CRIM: 3425 Final Project

Sexual Trauma Within Birthing Practices

Hannah Williamsen CRIM: 3425

Birth Trauma

Birth trauma refers to the distressing experiences that a woman may encounter during childbirth, which can have lasting psychological and emotional effects. This trauma can come from various factors, including complications during labor and delivery, unconsensual medical interventions, feelings of powerlessness or loss of control, and perceptions of a lack of support from family, friends, and healthcare providers.

Forms of Birth Trauma

And what they might look like to birthing mothers.

Emotional

Physical

Sexual

Social

Unsupportive or negative experiences had by the mother with friends, family, etc. This could be a husband holding down the mother or a friend dismissing their emotions.

Physical harm expierenced by the mother due to unexpected situations or unneccesary birthing practices. This could look like a tear, prolapse, internal cut, fracture, etc.

When a form of non-consensual or inappropriate behavior or procedure is done to the mother. This could look like unwanted pelvic exams, or comments about 'spreading her legs'. made by a professional.

Any harm that can cause distressing emotions and reactions. These can have long term negative impacts on a womans' well-being. These could be flash backs, being told not to make noise, shame, etc.

"She was crying out of fear of the [vaginal] exam, [because it] was being done by a male (very difficult for most Muslim women)…. Dr. tells her that if she is that scared and tense already, she'll never get the baby out naturally…. With each subsequent exam he would then…condescendingly comment on how much “better” she was doing with her vaginal tension. (Doula S, personal communication, October 16, 2005)"

Goer H. 2010

Identities

Being a Muslim woman is one of the many identities that a birthing mother could have that would contribute to her experience. Others might include race, socioeconomic status, sexual orientation and ability. Kimberlé Crenshaw talks about these identities as well as power dyanmics which are often at play in birthing scenarios. Power imbalances can easily manifest in a labor and delivery room with a mother in a vulnerable situation.

Author Britton et al. (2018) touches on a theoretical break down of sexual assault and coerced obstetrics practices by identifying hospitals as gendered orginizations. He breaks the occupational gendering down to three levels:

Morris et al., n.d.

"I specifically said that I did not want to be catheterized. And they forced me ... the nurse had my husband lay over my body and hold me down and the whole time that they’re doing this, I was like crying and cussing them out, like telling her, ‘Fuck you! Get the fuck off of me!’ Like, screaming, ‘No! No!’ It was literally like being raped. It was horrific ... And I have been raped before, and I didn’t mind being raped as much as I minded that. Like that is more traumatic to me than having been raped as a 14-year-old.” -Kelly

Morris et al., n.d.

The nurse insisting on a catheter is evidence of both gendered structure (the protocol) and gendered culture (the power of the nurse to direct care).

Kellys situation is unfortunately not unique. Kelly’s experience makes evident the three layers of gendered organizations within birthing scenarios.

Gendered agency is evident by the nurse and husband physically forcing Kelly to lie down for the catheter when she was resisting and had stated previosuly she was against catheterization

One could argue that Kelly is being 'punished' for not appropriately performing her gendered role of being a nice girl and complying.

Sexual Assault vs. Birth Trauma Responses

Comparing overlapping themes between sexual assault survivor aftermath and traumatic birth aftermath and the similarities in coping mechanisms.

Sexual Assault

Traumatic Birth

Self objection & reduced self esteem

Self blame, especially if something happened to the infant

Difficulty with intimacy & relationships

Avoiding the hospital where they gave birth

'Traumatophobia' avoiding reminders of assult

Postpartum depression & anxiety

Self blame for the attack

Having flashbacks on child's birthday

Anxiety, fear, depression, dissociation, etc.

Body image and intimacy struggles

"I don't remember my baby's first 6 months, I was so mired in depression and post-traumatic stress—flashbacks, nightmares, sweating panics…. You didn't only take my birth, though. I lost more than my son's infancy. For a long time, I lost myself. (Bax, 2007, “The Short and Long of It,” para. 17 and 18)"

Goer H. 2010

How to Protect Mothers

Patient Advocacy

Medical Ethics

Informed Consent

Prioritize patient-centered care that respects the autonomy, preferences, and values of mothers. Increase cultural competency among providers, to understand diverse cultural perspectives on birth. Train healthcare providers on communication skills that emphasize empathy.

Begin providing information on childbirth options, procedures, and potential complications early in prenatal care. Ensure the information is clear and accessible. Make sure all parties understand consent is an on-going process.

Train healthcare providers to recognize signs of trauma and provide care in a way that is sensitive to the impact of previous expirences. Promote continuity of care through the pregnancy and birthing process. Integrate mental health services into prenatal and postpartum care.

References

Goer H. Cruelty in maternity wards: fifty years later. J Perinat Educ. 2010 Summer;19(3):33-42. doi: 10.1624/105812410X514413. PMID: 21629381; PMCID: PMC2920649. Kimberlé Crenshaw on Intersectionality, More than Two Decades Later. (n.d.).Columbia Law School. https://www.law.columbia.edu/news/ archive/kimberle-crenshaw-intersectionality-more-two-decades-later Morris, T., Robinson, J. H., Spiller, K., & Gomez, A. (n.d.).“Screaming, ‘No! No!’ It was Literally Like Being Raped”: Connecting Sexual Assault Trauma and Coerced Obstetric Procedures. Social Problems, 70(1), 55–70. https://doi.org/10.1093/socpro/spab024

Reflection

Working on this project opened me up to a lot of information that I have 1. never thought about but also 2. never even heard anything about which as a pre-med student really saddens me. I even work with the med students as a 'simulated patient' and not once has empathy focused communication been exercised. It has opened my eyes up to a lot and introduced me to a new topic to 'preach' to people. While having my boyfriend proof read this project (he is also pre-med) some of the comments even he made just made me realize how much bigger of an issue this is. Something along the lines of like "well does it really matter if the baby is at risk" and "the mom isnt the only patient there" coming from someone who I know is pro-choice even comments like that made me take a step back. I really have gone down a rabbit hole and not only does it make me feel bad for mothers who have not had professional care but it also terrifies me to even consider having a child. Thanks for reading!

Gendered Culture

The gendered images and symbols that are tied to specific organizational roles within a hospital or healthcare. Occupation - Doctor: Often associated with males who are pegged as scientific, skilled and unapproachable. This feeds into the male heiarchy and the patient doctor power dynamic. This can affect multiple facets of birth:

• Shared-decision making
• Trust
• Patient preference

Gendered Structures

Organizational Policies and practices that presume and reproduce gender inequality. Even 'gender-neutral' policies themselves can have a gendered effect. This includes but is not limited to:

• Cervical checks
• Labor induction
• Episiotomoy
• C-Sections

These practices only hapen to pregnant bodies and are inherently gendered and can have a negative effect.

Gendered Agency

When physicians, nurses, patients, and their family and friends act in a way that reinforces gendered norms. Like patients in labor behaving passively, doing as their told, and internalizing these expectations to act like 'good girls.' The organizational role of "doctor" and "patient" and "mother" are powerful and influence male and females to step into the "doctor" role and behave differently towards laboring patients.