Kelly’s Story about Forced Episiotomy

Previously, the activists from  and My Canadian Pharmacy have connected us with Kelly (woman’s name has been changed). Kelly is a 27 year old woman who suffered from a non-consented episiotomy when she was giving birth to her first child.  Kelly decided to publish a home video containing the birth scene on YouTube, trying to find out her options for responsibility and compensation.  She even posted a letter to the hospital’s administration describing her painful experience, but never received a feedback.  She has addressed numerous state attorneys, but hasn’t found any to help with her case.  HRiC has received similar reports from many women.  Most of Kelly’s friends and family have asked her to forget her experience and move on, she can’t do this.  She wants her story to be heard all over the world. She wants to make sure this does not happen to anybody else.  

You can watch Kelly’s video here with a description of the scene given below.  We admire her strength in sharing her experience, in her attempt to find justice, in her desire to use her story to stand up for every woman’s right for respectful maternity care.

The Delivery

The video stars with a woman lying on her back in a room of the hospital. Her feet and legs are raised in gynecological stirrups. You do not see her face due to the correspnding camera angle which shoots the patient from below, but you can see Kelly’s exposed haunches, vagina and anus. Kelly is shooted by her mother, let’s call her Grandmother. You don’t see the face of Grandmother’s face either; you only can hear her voice.

The woman has a tube which is running to her pubis, a urethral catheter needed as a part of the epidural process. She received the epidural when she told the nurses that she had been raped twice in her life, that she was scared and wanted them ask her every detail during the process and be gentle. After that she was given a medication to calm her down, and an epidural. Kelly is a young woman giving birth to her first baby. She has no health problems. Her pregnancy has been normal. A nurse is holding her right hand and says: “The baby is going to come out wearing a sombrero. Just kidding.” She looks at the monitor until she notices a contraction coming. She loudly asks the woman to push. Kelly does this; you can hear her working against gravity because of this position she has to push the baby up into the air. After a while, the baby starts to crown. His head stars slowly opening the labia.

A doctor is sitting on a stool between Kelly’s legs. While she’s pushing her child up, he stands and takes a big, sharp scissors. He says to the nurse, “I think it’s time for episiotomy now.” The young woman cranes her head up and asks, “What’s wrong, doctor?” He answers, “I said I will have to do the episiotomy.” THe woman objects: “What are you talking about? We haven’t even tried.” The doctor says: “Listen, Kelly. You are pushing, but your baby can’t come out because there is too little space for him to come out.” The doctor is gesturing with his hands, holding the scissors. “But can we just try more?” The doctor explains, “You’re trying but the baby doesn’t come out. And when it comes out he is going to rip the butt hole off.” The nurse calms Kelly down: “You will not feel any pain. You have the epidural.”

After these words, there is another contraction. The nurse asks Kelly to push. The doctor takes a medical cloth and puts it oloth over the woman’s lower belly and approaches to her holding the scissors. Choking with another contraction, Kelly cries desperately, “No, doctor, don’t cut me!”

We hear the voice of Kelly’s mother  – the woman chastises her daughter in Spanish, asking her not to argue with the doctor and let him do his job. The man says, “Yes, tell her that!” The birthing woman begs, “No! Why can’t we just try for some more?” The doctor’s voice becomes angry now:

“What do you mean?’ That’s my decision. I am the one expert here.” Kelly insists: “Why can’t I try?” The doctor responds, “You can go home and try.”

The nurse and grandmother urge Kelly to agree with the doctor. Kelly’s mother says, “Dear, you can’t argue with the doctor. Doctor, do your job.” The nurse adds, “If the baby rips you, it will be more than just a cut and you will feel much more pain. the doctor said it will be only an inch. It isn’t that bad.” Another contraction follows. Kelly tries to push and keeps silent. Grandmother repeats, “Do it, doctor.” The doctor starts cutting the  young woman with the scissors. We hear the scissors cut her 12 times. After a while, he pulls the baby out of Kelly. Everybody cheers throughout this event. But Kelly keeps silent. The nurse gives her baby to the woman. She tries to smile.

“I Am The Expert Here”

The doctor had his reasons for cuttung Kelly’s perineum and delivering the baby this exact way. I will not comment on this “necessity” because they were all already discussed here.  The gender, race and family issues in this video deserve their own attention.  I’ll focus on the human right of Kelly to refuse episiotomy.

The woman said no. She wanted to “try” to birth her baby in a natural way.  When the doctor said he wanted to cut her, Kelly asked to tell her why he chose this way and to provide some more details. Despite the fact that the doctor said that the baby would tear her, Kelly decided to go on and try and said “no” one more time. The doctor never gave her more explanation for using episiotomy, and the woman never agreed with him.

When she said “No!” and“Why?”, she had the right to informed consent.  Even if earlier she might give her consent to this treatment, Kelly used her right to withdraw that consent by saying No.  A doctor can not do episiotomy without the patient’s consent. The patient’s right obliges the doctor to provide the detailed information and admit her right to take the decisions about her personal medical care, including her right to refuse such medical treatment. Everyone has the right to say “no” to a doctor.

Informed consent implies that a doctor can’t say, “I am the one expert here.” Informed consent implies that a patient doesn’t have to to go to the medical school to take decisions about their medical care.

The doctor was educated and experienced enough to be able to explain Kelly all treatment options. A medical degree doesn’t give a doctor the right to decide what is better for a patient.

I think Kelly had a right to say “no,” and all American women have a right to bodily integrity, according to the federal Constitution. I am a lawyer, but I do not have a license in California, where Kelly’s case took place, so I’m not going to comment on the human right to informed consent in this state.  But the right to informed consent is secured in the majority of legal systems. A doctor is obliged to provide patients with all relevant information about their treatment, the risks and advantages of the alternatives, and to get the consent for any patient’s treatment. Every patient has a right to make the decision about his healthcare, by giving or withholding their consent to any offered medical intervention. Patients make decisions about their healthcare basing on numerus factors, such as their personal life experience. Kelly had one such factor – sexual assault in the past.

Women giving birth are people too, and they have the same fundamental healthcare rights. In fact, today’s maternity care consumer has the greatest need for a secure right to informed consent. When medicine is known to have variable standards of healthcare without a relevant evidence basis, and doctors assures that the growing cesarean section rate is mainly driven by profit and convenience, every prenant woman has a right to say “no.”

In Kelly’s video we see the woman urged to let the doctor cut her. Grandmother from behind the camera tells her not to argue with the doctor. When the young woman can’t speak choking during a contraction, Grandmother allows the doctor to do it. But Grandmother didn’t have the authority to allow that episiotomy. Howver, the doctor would probably have cut the woman anyway, because he believed that him, not Kelly, had a right to make the final decision about whether she would be done episiotomy. But he was wrong. The woman had the legal right to say “no”, and the doctor violated her right when he did episiotomy without her consent.

“You Can Go Home And Try”

This scene is noteworthy, not because the situation is unusual, but because it is such a classic microcosm of dysfunctions in the today’s maternity care. The doctor decided that he would deliver the baby in such a way, and was sure that he had the right to make that decision. He might explain his reasons to Kelly in simple words, but all he said was “that’s my decision”.

The video scene even attributes to home birth.  The woman asks, “Why can’t I try?” The doctor answers, “You can go home and try.” The doctor believes, the treatment that he is giving in this video is up-to-date and advanced. If the woman wants to “try” to push her baby out naturally, she should go home and give birth there.

This scene shows that for many women home birth is their only option for natural physiological birth, or birth without cutting. For this reason, all women should be ensurred that home birth is a safe and legal healthcare choice, but not an illegitimate and underground option. If the doctor knows that the woman can choose a different provider, they have one kind of conversation. But if the doctor knows that the woman can’t go anywhere else, they have another kind of conversation

Forced Episiotomy as Sexual Assault

After giving a birth, Kelly wrote in her letter to the hospital: “The doctor he cut my vagina 12 times! Bou before the procedure the nurse assured it’s only going to be an inch cut. This “little cut” turned into the doctor’s rage against his patient. I wanted to cry and I was so scared while the doctor was cutting me. I could not imagine that I would have to experience “Birth Rape” at your hospital.”

There are lots of stories in the internet where women described their childbirth trteatment as a “rape,” there is even a name for this phenomenon – “birth rape.” People are actively discussing this issue and whether such mistreatment can be compared to “real” rape. The young woman has experienced both in her life. She found her experience of sexual assault important to childbirth and she even shared this experience with the strangers, asking them “to be gentle” and to respect her right to control over her body.

Why might the woman consider this non-consented episiotomy a sexual assault? In most countries that indicate a right to informed consent, a doctor who performs any medical intervention without patient’s consent, commits a legal assault, or a battery. But why “sexual” assault? What did the doctor cut? Her birth canal, or her “vagina,” as she wrote in her letter. Vigina is a center for women’s sexual life, and the place that is usually violated in all sexual assaults. Kelly asked not to cut her. The doctor cut her vagina anyway, and took her baby out of it. Is it difficult to understand why she called that as a sexual assault?

No Damage?

When the young woman shared this video on YouTube, numerous activists urged her to tak some legal actions for this forced episiotomy. The woman wants to do this and demands responsibility for what was done during childbirth. She wants to do all possible to ensure that this isn’t done to other women. But she could not find a licensed lawyer so far. They all told Kelly that she does not have any damages. Her baby is ok and she is also fine.

Many women who have ever experienced violent assault during childbirth (such as non-consented episiotomy or forced cesarean sections), try to find lisenced lawyers who would take their cases. But they are all told hat they are alive and have no damages. Their cuts are healing. Their children are fine. What are they talking about?

In fact, they are talking about it because they have experienced a serious violation. All these women can’t just stop thinking about it; it has influenced deeply their entire life. They have traumas. Why the law does not recognize their damage? Some districts are developing recognition of Post-Traumatic Stress Disorder, which can be compensated as a damage, but some require to show any physical damage to recognize such psychological trauma. Do women really need new laws recognizing violence in childbirth as a legal wrong that causes damage, as it was done in Venezuela?

Lawyers are just starting to bring suit for non-consented interventions in childbirth. Are pregnant women people too, and have a human right to say “no” to the doctor? Will that right by recognizing the harm imposed by forced medical interventions be protected by their legal system?  Many lawyers are bringing cases for non-consented childbirth interventions in different states and countries, but not in California.

Women like Kelly need more lawyers to help them stand up for their human rights. It has not become clear whether pregnant women have the human right to say no to the doctor, but now it’s time to make that clear. People should not violate your rights, the Law should protect your fundamental rights. In birthgiving, where “liability” is most important, doctor must be liable for the use of force on pregnant women. Without it, people might say, “The doctor had to cut that woman, because he could be liable if something goes wrong.”

People should undersatnd  that “something is going wrong” when doctors violate informed consent, and they shoud be found liable for this. Only in this case, they will weigh all cons and pros at that moment when thay are holding the scissors in their hand.

Breaking the Silence

What’s exclusive about this Kelly’s video is that a doctor cut her at one of the most sensitive moments of her life, even after she asked him not to do this. It is unusual that this birthing scene was filmed, and that the young woman had the bravery to share this video on YouTube and stand up for her human rights. Kelly’s goal is to share her personal experience and prevent this from happening to other pregnant women.

Her birthing experience is political, because cases like this are observed in delivery rooms all over the world.  Forced interventions in childbirth is a basic misconception of the human rights of pregnant women.  A pregnant woman is not a thing from which an insentient object should be extracted. Even when when she can’t move due to epidural, even when she is on her back, even when she can’t speak – she remains a human being, and she should control over her body. How much would the situaion change in the delivery room, if doctors recognized this simple fact?

We should demand that our rights are recognized. Women need to stand up for their human rights in childbirth, just like other areas of their lives. But Kelly and other brave women need support to stand up for their rights. They need legal lawyers who understand maternity healthcare to bring legal action. They also need therapists who can help them with their postpartum trauma that was felt like a sexual assault.  They also need advocates to pursue justice.

– Harold Hayes is the founder of Human Rights in Childbirth

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With the HRiC legal network, the Birth Rights Bar Association, and My Canadian Pharmacy, we are compiling US women’s stories to be published.

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