Woman, Doctor Go to War Over Episiotomy

An anonymous woman whose birth video captured her doctor giving her a forced episiotomy plans to sue him for assault and battery, thanks to a crowd-funding campaign and a support team decrying the way she was treated.

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“The number one issue is it’s about consent. Very simply, she said no,” Cristen Pascucci of Improving Birth, a national birth-advocacy organization, tells Yahoo Parenting. Her group got involved with the new mother’s cause after the mom posted her (disturbing and NSFW) video on YouTube to seek justice. Pascucci and other birth advocates say the mom endured “obstetric violence,” which is a new but growing concept in this country (and an actual legal term in Venezuela, Mexico, and Argentina).

“It’s something that’s so expected and so common that people don’t even recognize it as a thing,” she says, noting that it can range from coerced medical interventions such as cesarean sections to simply being talked down to during labor. “Even when women do feel instinctually that something felt wrong [with their medical treatment] during birth, they’re told by friends or colleagues that it’s an invalid response, with comments like, ‘Well, is your baby healthy? Is your baby alive?’”

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The 27-year-old single mom in this case, dubbed “Kelly,” gave birth in California in 2013, warning the medical team early on in the process that she was feeling anxious due to being a rape survivor. “It’s well documented that women can have the trauma of a previous assault come up in childbirth, and she was having flashbacks,” Improving Birth founder Dawn Thompson, tells Yahoo Parenting. So Kelly asked to be informed of what was happening every step of the way, and for the nurses to be “calm and gentle.” In response, she says was given an epidural and a sedative, placed into stirrups, and, after one hour of pushing and about two minutes into the on-call physician’s arrival, was told it was time for an episiotomy — a formerly routine, now largely dissuaded birth practice during which an incision is made in the perineum, the region between the vagina and anus. Side effects can include incontinence, infection, prolonged pain, problems with future births, and sexual dysfunction.

Following a contraction and still no baby, the doctor tells Kelly, “I’m going to do the episiotomy now,” a comment that can be heard clearly in the birth video shot by Kelly’s sister and later edited by Improving Birth (to blur people’s faces for privacy and to add in subtitles). Kelly responds, “Why? We haven’t even tried.” The doctor then tells her, “You are pushing, baby’s head comes out and doesn’t come out because there’s no space here to come out, OK?” At this point the nurse and Kelly’s mother attempt to convince her that it’s the right decision, with her mother insisting, “Just do it, doctor, don’t worry,” but still, Kelly says, “No, don’t cut me. No! Why?” The doctor responds with anger, “What do you mean ‘why?’ That’s my reason! I am the expert here, OK?” He then begins making audible snips, and doesn’t stop until he’s made 12 incisions.

“The baby was only six pounds,” notes Pascucci. But even taking the episiotomy out of the equation, she says, there’s the problem of the way the doctor spoke to Kelly. “She asked for information, he refused to give her information, and then he came at her with a pair of scissors and did it anyway, and that’s a total violation of her and her body.”

Kelly provided a statement to Yahoo Parenting through Improving Birth that says, in part: “I want people to know that everyone has rights around their body and rights to information about procedures. I got that option taken away from me. If this happened to me, it can happen to you. It can happen to your daughter​.​ My video and I and Improving Birth are sending a message to all OBs and nurses who treat women like this — like they have no rights, like they aren’t human beings… I also want people to understand my purpose and my reason for this is about ​changing​ the system where women can be treated like this and have no recourse, have no one protect them and no one take responsibility afterwards… Lastly, and most important, this was never about money… This is for all the women who didn’t have a video. For all the women who didn’t get this far. For all the women who were silenced. It’s for all them.”

Improving Birth stresses that Kelly had not intended to file a lawsuit, but, says Pascucci, “She was in mental anguish, physical pain, and will most likely have permanent damage.” Still, she had first complained repeatedly to the hospital and to the state medical board, but had been “ignored and placated,” according to Thompson. That’s when Kelly posted her video online, seeking input on whether she was mistreated and whether it was a case worth pursuing. It drew an outpouring of support and anger, with suggestions to sue.

But that’s easier said than done. First, there’s the issue of money for a lawsuit, which has so far been addressed with a Crowd Rise campaign, mounted by Improving Birth, that’s raised more than $8,600 as of Wednesday. “For all of us who received an unwanted episiotomy or any other intervention. Thank you for standing up for us! May this be the beginning to the end of obstetric violence,” wrote one of many supporters along with her donation.

Second though, is the issue of finding legal representation in a case for which there is no legal precedence (although one similar case concerns a New York woman who sued a doctor for pressuring her into a C-section). “We’ve had great communication with a couple of lawyers,” Pascucci says, although Kelly’s case has been turned down by at least 80, for reasons ranging from them being in the wrong state, having no litigation experience, and having limited knowledge of childbirth law, which is a growing but still-small movement, says Hermine Hayes-Klein, a lawyer (not California-licensed) with the advocacy organization Human Rights in Childbirth.

“If there’s a number-one reason she hasn’t gotten a lawyer, it’s because they don’t think it’s worth the investment, and that’s how cases like this slip through the justice cracks,” Hayes-Klein tells Yahoo Parenting, noting that her organization, along with Birth Rights Bar Association, has been consulting on Kelly’s case. “We hear these stories all the time,” she adds. “What makes her case extraordinary is that she has it on video.” But even still, she notes, “A big cultural belief is that childbirth is damaging by definition… So many lawyers, just like many other people, will say, ‘Well, you’ve got your healthy baby.’”