Birth Justice: Where #MeToo and Medical Sexism Intersect December 14, 2018 by Marea Goodman
Never before have conversations about sexual harassment and violence been so commonplace. Around the world, feminists are declaring that they #BelieveWomen and women are telling their #MeToo stories. Despite a wave of fierce backlash to the feminist movement, we have broken the silence around the interpersonal and systemic violence that so frequently faces women, female-bodied, queer and trans people.
But I can’t help but notice a huge blind spot around birth.
Thousands of birthing women experience violence every day. (George Ruiz / Creative Commons)
UNICEF estimates that about 353,000 babies are born each day around the world—and in the process, thousands of birthing women experience violence. Birthing people are often coerced, threatened and violated during and after labor; they are separated from their babies, ignored by their doctors and forced into numerous other inhumane acts perpetrated by the patriarchal hospital system.
Doulas often say there is a “hidden epidemic” of doctors abusing women in labor—and in the last five years alone, women have begun to speak up about obstetrical violence. Caroline Malatesta won a lawsuit against the hospital where she gave birth after she suffered from PTSD and permanent nerve damage in response to the nurse forcefully holding her baby in her vagina while she waited for the doctor to come into the room. A woman known by the pseudonym “Kelly” sued her obstetrician for assault and battery after he conducted a multiple-cut episiotomy after she explicitly refused the procedure.
But there are still millions of cases globally where the rights of birthing people are ignored—where their genitals are touched or cut without their consent, or their bodies are used in ways they explicitly refused. It is not uncommon to see doctors forcefully conduct vaginal exams on women during labor, even while they explicitly tell them to stop, for no medical reason whatsoever—a course of action that is, by definition, rape.
The #MeToo movement has openly grappled with the issues of privilege that shape its explosion. It takes privilege to stand up and say that one has suffered sexual harassment, abuse and rape. It is, in some ways, still a privilege just to be believed once you have spoken up. For every story told with the hashtag, thousands of stories go untold by women around the world because they fear greater violence or disenfranchisement.
While every woman is vulnerable to obstetric violence, we are not all affected equally. Immigrants, people of color and poor folks are the least likely to be heard, and in many cases the most likely to be impacted, by birthing violence. In the U.S., black birthing people are dying in childbirth three to four times as often as white women. Latinx birthing people are dying twice as often as white women.
My partner’s mother was raped when she went to her doctor for a routine prenatal checkup; she stopped going to that doctor, but didn’t report him to the hospital because race and class dynamics made her feel that nobody would listen. My grandmother is more willing to talk about the horrible atrocities she suffered during the Holocaust as a teenager than her first birth experience in a Brooklyn hospital in 1962—in which she was strapped to a bed, verbally abused and locked in a room alone during labor, and then separated from her baby for a week and discouraged from breastfeeding.
Unfortunately, although the vast majority of doctors have good intentions and want to take care of their patients as best they can, they work in a system that does not prioritize consent, that positions their patients as less knowledgeable about their own bodies than they are and that sets up a power dynamic where doctors can exploit their knowledge to get inappropriate access to their patient’s bodies. This violence is rooted in the history of the field: James Marion Sims, known as “the father of modern gynecology,” conducted experiments against female slaves without their consent and without anesthesia; today, medical students are still sometimes taught to perform pelvic exams on anesthetized women without their knowledge or consent—a practice that is only illegal in four states.
The midwifery model of care offers a much-needed alternative to western obstetrics. Midwifery, a century old craft which means “with woman,” utilizes a model that prioritizes holistic female well-being. It is not only about keeping the birth safe—it is about keeping the birthing person feeling safe, and thus protecting the physiological process of birth.
We are all born, and medical research has concluded that birth affects us in deep, lasting and powerful ways. If mothers feel unsafe, violated or abused during births, their newborn babies will store those experiences in their nervous systems. Whether we are born through a cesarean section, vaginally in a hospital with an epidural or at home, our birth experiences affect us for the rest of our lives. Birth justice is finally becoming a part of the conversation, with states like New York and California creating initiatives to attempt to address the birth disparities facing communities of color—but we have so much more to do. We need to start calling obstetric violence what it is, and we need to start connecting the dots between #MeToo and medical sexism.
Men who are true allies to women need to be actively engaging with other men to end rape culture, and obstetricians must band together to stop obstetric violence. Men need to stop thinking that they deserve control over female body, and doctors need to stop thinking that they can do anything they want to our bodies under the guise of practicing medicine.
Marea Goodman is a home-birth midwife practicing in Oakland, California.