't need to be respected in this model. Their bodies don't need to be respected. Consent is an ideal not a fundamental right. Women's feelings don't need to be considered in the birthroom because feelings are not scientific. They are a weakness. A distraction. A dangerous diversion from the real work and machinations of birth.
Isn't this the nub of it?
Is this why a woman's body is treated so mechanistically? In this busy modern era of mass production, robotics and standardisation, is it any wonder we've reached a point where we treat women like products?
In the same way that a factory production line 'weeds out' or rejects wonky veg, women (and their babies) who don't fit the definition of standard are being found to be defective and high risk and treated as faulty. Their birth options seem to shrink.
But women are not wonky carrots. They are not subnormal if they don't fit neatly into the definitions and categorisation of the factory floor. Women are real. Flesh and blood. Unusual shapes. Sizes. Ripe and ready at different times. Organic. But the comparisons to carrots must stop there. Women don't want to be chopped just because they don't fit some imaginary charts of perfect size and shape and readiness.
So how do we cure hospitals of knobstetricians? Of matrons and patrons and all that old hierarchical nonsense?
A start would be to force all practitioners to go on training days learning about what true consent really means. Make sexual abuse/violence awareness training mandatory so obstetricians can become more aware of what might be triggering for women. Make it mandatory for all obstetricians to have to sit in (silently) on some normal physiological births so they also see what supports/ hinders them. Help obstetricians to see women as more than wrappers, more than packaging, more than dumb vessels. Mandate obstetricians to have to attend biodynamics study days so they know all the ways to support midwives and women to AVOID caesareans as much as how to perform them.
Let's make knobstetricians a thing of the past. A blip in history, before we arrived at a gentler, more compassionate age. This in turn will have the effect that we all want - safer (and more satisfying) births for babies and mothers, with ripple effects that make the birth world kinder and gentler for all.
Women remember HOW they are treated as vividly after their birth as any other event that happens to them upon a life altering threshold. Ask any old woman about her birth and she will tell her story as clearly as if it was yesterday.
It matters how we treat them. Who knows what they've already suffered? Who knows how your actions will stay with them?
Go gently. It costs, literally nothing. First, and to your last, do no harm. Not only to babies.
Women matter too.