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  • Writer's pictureDalia Abrams

PERMISSION to Touch: bodily autonomy during pregnancy and birth.

I’ve always wondered why people feel entitled to touch a person’s belly when it is full of a baby, while it’s culturally taboo to touch it at any other time. -- No one would dream of touching my daughters’ bellies? Why does it seem OK to touch my pregnant belly?



Along the same lines.... Why is it acceptable to put fingers in a vagina of a pregnant person with no more than a “I’m going to check you now” – when in any other situation, you need permission? 


Why do we tolerate cutting the opening to a birthing person’s birth canal without asking for permission first, when no medical professional would ever cut a patient anywhere without a discussion of risks and benefits and obtaining true consent?


How can one sew up an episiotomy or a perineal tear without ensuring that this sensitive tissue is adequately numbed, when no medical professional would ever sew up a cut or tear anywhere on anyone’s body without adequate anesthetic and pain control?


Why when a person’s body is growing a new life inside, does that body suddenly lose its civil rights, its status as a human being?


Are you pregnant? Here’s what I want you to know: 


You still own your body. Being pregnant does not change your right to bodily autonomy. (To read about this issue from a legal perspective, read The Nature and Significance of the Right to Bodily Integrity here. Full reference below.)


Nobody, not a doctor, midwife, nurse or friend… NOBODY has the right to touch you ANYWHERE without asking for and receiving your express permission. You have a right to deny anyone permission to touch you, and you have a right to change your mind and withdraw your permission after you have first given it.


With that in mind, I want to describe for you what a vaginal exam should look like, so that you can recognize when your rights are being respected.


Step one in a vaginal exam is the medical professional asking you if you want one:               


“Would you like me to do a vaginal exam right now?”

As you consider this offer, you might have some questions you need answered. Here are some examples:

  • Why are you suggesting a vaginal exam right now?

  • How will it be done?

  • What are the benefits of doing this now?

  • What are the benefits of NOT doing this right now?

  • What are the risks of doing this now?

  • What are the risks of NOT doing this right now?

You always have a right to refuse the exam, and the right to change your mind!


Once they have described the procedure and you decide you do want to do it, then you can tell them how you will let them know when you are uncomfortable or need a break. I suggest giving them two words so you have the power to change your mind at any point: STOP and OUT. You might say:

"If I say STOP, I need you to immediately stop what you are doing.
If I say OUT, I need you to immediately take your hand OUT of my vagina.”

Remember… it’s YOUR vagina!


Finally, under normal circumstances, while they are doing the exam it shouldn’t hurt.


A few other important points about permission to keep in mind:

  • Signing a consent form when you enter the hospital Labor and Birth suites (L&B), does not equal consent to an episiotomy, or any other procedure. Each procedure requires a separate, INFORMED consent discussion, where the procedure is described, questions are answered, and you have the right to consent or refuse.

  • You have the right to withdraw consent that has been given, at ANY time. Just like withdrawing consent to having sex. Check out this great British explanation using an invitation to drink tea as a humorous way to illustrate these important points.

  • Repairing an episiotomy or a perineal tear can be done with adequate anesthetic so that it doesn’t hurt you. You may feel a tug, but you should not feel a sharp pain. If you do, the person sewing you up can stop, administer more anesthetic, and wait for it to take effect… they can do this as many times as it takes, regardless of how long it takes.

  • Remember, your word is “STOP”, not “ow”. Ow tells them it hurts, they know that. Sometimes, people think the best thing to do is to just get it over with, so saying “ow” encourages them to just hurry up. With the word STOP you are giving an order. You are effectively saying “STOP what you are doing now! We can talk about it after you stop! I need a break NOW.”


All of this may seem strange. Not many of us have had visits with medical professionals that look like this. But you don’t have to do this alone. Bring a support person with you to your prenatal visits, and to your birthing space, whenever you can. Consider hiring a doula. Your chosen support team can help you stand up for yourself -especially if you’ve talked to them about all of this in advance. Let them know about their role in lifting up and amplifying your voice. Tell them that if you are saying “ow” or acting like the procedure is painful by squirming or wincing (they may already know what you look like when you are in pain), that you need them to step up and say stop:


         “You are hurting my partner/daughter/friend/client, stop what you are doing and ask them how they want to proceed”.

There is rarely a need to hurry, and therefore no reason not to take a moment to pause and reassess what’s going on.


Touching a person without permission is unacceptable. Continuing that touch when a person is saying stop or otherwise acting like they are not comfortable with what is going on is assault. Since we are talking about a person’s vagina, this is sexual assault. And it’s NOT OK!



If you want to file a complaint about mistreatment during childbirth, you might find this Accountability Toolkit from Improving Birth helpful.


I am sharing this blog because I want more people to recognize medical care that respects your bodily autonomy. Once you are aware, you can actively choose a medical care team that practices this way. You can also inform your support team what to look for and how to intervene. Respectful care is your right. We all need to recognize it, search it out, demand it, and walk out when it’s not being provided.


References:


Herring, J., & Wall, J. (2017). THE NATURE AND SIGNIFICANCE OF THE RIGHT TO BODILY INTEGRITY. The Cambridge Law Journal, 76(3), 566-588. doi:10.1017/S0008197317000605. Or download here.


Sexual Consent Explained… using tea. View it here.


Improving Birth Accountability Toolkit: A Guide to Filing a Formal Grievance After a Difficult Childbirth. Download from here.





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