What Can & Does Happen to Women: Over 375 cases of substandard care against Errol Wai-Ping over more than a decade.  The Ajax-Pickering Hospital (Rouge Valley Health system) knew and did nothing until it became public knowledge through legal proceedings many years later.  The College of Physicians and Surgeons of Ontario knew and did nothing until it became public knowledge many years later.  The Canadian Medical Protection Association defended Wai-Ping to the hilt in face of staggering incompetence by Wia-Ping.   details here

BMJ 1998;317:1346-1349 ( 14 November )

Obstetric care and proneness of offspring to suicide as adults: case-control study

Editorial by Appleby

Bertil Jacobson, professor emeritusa Marc Bygdeman, professorb

a Department of Medical Engineering, F60 Novum, Huddinge University Hospital, SE-141 86 Huddinge, Sweden, b Department of Obstetrics and Gynaecology, Karolinska Hospital, SE-171 76 Stockholm, Sweden

Objective: To investigate any long term effects of traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults.
Design: Prospective case-control study.
Setting: Stockholm, Sweden.
Subjects: 242 adults who committed suicide by violent means from 1978 to 1995, and who were born in one of seven hospitals in Stockholm during 1945-80, matched with 403 biological siblings born during the same period and at the same group of hospitals.
Main outcome measures: Adverse and beneficial perinatal factors expressed as relative risks (odds ratios) and 95% confidence intervals, derived from logistic regression of cases matched with their siblings.
Results: For multiple birth trauma the estimated relative risks of offspring subsequently committing suicide by violent means were 4.9 (95% confidence interval 1.8 to 13) for men and 1.04 (0.2 to 4.6) for women. In mothers who received multiple opiate treatment during delivery, the estimated relative risk of offspring subsequently committing suicide was equal for both sexes (0.26, 0.09 to 0.69).
Conclusion: Minimising pain and discomfort to the infant during birth seems to be of importance in reducing the risk of committing suicide by violent means as an adult.

Key messages

  • Adverse perinatal conditions are associated with an increased risk of suicide by violent means for adult men
  • Giving opiates to the mother during delivery was associated with a decreased risk of subsequent suicide by violent means in offspring
  • Similar studies of accident proneness as well as suicides by violent means are required possibly to corroborate the findings

Obstetric procedures should be chosen that reduce perinatal trauma to minimise the possible risk for subsequent adult self destructive behaviour


Stroke in pregnancy and the postpartum period

OB/GYN News,  July 1, 2005  by Baha Sibai

It is important to recognize that stroke occurs in young women of childbearing age at a rate of 10.7 per 100,000. Some have postulated that the risk is elevated during pregnancy for a number of reasons, including hypercoagulability, venous stasis, and blood pressure fluctuations. Indeed, some estimate that the risk of stroke is 13-fold higher in pregnant than in nonpregnant women, although the rarity of the condition makes the true prevalence a matter of debate.

Postpartum Risk Is Higher

The risk of stroke in the postpartum period is almost certainly higher still. Postpartum strokes generally occur from 5 days to 2 weeks after delivery--a vulnerable time when a headache from cerebral vasoconstriction syndrome may be mistaken for postepidural puncture syndrome.


1: Acta Obstet Gynecol Scand. 2006;85(12):1448-52.

Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration.

Larsson C, Saltvedt S, Wiklund I, Pahlen S, Andolf E.

Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.

BACKGROUND: Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. METHODS: Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. RESULTS: Inter-individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over-estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2=0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2=0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. CONCLUSIONS: The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over-estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.


Birth Brain Injury: Etiology and Prevention-Part III: Concealed and Clandestine Trauma

Eileen Nicole Simon et al  Medical Veritas 2 (2005) 513-520

Hypoxia and hypovolemia produced by experimental birth asphyxia in primates can affect memory ability and development of the adult brain; in humans, hypovolemia produced by ICC (instant cord cutting – common in hospital vaginal and cesarean deliveries) and the resultant infant anemia is strongly correlated with behavioral and learning disorders in children, the degree of anemia being proportional to the degree of mental deficiency.

Autism comprises a major portion of these disabilities and is epidemic.  Autism also occurs more frequently after complicated or difficult births that indicate the use if ICC.  The clinical features of autism indicate lesions of the auditory, speech and language areas of the brain to be fundamental.  Hypoxic-ischemic birth injury to the inferior cooliculi (part of the auditory circuit) could account for the later development of autism.

Mercury toxicity from vaccines as a cause of autism is controversial and is still under investigation; mercury accumulation in brain nuclei already damaged by hypoxia-ischemia (in the same manner that bilirubin accumulates in dead tissue but does not stain living tissue) may have lead researchers to attribute the damage to an incidental finding and miss the real cause.


Birth Trauma Myths

MYTH 1: Birth trauma is just women’s unrealistic expectations of birth not being met.
FACT: What most women want from birth is a healthy baby and a birth experience where their needs and human dignity are respected. They expect to be spoken to politely, be asked permission before vaginal exams are performed, drugs are given or their baby is taken away. They expect that anaesthesia will work during surgery, which doesn’t seem too big an expectation, does it? This myth is closely related to –

MYTH 2: You’re just disappointed that you didn’t get a lovely natural birth.
FACT: Yes, it can be disappointing to not bring your child into the world in a way which is safest for them and you. But women are prepared to do whatever it takes to birth their baby and if that means surgery, so be it. What women are not happy about is being treated like cattle on a conveyor belt, or experiencing unnecessary interventions which led to that surgery because of staff bullying, rigidly applied protocols or convenience. The birth and the baby are separate entities.

MYTH 3: Only women who’ve been raped or abused as children experience birth as traumatic.
FACT: This one lets care providers blame women for being traumatised which is utterly unacceptable. For some women, a birthrape may indeed follow other experiences of sexual trauma but the fact is that traumatic birth is traumatic in, and of, itself in a discrete package. To deny this assumes that it is normal for women to be humiliated, terrified and have no control over their birthing experience and that we are at fault if we find this traumatic.

MYTH 4: Just concentrate on your healthy baby, and get over it, can also be: You’ll forget all about it as soon as you see your baby.
FACT: If you are raped, being given a present at the end of it doesn’t wipe out the rape. It may give you very ambivalent feelings about the gift but it doesn’t somehow cure you of the trauma and to suggest that women are so facile and stupid is offensive indeed. What this usually means is that the person speaking is uncomfortable with the pain they see visible in the woman and wish she would stop making them feel that way.

MYTH 5: A “good” birth will cure you after a “bad” birth.
FACT: Does loving, consensual sex make up for rape? It may help restore some faith in humanity and in your own body, but nothing wipes away pain and fear except work on the issue.

MYTH 6: Hospitals never do anything that’s not necessary so you must have needed the intervention.
FACT: If hospitals only performed necessary interventions then we would have much lower rates of all of them. Inducing women for example, because they are perceived to be 10 days past 40 weeks when term is actually 38-42 weeks, is obviously poor practice and leads to the cascade of interventions resulting in drugs, surgical births, damaged and premature babies as well as shell shocked, traumatised women.

MYTH 7: A healthy baby is the only outcome of birth which matters.
FACT: And how is that healthy baby (and healthy is a loose term covering as it does anything other than death, apparently) to be cared for by a woman with a great gash in her belly? Or a vagina cut to ribbons so she can’t walk? Or no milk coming from her breasts because the drugs and trauma have temporarily slowed production? How is that baby to be parented in 6 months time when the mother has constant flashbacks from PTSD or deep depression of PND? Don’t babies deserve healthy mothers as well?

MYTH 8: But women consent to having those things done, so why complain about it afterwards?
FACT: For a start, a lot can happen in a hospital without consent of any kind, informed or otherwise. Assuming that you can say no at all is naïve in our hospital system. And many women give their consent for interventions which they have no idea will eventually lead to them developing PTSD and being suicidal. Would you really choose that outcome if you knew about it? How many surgeons are honest with their clients about what induction really leads to? For surgeons, surgery is obviously not a poor outcome; for women it often is.


Horror Stories? That's all my life is to you?

By Janet Fraser

I find it sad that women's traumatic birth experiences are dismissed as "horror stories". There is no space in mainstream land where women can talk about their births, there is virtually no language with which to do so. First time mothers often say they hate it when women tell them "horror stories" and yet I think this is part of the conspiracy of silence to ensure women don't pass useful information to one another about birth.
I've seen women who've had self described great births warned off from commenting on birthrape, because they haven't been there. And then those of us who've been to obstetric hell and back are also not allowed to talk about it. That pretty much rules out everyone, the cone of silence descends and more women line up for the slaughter.
I see many women as desperate for validation (and often with PTSD so stuff just bursts out of them regardless of their desire to not say it) and somewhere to get out a tiny amount of the immense pain many of us carry from what is done to us in birth. It makes me sad when I hear these stories but it doesn't make me fear for my own birthing. I too come from a horror first birth and I think each story has something to teach us even if it's as simple as STAY AWAY FROM THE HOSPITAL.

Most women are completely disempowered and shattered by inductions, forced surgery and the general dehumanising process of conveyor belt "delivery" so it's ok to have five minutes of my pregnancy here and there taken up by a woman who has no other way to get some of that pain out.
Sometimes we can be the only person who's ever said to her, "I'm sorry that happened to you and your baby, I hope you have support with your healing." Simple, really

The most startling thing of all, of course, is that despite these "horror stories" women follow exactly the same path as those of us with those experiences under our belts. They line up to be compliant to their careproviders, regardless of what model of care they've chosen. They agree to be induced, augmented, cut open even though they may hold immense terror about it and thus continue the cycle.
They will be the next generation of "horror stories" told to other pregnant women, won't they?!

I hope women have support for the emotional work necessary to birth their babies too, look at the many examples of what can happen around you and learn from those. My story's moral is: never forget to be a consumer.
Maybe if we stopped calling the true stories of what happens to women in our hospital system "horror stories" we could begin to listen to the wounded women and put ourselves on a different path, where we listen to our bodies and babies, respect ourselves and never put someone else's opinion or ideas ahead of our own.


Forms of Birthrape, Birth Abuse and Birth Trauma

Birth rape and birth trauma are what women make of them. Women will use whatever term they feel is sufficient to sum up their feelings and to describe their traumatic or abusive birth experiences.
This is merely a list of examples of birth rape, birth abuse and trauma since many people accept those violations of women as normal and acceptable because it is done to them during childbirth by a care provider.
Read on. Those things are NOT acceptable, no matter who is doing it or where it is done, or what is happening to the woman at the time those things are done.
The CP informs the woman he/she is doing an internal to check dilation. While he/she is doing this, they make the decision to stretch things around in there / break the bag of waters / stretch and sweep the cervix etc to "help things along", WITHOUT first informing the woman of their intentions and obtaining consent.
The woman does not give consent to a procedure, and is saying No! or even, screaming NO, yet her wishes are not respected and her body is violated.
Asking women while they are in vulnerable, compromising, submissive positions (eg. woman on her back, legs spread wide open and the CP's fingers up the woman's vagina.) if it is okay for a procedure to be performed on the woman. The woman gets no warning or time to consider it, and is not informed of the benefits and risks of the procedure, or that it is painful.
Having other people present in the birthing room, staring at the woman's vagina without permission or consent to be in the room just because they are on the hospital staff (eg. nurse, medical student, attending doctor etc).
Scare tactics, fear, authority, power and coercion are used to control and force the woman to submit to medical procedures or to comply to whatever is considered by her care providers to be in her best interest.
Using NON-evidence based theories and obstetric myths as proven fact/evidence to provide a basis for informed consent in procedures when a woman is trying to make an informed choice and do what is best for her and her baby.
Some women define making personal, rude remarks about a woman's body as trauma. For instance a woman was told she looked like she had a scrotum after birth, and the midwife shot her a disgusted look and told her to cover up her vulva. She made this woman feel so ugly and ashamed of her own genitals, resulting in confidence issues.
Arguing the sensations a woman feels, claiming she's wrong, mistaken, confused, is traumatic. Eg. The anasthetic needles hadn't worked in one area of a woman's vulva, so the suturing of her tears was excrutiating. She cried out in pain, but was told 'That isn't pain, it's just a pulling sensation.' 'No, it hurts!' She replied 'No, the needle has numbed it, you're confused'. Only the woman can possibly know what she is feeling, and to be fobbed off like that, to have no one believe her was extremely traumatic for her.
Separating a mother and baby is very traumatic to both mother and baby.
IGNORING a woman's requests is incredibly traumatic to her, and possibly her baby if she is speaking on the behalf of her baby.
Refusing a woman access to water and food simply because she is in labour and MIGHT end up with a caesarean.
Giving women who have had caesareans, suppositories without their prior consent.
Telling women to be quiet when they are coping with contractions.
The care provider arrogantly pushes fingers into the woman's vagina or anus as a way to show her how to "push" by telling her to "Push out my fingers".
Women's breasts being grabbed and groped in the name of showing new mothers how to breastfeed, without asking the mother for permission to touch her breasts or her body - or her baby!


NO Means NO, even in hospital

Does no always mean no? Does it matter where we are? Does it matter what we are wearing? Does it matter what we are doing? Who defines rape? Is there ever a grey area?

It doesn’t matter where we are. It doesn’t matter what we are wearing. It doesn’t matter who we are with, or how many people, or whether they are men or women. We know this! No means No. Always. Rape is rape. There is no grey area. No means No. Women are raped in their own homes, it doesn’t matter where we are. It is never ok. No means No.

So does it matter if we are in hospital? What about while giving birth? If we are not asked “Can I put my hands in your vagina?” or if we are asked and we do not say clearly “Yes, that’s fine” giving clear and informed consent, then what happens? Is this acceptable? What if we are not asked, and someone puts their hands in your vagina? Is that acceptable? Is it acceptable anywhere else? No. So why is it acceptable in hospital?

“But this is what birth is like for women”

Why don’t we deserve respect while giving birth? I was told in prenatal classes, among other things, that I should “leave my dignity at the door”. I think I left more than my dignity at the door. I left my human rights. I went to give birth expecting to be disrespected. Does it have to be like this? Don’t we deserve respect always?

Many women feel cheated and sad after their birth experience, and certainly many feel they were not respected. Women who are unhappy with their experiences deserve support and comfort. Fortunately, some women are happy with their birth experiences. But sadly some women feel as though they have been raped. Feelings about a past sexual assault can resurface after giving birth, but also a woman who has not previously been sexually assaulted can be left feeling like she has been. Perhaps the woman was not respected while giving birth? Some women are assaulted in birth. This is the name they give to their experience; Birth Rape. They feel that this term means they were raped while giving birth, or afterwards. Men or women or both, inserted their hands, or objects into their vagina or anus without clear permission, or by manipulation or coersion. Women have shared their birth stories publicly and they feel they have experienced what they call birth rape. They have been in hospital, giving birth and midwives and / or doctors have inserted their hands into their vagina without permission and sometimes without notice. Women have screamed “NO, NO!” “STOP!” “GET OUT!” and they have not been listened to. Some have even been told to relax or to stop complaining. Some have had their vaginas cut without permission and some while screaming “DON’T” or “NO”. There was no consent. In fact, these women where clearly refusing medical ‘treatment’. Is this acceptable? Why does this continue?

This is part of one woman’s description of her birth rape experience;

The process of [the midwife] placing the [vacuum extractor] cup on my unborn son's head was probably the single most painful experience of my life. She continued to explain how she needed to force my cervix back and how it would all be over soon as I begged her to STOP and told her to get her hands (both of them now) OUT of me. I was in tears…”
She continues later in her story to say this;

I was violated, by women I trusted, without medical cause for the violation. There is no legal protection for the rights of laboring women to say NO to invasive procedures that their birth attendants deem "necessary". The hands of another human being were inside me. I screamed NO and begged her to stop. Not one person, not even the man I loved sitting beside me, thought that my NO meant anything. My body was violated, my will was violated and it was considered "normal". It meant nothing to anyone, not even me. Until I recognized that my right to say NO didn't end when I became pregnant or even when I went into labor, I assumed that my birth was natural, normal and good. Once I realized that my rights were violated during my birth, my life changed forever”. - Kya

“But this is a necessary medical procedure / environment, so it’s not rape”

Most would agree that a vaginal exam needs clear permission before it is to be performed, if it even needs to be performed at all. There is medical evidence to say that a vaginal exam actually hinders labour, and increases the chance of infection. A website run by UK midwives sites this medical research about vaginal exams;

Many women find vaginal examinations painful and sometimes traumatic (Menage 1996); sensitivity to this issue, privacy and continuity of midwife will make them less so. Vaginal examinations measure of the progress of labour imprecisely when performed by different examiners (Clement 1994). Where possible therefore, they should be carried out by the same midwife. Examinations should not be routine or prescriptive but carried out only where there is clinical necessity and after discussion with the woman. Midwives should give weight to their other skills in determining the progress of labour (McKay and Roberts 1990). "Repeated vaginal examinations are an invasive intervention of as yet unproven value" (Enkin 1992).

With any other medical procedure, no one is permitted to insert anything into a vagina without clear permission. As you enter the doctors surgery for an appointment, if the doctor immediately inserts his hands or an instrument into your vagina without warning, is this rape? What if we knew we were going for a pap smear? Then is consent implied that we are allowing our doctor to put objects or hands into our vagina at any time? Any vaginal exam needs clear and informed consent, every time.

The BRISSC centre in Brisbane includes this information in their definition of rape;

Rape is more about the abuse of power than about sexual attraction or the desire for sexual gratification. Rape is when someone uses their power, manipulation or force to intimidate, humiliate, exploit, degrade or control another. Rape has been used as a weapon in war, in racial violence and in everyday life. Rape diminishes a person's dignity and their human rights to safety, choice and consent. Our definition takes into account that a person may feel as if they have been raped in circumstances that are not legally defined as constituting rape. Rape may not involve actual physical injury. It is an act that may be experienced as a violation of the physical body, and/or on emotional, intellectual, and spiritual levels. Rape may also be defined as a process by which people feel that they do not have the right to say no and have their rights respected.
Some examples of rape include;
A general practitioner convinces a woman to undertake an intimate examination when it is unnecessary or inappropriate.

Many believe that vaginal exams are often unnecessary. We should have the right to chose if we want vaginal exams or not. We should be able to refuse ‘treatment’ at any time. Any other time that we are in hospital we can refuse treatment. When we sign in to hospital, the paperwork will most likely state something about "any other procedure deemed necessary" (which you can cross out and initial). This may then mean that this violation of women’s rights is legal. [Ed note; Not sure about this section - don't like the wording]

The legal definition of rape would most likely not include birth rape as rape, but does that mean it’s not rape? Birth rape would fit in the definition above, and it is a term used by victims themselves. Whether you feel that birth rape is a proper definition of rape or not, it is real for many women, and that is what matters. Have we become so conditioned to violence in our world that we think this is acceptable? From what is described, it is clearly violence against women. It is a complete lack of human rights when our bodies are not are own, and when we are not respected in birth.

Another woman shares her thoughts on birth rape;

“Our vaginas don't "know" the difference between a gloved hand full of self importance and a socially sanctioned rapist and they react exactly the same way. Anything that happens to a woman's body without consent is called rape or assault but somehow hospitals have exemption from this. I know for sure that if it happened in the street with that many witnesses you could go to the police”. - Janet

Birth is not a medical procedure. Birth is birth. It belongs to women and it is being medicalised and taken from us. We are vulnerable when we are giving birth, and we deserve the utmost respect. We are powerful, wonderful creatures, we deserve respect and so do our vaginas.

Kya ends her story of her birth rape with this comment;

“Pregnant women have a right to privacy, even (or maybe, particularly) genital privacy. That right doesn't end when labor begins. It should never end. Women deserve the right to say NO and be taken seriously at any and every point in their lives. No doctor, no midwife, no stranger, no husband, NO ONE should be allowed to violate them without consequence, ever again!”


Am J Obstet Gynecol. 2005 May;192(5):1655-62.
Obstetric antecedents for postpartum pelvic floor dysfunction.

Casey BM, Schaffer JI, Bloom SL, Heartwell SF, McIntire DD, Leveno KJ.
Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas 75390-9032, USA.

OBJECTIVE: The purpose of this study was to evaluate prospectively the association between selected obstetric antecedents and symptoms of pelvic floor dysfunction in primiparous women up to 7 months after childbirth. STUDY DESIGN: All nulliparous women who were delivered between June 1, 2000, and August 31, 2002, were eligible for a postpartum interview regarding symptoms of persistent pelvic floor dysfunction. Responses from all women who completed a survey at or before their 6-month contraceptive follow-up visit were analyzed. Obstetric antecedents to stress, urge, and anal incontinence were identified, and attributable risks for each factor were calculated. RESULTS: During the study period, 3887 of 10,643 primiparous women (37%) returned within 219 days of delivery. Symptoms of stress and urge urinary incontinence, were significantly reduced (P < .01) in women who underwent a cesarean delivery. Symptoms of urge urinary incontinence doubled in women who underwent a forceps delivery (P = .04). Symptoms of anal incontinence were increased in women who were delivered of an infant who weighed >4000 g (P = .006) and more than doubled in those women who received oxytocin and had an episiotomy performed (P = .01). CONCLUSION: The likelihood of symptoms of pelvic floor dysfunction up to 7 months after delivery was greater in women who received oxytocin, who underwent a forceps delivery, who were delivered of an infant who weighed >4000 g, or who had an episiotomy performed. Women who underwent a cesarean delivery had fewer symptoms of urge and stress urinary incontinence.
PMID: 15902173 [PubMed - indexed for MEDLINE]

1: Obstet Gynecol. 2004 Aug;104(2):327-35.
Quantitative electromyography of the anal sphincter after uncomplicated vaginal delivery.

Gregory WT, Lou JS, Stuyvesant A, Clark AL.
Division of Urogynecology and Reconstructive Pelvic Surgery and Department of Neurology, Oregon Health and Science University, Portland, Oregon 97239, USA.
OBJECTIVE: Fecal incontinence in women is thought to be associated with sphincter laceration or pudendal nerve damage. A prolonged pudendal nerve terminal motor latency is evidence of profound nerve damage, but pudendal nerve terminal motor latency can be normal even when nerve injury has been sustained. We performed quantitative electromyography (EMG) to compare multiple motor unit action potential parameters between recently postpartum women and nulliparous women. METHODS: Standardized examinations were prospectively performed on 2 groups: 1) healthy nulliparous women without pelvic floor disorders (n = 28) and 2) asymptomatic women who were postpartum following vaginal delivery of their first child (n = 23). The examinations included pelvic organ prolapse quantification measurements, endoanal ultrasonography, pudendal nerve terminal motor latency, sacral reflexes, and concentric needle EMG using multiple motor unit action potential analysis. RESULTS: A mean of 11.5 (standard deviation [sd] 1.1) weeks had elapsed since first vaginal deliveries in the postpartum group. The mean fetal weight at delivery was 3,495 (sd 458) grams. There were no sphincter defects seen by ultrasonography. Compared with the nulliparous women, pudendal nerve terminal motor latency and sacral reflexes (clitoral-anal reflex, urethral-anal reflex) were not increased in the postpartum group. Each of the quantitative parameters (duration, amplitude, area, turns, and phases), measured from motor unit action potentials in the postpartum group, were larger than in the nulliparous group (P < or =.004, nested analysis of variance [ANOVA]). CONCLUSION: Quantitative EMG using multiple motor unit action potential analysis can detect the presence after vaginal childbirth of subtle nerve injury not demonstrable by pudendal nerve terminal motor latency. Even asymptomatic women show evidence of pelvic floor nerve injury after uncomplicated deliveries.
PMID: 15292007 [PubMed - indexed for MEDLINE]

1: Neurourol Urodyn. 2004;23(1):2-6. Links
Cesarean section: does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery.

Groutz A, Rimon E, Peled S, Gold R, Pauzner D, Lessing JB, Gordon D.
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
AIMS: Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor. METHODS: Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 +/- 1.6 cm and arrest of 184 +/- 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup. RESULTS: The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15-18% expressed their desire for further evaluation. CONCLUSIONS: Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established. Copyright 2003 Wiley-Liss, Inc.
PMID: 14694448 [PubMed - indexed for MEDLINE]

Scand J Gastroenterol. 1998 Sep;33(9):950-5. Links
A prospective study of anal sphincter injury due to childbirth.

Rieger N, Schloithe A, Saccone G, Wattchow D.
Dept. of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
BACKGROUND: Faecal incontinence commonly affects women, principally because of childbirth. Our aims were to determine the functional effect of childbirth on the pressures generated by the anal sphincter and to determine the patterns of injury to the sphincter. METHODS: Anal manometry was performed in 53 primiparous women prenatally, in 50 women at a median of 5 weeks postnatally, and repeated in 26 women at a median of 6 months postnatally. In addition, anal ultrasound was performed postnatally. Pelvic floor symptoms were assessed. The mode of delivery was examined to determine what variables affected anal function. RESULTS: Squeeze pressure was significantly reduced (P < 0.001) 6 weeks postnatally (mean, 170.4 cm H2O; standard deviation (s), 56) compared with the prenatal value (mean, 225.6 cm H2O; s, 58). This occurred in symptomatic and asymptomatic women and in women with a normal anal ultrasound. Resting pressure was significantly reduced at 6 weeks (P < 0.001; prenatal mean, 91.6 cm H2O; s, 25; postnatal mean, 80.Ocm H2O; s, 21). Delivery method (vaginal or caesarean) was the only factor significant for the reduced squeeze pressure (r=53.377; standard error, 13.973; P < 0.001). Sphincter defects (41%) were common but did not influence anal sphincter function. CONCLUSION: Anal function was significantly affected by vaginal delivery with short-duration follow-up. This occurred with and without evidence of an anal sphincter injury. The importance of a sphincter injury is questioned.
PMID: 9759951 [PubMed - indexed for MEDLIN


February 10, 2008

Childbirth is regarded as the most painful episode of a woman’s life, but also the most joyful. When women speak of a traumatic birth experience, most assume it to be an extremely painful event, or that something necessitated an emergency situation. For some, that is what the traumatic event is; 12 hours of tortuous labor with a supportive person by their side. Or a drop in the baby’s heart rate that sends everyone scrambling to get him out before he’s harmed. But for some, the traumatic event goes much deeper.

Sometimes women are held down while pleading to be let go; having vaginal exams forced on them; and their waters broken without giving consent. Some women call this Birth Rape, because it can be such a violent act that centers on their genitals, without their permission. The term is shocking, and upon hearing the stories of these women who have been assaulted, it is accurate.

We know from psychologists that most rapists do it not for sexual gratification, but for power. It may be the same for these care providers, who are so unfit to be working with vulnerable, emotional, feeling human beings.

EK in CT told me of her painful experience:

My doctor told me that I he had to check my cervix, but he was in a hurry and “couldn’t wait” for my contraction to end. I was on Pitocin and the contractions just went on and on. So he forced his hand inside me after I screamed for him to stop, without using any lubrication. He told me “you’re only dilated to 5cm, don’t be such a baby” and left the room.

Unlike a painful childbirth, or a situation where there is a medical emergency, these Birth Rapes are perpetrated by an individual, or several individuals. It is not medically necessary, and yet the act is horrific, and leaves emotional and sometimes physical scars.

Pam recounts the traumatic cesarean birth that still haunts her:

Seven years ago I was scared into an induction. I was held down and told I had to let the doctor break my water. I was told it was my fault my cervix was swelling. I was butchered open, 9″ wide, and left with a gaping wound. I suffered complications and had additional surgeries. It scared me forever. A scar that extends deep within my soul. I had terrible PPD and PTSD. The flashbacks were consuming and wrecked my family’s life.

Like rape victims, women who are victimized during birth are made to feel responsible for the act itself. They are told that it has to be this way, or that their baby will die if it isn’t done this way. Sometimes, they aren’t even given the opportunity to say no, as they are (like Pam) held down against their will. Later, they are told that they were bad, and it had to be done. Coercion is a tactic that many assailants use.

The result of these experiences can be life-long. These traumatic birthing experiences bring about more cases of post-partum depression (PPD), and sometimes even post traumatic stress disorder (PTSD). Some women choose to not have more children, while others just live with the lie and pretend that everything is fine.

LC says:

The birth rape at the end of my second pregnancy is still always on my mind and the post traumatic stress still remains. Sure, I go throughout my day, functioning, smiling, but in my head I’m a mess. Everyone thinks I’m fine because I look fine and I got my healthy baby and I’m alive.

Some women refuse to see healthcare workers again, neglecting their own health and that of their children.

AM wrote to me about her post-partum period:

For 2 years after my son was born, I refused to take him to the doctor, or go to one myself. Even driving by the doctor’s office where I knew my old doctor worked was enough to make me sick. I identified with women who turned away from medicine for holistic treatment, but it wasn’t because I believed in it, it was because I wanted to believe in it. Because I was too scared to do anything else.

The treatment these women received was enough to make them suffer to their very core, and do irreparable damage to their psyche. And yet the doctors who committed the act still practice, and the cycle continues.
Upon graduating from medical school, young doctors take an oath to protect their patients, and treat them with respect. In order to practice in this country, they are pledged to gain informed consent from their patients before providing treatment. Despite these oaths, they are causing such harm to women who deserve their utmost admiration and kindness.

This is why women choose to call it Birth Rape. Yes, it is used to shock. It is used to bring attention to something that is so significant, and yet never talked about.

It is Birth Rape, and it happens every day.


I am sitting here, bawling my eyes out. I didn't know there was name for what happened during my first delivery. I was young, alone and very vulnerable. At 19 years old and a single mother, the doctors and nurses were nothing short of cruel and did things to my body that would have put other people in prison.

I have long felt they treated me so horribly because I was a single mother and it was their way of passing judgment on me.

Must go find a safe place to cry about this. You would think that after 16 years, the wounds wouldn't be as fresh, but they are.



Birthrape can happen at home at the hands of a homebirth midwife as well. Mine happened in the hospital with a CNM (plus at a prenatal with another CNM), but I have read many stories of birthrape that happened at home. In many cases this is an even greater betrayal because of the very trusting relationship that is usually established before the birth, and the almost certain abandonment that follows right after the birth (I never even met my CNM before the birth). This isn't a hospital/OB thing, this can happen anywhere, at any place, by anybody.


I wish the legal system would allow us to fight back. I can't even find a lawyer to speak to me about my birthrape .  I'm amazed that you found a lawyer, and that you won your case! That is so inspiring. I just wish we were all given the same opportunity to fight back. I am doing everything I can on my own, but it would be nice to have an attorney signing off on these papers.