Many health care providers today assert that the hospital is the safest place for women to give birth. Even low-risk women should have their babies in the hospital, the argument goes, because then you have a “safety net” in case things go wrong quickly.
I have been in practice long enough to have experienced things going wrong quickly. I am not here to argue that there will never be bad outcomes with home birth, or that the hospital is an evil place that every pregnant woman should fear. I simply want to share that what often goes on behind the closed doors of a labor unit is typically not known to the general public. If it were, they might well form a different opinion of the risks and benefits of hospital birth.
Before I proceed with these stories, I want to emphasize that NONE of these incidents occured at the hospital in which I currently have privileges.
“Do You Want Your Vagina To Be Like a Paper Bag?”
Dr. A was well known for his highly interventive obstetrics. He was in a group practice with several other popular OBs, and had a friendly bedside manner, so had no problem getting patients despite his obstetric practices.
Anna (not her real name) arrived at the hospital in active labor, at about 4 centimeters dilation, having her fourth baby. She shared with me her desire to avoid an episiotomy. We discussed things she could do to avoid both an episiotomy and a tear. Shortly after that, Dr. A came in to examine her. When Anna expressed her wish not to be cut, he sharply retorted, “You’re to small to give birth without an episiotomy! The baby would never be able to get out!” Dr. A told me that Anna was 6 centimeters dilated, and that he would be available on his pager when she was ready to deliver.
I was a little surprised that he was leaving the hospital with a fourth-timer at 6 centimeters, but told him I would page him once she was getting close to delivery. A very short time later, Anna told me she felt like she needed to push. She was completely dilated, so I quickly paged Dr. A to return to the hospital, and prepared her for birth. It soon became apparent that Anna would have her baby before Dr. A could arrive. I supported her perineum and coached her with gently breathing her baby out. We were both delighted that she was able to push her baby out without any episiotomy or tears!
It was some time before Dr. A arrived, but when he walked into the birthing room, Anna smiled and said, “Dr. A! I had the baby without any tears!” He didn’t look too happy at this announcement, and proceeded to examine her. He reluctantly agreed that there were no tears, but then injected lidocaine into her perineum and cut a generous episiotomy. As he pulled the placenta out, he told Anna, “I had to cut an episiotomy for the placenta, otherwise it would not have come out because it is so big.” Anna objected, pointing out that the baby was bigger than the placenta.
Dr. A angrily retorted, “If I didn’t do this, it would ruin your sex life! Your husband would feel like he was having sex with an old paper bag! Do you want your vagina to be like a paper bag?
Unfortunately, the belief that episiotomy is beneficial to a woman’s sex life or to her pelvic floor integrity is still prevalent among many OBs, despite evidence to the contrary. Many women will ask their providers not to cut them, and many providers will reply that they only cut episiotomies if absolutely necessary. This requires a level of trust in the provider’s judgement; the woman should also inquire what percentage of women require “absolutely necessary) episiotomies. The episiotomy rate should be very low; authors of a JAMA study recommend no higher than 15%. ¹ Most midwives’ episiotomy rates are significantly lower than this. According to the Listening to Mothers survey, approximately 35% of women are still recieving routine episiotomies.
Women are in a vulnerable position if their provider tells them an episiotomy is necessary. The best prevention for unnecessary episiotomies is choosing a provider who believes in normal birth and understands techniques for minimizing lacerations and/or need for an episiotomy. These include:
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Physiologic pushing (the mother pushes when and how much she feels the urge to, rather than being coached in how long and hard to push)
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Slow, controlled birth of the head (no commands to “Push through the pain! Push the hurt out!”)
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Use of lubricant on the perineum at time of birth
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Optimal positioning for pushing–upright or side-lying positions are ideal.
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Warm compresses have not been shown to decrease lacerations, but may help the mother relax more if she finds them soothing.
1. Hartmann K, Viswanathan M, Palmieri R, Gertlehner G, Thorp J, Lohr KN. Outcomes of routine episiotomy: a systematic review.JAMA 2005;293:2141-8.
I couldnt believe what I was reading when you wrote that the doctor did an episiotomy to deliver the placenta. I am truely shocked and quite frankly outraged on the womans behalf.
Absolutely. Unfortunately, she believed the physician and was grateful for his help.
OMG, I would be suing the daylights out of that doctor. The reason these med-pros behave this way is because people only sue when something goes terribly wrong. They don’t sue to assert their rights to informed consent, and what that doctor did was flat out against the law. It’s rape by instrumentation, and constitutes criminal battery.
I’m truly sick to my stomach right now.
I agree that this doctor should have been sued. However, unless the women who give birth in hospitals educate themselves, they don’t even know when something inappropriate is being done to them. They are deceived by the provider’s sensitive bedside manner (sometimes) or by his/her explanations of why something is necessary, because “the most important thing is a healthy baby”. Unless women take the responsibility to educate themselves about normal birth, they will continue to be mistreated and not even know it.
I am shocked!!! I cannot believe that doctor raped her with a blade!!! She should sue the pants off that guy, JUST to assert her rights. Unfortunately way too many patients go into everything like lambs to the slaughter, without reading up on their patient rights, what is actually law & what is considered ’suggested’ by the medical staff, personnel, & hospital. U HAVE RIGHTS…assert them, BE INFORMED!!!! If U R pg & know u must, maybe bc of insurance or whatever, deliver at a hospital or even a so-called birthing center, start reading NOW, call ahead & talk to the HR person there. Find out what you are mandated to do as law requires, which actually isn’t much, & what is just medically suggested.
I couldn’t believe I was reading that!! That makes me so sick he cut the episiotomy anyway just because he says she needed one, having had the baby already or not. That’s just sick.
It is unbelievable, and I would never believe it if I hadn’t seen it with my own eyes. Most women don’t realize what goes on in hospitals and is defended as “necessary”. They completely believe that whatever happened to them was essential to their wellbeing.
I am speechless…
Oh my! please submit this to the website myobsaidwhat.com. This has got to be one of the most hurtful things! I ache for that mama!
Lawsuit? I’d say *criminal prosecution* and he needs his medical license taken away.
Note to self (newly moved to USA from abroad): definitely have an unassisted birth at home next time, if this kind of thing happens in US hospitals without the obstetrician getting struck off and prosecuted criminally.
I cried reading this. Because I can believe it.
It takes my breath away that this doctor needs to be right at the expense of his patient’s physical integrity.
A woman has a right to bodily integrity and to refuse any procedure, even during labor. I agree with Sarah- criminal prosecution for assault.
I wish it were so simple. Women often just accept what their beloved obstetrician tells them, and never realize that they have been abused. It is difficult to sue successfully for something like this, where there is no damaged baby, because doctors protect each other and won’t often speak up against this sort of practice.
oh. my.
Even though I know–it still stops me to hear these stories every time. What a blatant lack of respect.
ugh.
What shocks me perhaps the most is that he actually thought she’d buy the “placenta is SO big” bs. My god, do these people think we are stupid?!?!!
Yes, these people do think we are stupid. It seems like there are three classes of human beings: Men, women and mothers. When a woman makes the decision to become a mother, she is no longer treated with as much respect and dignity as she was when she was a woman.
Surely this couldn’t be true? Did you really see this? How could this have been allowed to happen.
I gasped aloud when reading. This is outright sexual assualt.
I wish it were not true. I did see this with my own eyes, as I was in the room when it happened. I know for a fact that nothing was done about the complaints we made regarding this physician.
What a shocking story. I agree, with the above comments that this ‘physician’ should not be allowed to practice. I’m always amazed to hear these horrible stories…I have been fortunate in that I have not seen woman subjected to this level of blatant disrespect. I have seen many things in the 6 years I have been a L&D nurse then a CNM. I am thankful to work in a wonderful practice with docs that are great, and supportive of what we midwives do.
I really believe that these issues go far deeper than childbirth…but are more about gender discrimination.
Reading this story just made me feel like I was going to die–I had to scoop my jaw up off the floor. And here I’ve been ticked because I’m pretty sure that the OB who attended my daughter’s birth sewed me up too tight–and that was after a tear, not a cut. Ha. I should just be thankful she didn’t cut me up even more before sewing me back together.
How can you justify not reporting this CRIME to the police? don’t blame the Mother, that is just as disgusting as blaming any other Sexual Assault victim. She did NOT consent to being attacked, no person can or would EVER consent to this willful hate-based ATTACK! Take responsibility as a medical professional and report this MONSTER now!
I did report him, but as is often the case, the investigation was dropped. Whether this was because the mother did not wish to pursue it or did not understand fully the implications of his actions, or the “good old boy network” prevented him from censure/prosecution, I do not know. That information was not shared with the nursing staff. I did not intend to imply that this was in any way the mother’s fault, as she certainly was the victim.